The pandemic has made end-of-life care everyone’s business, says North London Hospice Medical Director

August 27, 2021
“Where death and dying wasn’t in people’s minds before, the priority for end-of-life care has become everyone’s business, and I welcome that”
 

Our Medical Director Dr Sam Edward gave a heartfelt account of the realities faced by hospices during the first wave of the pandemic in 2020. A year on she looks back at the challenges of the second and third waves and how the learnings from the pandemic are influencing the future of hospice care.

Over the last 18 months Dr Edward has led our medical team through the most challenging time in its 30+ year history, assisted the herculean effort on intensive care hospital wards, provided specialist palliative advice to medical teams across London…. and cried when she got the news that some of that help was repaid with the offer of early vaccination for our frontline hospice staff.

“The second and third waves were more brutal than the first, hospitalising more people and claiming more lives than we could have imagined. Yet, the steep learning curve during the first wave, meant we were better prepared to cope with what was to come.

“At North London Hospice we cared directly for many more patients with Covid through the winter but by then we had introduced processes and screening programmes, which were a huge help in ensuring we weren’t overwhelmed.

“We’ve had to provide more support for families. Often families with children had received no support until arriving at our doors and we’ve been able to offer practical support from our social work team as well as patient care.”

Visiting

Visiting remains at the core of what we do, enabling families to be together, and this has been one of the most challenging areas to manage.

“We’ve all been scarred by situations where we haven’t been able to keep patients and their loved ones together at the end and this has, at times, taken its toll. However, visiting on our Inpatient Unit is slowly opening up in a safe and secure way. We routinely conduct lateral flow testing for people visiting our symptom control patients, and for terminal care we now allow two named visitors in the last weeks of life and up to six people during the last hours of life. It has been a real journey to reach this point where at last we have the tools (testing and PPE) to enable us to do this”

Vaccination Support

We experienced two outbreaks of Covid-19 on our Inpatient Unit during the second and third waves but fortunately there was much less serious illness amongst our staff.  This was largely thanks to the vaccination programme. Thanks to a partner GP practice, our frontline staff were invited to receive the vaccine in the earliest phase.

“On 18 December I got the call from a GP surgery in Enfield that they would vaccinate our staff as category 1 workers. I have to admit I cried. I felt so strongly that hospices should be recognised for the work we were doing on the frontline. So, to have one of our partners call us early and offer to vaccinate our staff so they could be protected…. it was huge and such an emotional relief that we weren’t at the back of the queue. This meant we could keep our staff and patients as safe as possible and carry on!

“But what was truly breath-taking was that after that kind offer, our staff volunteered to assist with the vaccination programme in their own time. When I had my second dose, I was greeted by my PA, who was checking people in and one of my North London Hospice colleagues administered my vaccine. I felt such a sense of pride that our staff were saying thank you to the people that helped us. It spoke volumes about our incredible team here at North London Hospice.”

The Darkest Days

“I volunteered through the darkest days in January on the intensive care unit at the Royal Free Hospital. It was a fascinating and very grounding experience. I’ve taken a lot of learning from that month that I’m able to use at the hospice.”

In the community, the impact of the pandemic was huge. GPs and district nurses were hit, but even with an outbreak among our community team, we never stopped visiting patients at home. They needed us more than ever. We saw a massive rise of over 25% in referrals to us, and a huge increase in demand for our out-of-hours and overnight service. Visits went through the roof for our night service, and we were busier than ever supporting rapid response and emergency providers.”

We’ve come out stronger than ever

“The strength of the hospice is its spectrum of services. We are 24/7. We were able to put professionals in place when people were desperate for help. We struggled through the first wave, but our new processes kept staff and patients safe later on. We’ve also done a huge amount of work with care homes and enhanced care home services.”

Demand for hospice care will continue to grow

“Even though the number of covid related cases in hospitals varies but is generally lower than previously in the pandemic and life in many ways is returning to something resembling a new normal, the numbers of patients we are seeing at home is still increasing and likely to continue to increase for at least the next two years. The need for our services will be greater than ever.

“The NHS recognises that at least over the next 18 months the secondary consequence of the pandemic will be borne out in waiting lists. We meet people who have been are waiting for surgery or cancer care, and I can’t say now  whether that surgery or treatment would have made a difference…. because in some cases it would have. And people will live with that anger and families will lose loved ones as a consequence of this pandemic. Our bereavement care will be influenced (crucial) for years to come.

“Covid has really brought hospices and the funding of hospices into the public eye, we, like many organisations have been supported by government in an urgent but short-term way. But the real challenge is going forward and the next two years. Our contract money from NHS is unlikely to increase in the short term, but the gap of the cost of what we are providing is going to widen. Where death and dying wasn’t in people’s minds before, the priority for end-of-life care has become everyone’s business and I welcome that.”

 

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