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Guest blog: Dr Karen Chumbley


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Friday, 12 June 2020

Guest blog: Dr Karen Chumbley

This week we have a guest blog submitted by Dr Karen Chumbley, clinical director and deputy chief executive at St Helena (https://www.sthelena.org.uk/)

The Covid pandemic has brought huge challenges to community palliative and end of life care. As infection rates slow, we reflect on what we have learnt.

In North East Essex St Helena Hospice coordinated the community end of life response on behalf of the North East Essex Health and Wellbeing Alliance creating a hub and spoke model. Non urgent hospice visiting ceased and community specialist nurses, rehab and family support teams joined the single point of access team (SinglePoint) to create an enhanced community rapid response hub. Continuing health care funding resources were allocated through the hub, and local voluntary services coordinated relief services for those on the palliative care register. We created a 24-hour non-medical prescriber rapid response service in partnership with Anglian Community Enterprise to enhance overnight nursing capability and offered bereavement services across the community.

We created integrated spoke teams with weekly virtual meetings between primary care, community nursing and the hospice, and developed a single caseload between the providers to enhance care coordination.

We developed our electronic palliative care coordination system (EPaCCS) called My Care Choices, to capture advance care planning discussions about Covid and gained access to it for care home staff.

We rewrote anticipatory prescribing guidance, verification of death procedures, created patient group directives, wrote policies to allow hospice medications to be taken into the community for urgent visits and supported carers to learn to administer sub cutaneous medication. We expanded the hospice inpatient unit and also a virtual ward in collaboration with a local care provider and merged community hospital and hospice beds into an integrated community bed base. We taught colleagues across the community about symptom control and advance care planning. We ate a lot of cake and spent a lot of time on Microsoft Teams.

And so, three months later, what do we know?

We learnt, like many others, that a crisis created more inter-organisational co-operation in two weeks than years of previous meetings. We learnt how many more people can be cared for in the community at the end of life when organisational barriers are dismantled. We learnt the value of established advance care planning programmes and a functioning EPaCCS to get people the care they need in a place of their choosing.

We wish to continue the integrated community teams to support our shared patients and to make further progress in non-medical prescribing. The electronic medications authorisations work well between clinical systems and we want to further expand access to our EPaCCS. We would like to continue with the virtual ward, allowing more people to be cared for at home whilst accessing the expertise of the hospice team.

We want to use this momentum to finalise the population approach to end of life care that our Alliance has developed focusing all our system energy and resources on what matters most to dying people and their relatives.

A crisis made us do it differently and showed us what can be achieved when organisational barriers are broken down and service is driven by the needs of the patient. We need to build on what we have started to benefit our patients of the future.

If you would like to share an article get in touch – maria.axford@networks.nhs.uk