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Palliative care service

End of Care Team

By 2025 there will be ten million more people in the UK over the age of 65 than there were in 2015 - that's an amazing increase of 66%.  In the North East, life expectancy, though slightly under the national average, is 77.9 years for men and 83.1 years for women. 

End of Care Team

One of the main factors behind why so many more of us are living longer is, of course, improvements in healthcare, such as better treatments for cancer, heart problems and other diseases.  Earlier diagnosis thanks to screening programmes, better testing, plus improved awareness of the symptoms to look out for mean many serious conditions are detected early, making survival and recovery much more likely. 

With so much good news about how long many of us will live, we could be forgiven for not giving any thought to how we might want to spend the days or months right at the end of our lives if illness means we need palliative care.  But, at County Durham and Darlington NHS Foundation Trust, there's a team dedicated to making sure the wishes of this group of patients are met and who have realistic conversations about the options open to patients which they handle with sensitivity and kindness. In a recent inspection by the Care Quality Commission, which rated the Trust as 'good' overall, the end of life service was giving the highest possible rating of 'outstanding. 

Dr David Oxenham, consultant in palliative medicine, explains, "Medicine usually focuses, quite rightly, on helping people live well for as long as possible.  My focus though, and that of my colleagues, is ensuring we meet the needs and wishes of patients where medical treatments are not going to extend life.

"Increasing numbers of us are living independent lives well into our 80s and 90s - no real medical problems but perhaps increasing physically or mentally frail. Younger people with very serious illness or chronic conditions can also live longer than previous generations thanks to improved treatments and care.  Because there's so much that can be done, it's important that doctors recognise when treatments will no longer extend life so that, where possible, this can be shared with patients who may want more control over decisions.  Some may not wish doctors to interfere with the natural course of their dying, others may wish to be admitted to hospital for palliative treatment - these decisions are for them to make, within the boundaries of what is possible.

"Having a conversation with a patient about this is difficult but can help reveal how much information to share with them, and when.  Some people seem more comfortable taking things a day at a time while others want details.  Some people have very specific things they want to achieve in their final months or days or to make precise plans. Having this initial conversation with them in a sensitive way helps us to know how best to support them.

"If the most important thing for a patient is to stay alive for as long as possible, that's what we'll do, while being honest about the limits of medicines and treatments. Other patients are tired of being ill and don't want to stretch out this last phase of their life. 

"Having this conversation is part of our role and if the patient is too ill to understand or has told us they don't want to know, we may tell their next of kin, if appropriate. I'm amazed at how pragmatic, resilient and realistic some people can be when faced with the inevitability of their own death.  For some, the most important thing is to go home, to not be in hospital, and we'll do everything we can to make that happen for them without delay and to ensure they have all the support they need once there.

"Approximately 6,000 people die each year in County Durham with around 2,500 of those dying in hospital or whilst receiving care from our community teams.  Of those around 2,000 patients will receive care and support from our Palliative Care Service and we've increased our palliative care consultants from two to four to help meet this need.  We also have community Macmillan palliative care nurses available every day, including at weekends, so if a patient receiving palliative care wishes to go home on a Friday, they can do so knowing the specialist clinical support is there if they need it.  A palliative care advice line, supported by Marie Curie Hospice, Newcastle, means GPs and other healthcare professionals can access palliative care advice and support for patients out of hours.

"We want to ensure that patients in the final phase of life have the information, medicines and care to make their life as good as it can be and to achieve what is important to them as individuals and for their families.

Ends

Published 8th January 2020

'As I was very, very nervous, I must have been the worst patient ever and they were brilliant with me and I can't thank them enough - could you please pass on my sincere thanks.'

Patient, Hysteroscopy Unit, Chester-le-Street Community Hospital