End of Life Care
Our End of Life Care team was formed in 2018 as a result of a partnership with the charity Macmillan Cancer Support.
The partnership was developed to provide our staff and volunteers with specialist training to ensure that terminally ill people get care that meets their needs but respects their wishes.
As part of this, Macmillan funded three roles in our End of Life Care (EOLC) team.
What do the terms ‘palliative care’ and ‘end of life care’ mean?
Palliative care refers to the approach health care professionals will take when someone has been diagnosed with a condition that is not curable. The focus of care is based on any physical, psychological, social or spiritual needs that the person and the people important to them might have/experience. The care can be delivered by a specialist team or by a community team led by the GP.
End of life care is when the person is likely to be entering the last 12 months of life. This is determined by a change in the intensity and/or number of needs a person might have. They will show signs of deterioration, which will vary according to the person and the condition.
This is an ideal time to consider any future care needs (often called advance care planning – see below), if this has not already been addressed.
Our work to educate and support our crews
The Service’s End of Life Care team provides training to medics and other staff and volunteers in the Service so they can best support patients who are nearing the end of their life. This can help avoid unnecessary trips to the hospital which can be distressing to the patient and their family.
They also provide additional training to increase confidence among clinicians in fulfilling patients’ wishes – where appropriate and safe to do so – about treatment and other key decisions, and offer staff small, virtual reflection debriefings that focus on wellbeing.
End of Life Care 'Coordinators'
EoLC Coordinators work alongside our Macmillan Cancer Support-funded EoLC Programme team as part of the Service’s work to improve the care we give to patients nearing the end of life and develop staff and volunteers’ training and confidence and skills.
The Coordinators – made up around 40 staff across different ambulance stations and EoLC ‘Ambassadors’ in our control rooms – undertake this role voluntarily, to make improvements in their local areas.
After undertaking training and courses, the team have shared their learning and good practice with colleagues at a more local level – driving a cultural change.
They’ve also provided and sought useful feedback on technology used in EoLC ensuring their colleagues are confident in using electronic patient care records.
Coordinators have also been building strong partnerships with stakeholders in their areas. These include hospices, charities, community services, GPs and Clinical Commissioning Group partners, resulting in two-way shared learning across organisations.
On the impact the Coordinator have had, The Macmillan EoLC Programme group said:
“The Coordinators have formed an effective network across the Service and as a team we would like to recognise their commitment and passion to improving EoLC for our patients and their families.”
What should I do if a crisis occurs with a loved one who is in palliative care?
In the majority of cases the best people to call first are the healthcare professionals who are looking after the patient and who know them best.
This is likely to be the person’s GP, District Nurse or their Palliative Care Team if they have one.
If you need to call 111 for an urgent need or 999 in an emergency it is helpful to make the call handler aware that the patient has palliative or end of life care needs.
Depending on the problem you have, we may call back to assess the person or an ambulance response may be sent to the address.
Our crews are able to manage distressing symptoms and will discuss the options with person, those important to them and the health care professions who normally look after them. We work collaboratively with hospices and palliative care teams across London and have agreed pathways which we can use to gain support and access to care. This can enable the person to stay at home, if this is what they want and it is safe to do so.
What our crews need to know when we arrive or when we call you back
In an emergency situation our crews will need to know information about the patient’s medical conditions, what treatment they have been receiving and if they have a specialist team in the hospital or community.
Most importantly they will seek to understand what the patient’s wishes are for their care. For example, if they have any views on where they would want to be treated, at home or in hospital? Or if there any treatments that the patient would want or not want?
If the patient is unable to communicate then our crews will ask relatives, carers and those close to the patient if they are aware of any views the patient holds or any previous conversations they may have had about the person’s care preferences.
They may also ask if the patient has an advance care plan or care record, this may be paper based or electronic.
How future planning helps patients, families and our crews in an emergency
Some people do not want to think about what the future holds or what might happen should they become severely unwell. For others thinking and talking about what is important to them and making their choices clear brings comfort and reassurance.
An advance care plan or care record is a plan that has been made with the person’s GP or wider medical team and records essential information about what the person would like to happen should their condition deteriorate. The plan is used by our crews to guide them in providing the best care for the patient and helps them contact the patient’s medical team and those important to the patient.
We want the patient’s voice to be central when we respond to a call for help. Knowing their wishes and preferences helps our crews make the right decision. We encourage family and friends to have these conversations and share what is important to them, for further information.
Information for health care professionals
There is a dedicated EoLC team at LAS comprising of a nurse consultant and two paramedic leads with special skills and knowledge in EoLC.
They do not provide an EoLC clinical response.
The EoLC team provide service education to ensure an upskilled and competent workforce for this cohort of patients. We also engage and work collaboratively with external partners and stakeholders to provide high quality care in the pre-hospital setting.
The LAS response to palliative and end of life care issues are:
- Advanced Paramedic Practitioners in Urgent and Critical care – they have additional education and skills to assess and support patients nearing their end of life, including access to additional paramedics medications. They have many aspects to their role so may not always be able to respond but will be able to provide advice and support, via telephone, to the ambulance clinicians on scene. Find out more about our Advanced Paramedics.
- Non-Emergency Transport Service (NETS) who are commissioned for transfers for patients near end of life. Please contact the HCP line for further information.
- Our Integrated Urgent Care Centres (NHS 111) have clinicians who can offer advice immediately and refer on to OOH GP services. They also use star lines for care homes.