End of Life Care

Our End of Life Care (EoLC) team plays a vital role in caring for patients who are in the final 12 months of life.

The team was formed in 2018 from a partnership with the charity Macmillan Cancer Support.

The partnership was developed to provide our staff and volunteers with specialist training so that terminally ill people can get the care that meets their needs and respects their wishes.

Defining ‘palliative care’ and ‘end of life care’

Palliative care refers to the approach healthcare professionals will take when someone has been diagnosed with a condition that is not curable. The care is based on any physical, psychological, social or religious needs that the person might have. The care can be provided 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 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 and future care planning – see below) if this has not already been addressed.

How we educate and support our crews

Our EoLC team provides training to ambulance clinicians, including paramedics, and other staff so they can best support patients who are near 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 help clinicians fulfill patients’ wishes – where appropriate and safe to do so – about treatment and other key decisions.

In most 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 urgent advice 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 emergency, we may call back to assess the person, or we may send an ambulance.

Our crews can manage distressing symptoms and will discuss the options with the person, those important to them and the healthcare professionals who normally look after them.
In an emergency our crews will need to know 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 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 and future care plan or care record. This may be paper-based or electronic.
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 and future 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 can be accessed and used by our crews to provide the best care for the patient and helps them contact the patient’s medical team and those important to them.

Electronic plans are increasingly common. In London, patients may have a Universal Care Plan (UCP) which crews can access. Patients can also view their own UCP via the NHS app. These are designed to be an up-to-date record of patient wishes and can be updated as preferences change. You can speak to your GP or specialist team if you think creating a UCP might be appropriate for you. We want the patient’s needs to be at the centre of the care when we respond. Knowing their wishes and preferences helps our crews make the right decision. We encourage family and friends to have these conversations and share with us what is important to them. For further information please visit the NHS website.
Our dedicated EoLC team comprises of a paramedic lead, two paramedic associates and a clinical nurse specialist with special skills and knowledge in EoLC.

They do not provide an EoLC clinical response but fulfil a strategic, governance and education role to help our workforce provide the very best care.

We also engage and work collaboratively with external partners and stakeholders to provide high quality care in the pre-hospital setting. Alternative responses to palliative and end of life care cases:
1. Advanced Paramedic Practitioners in Urgent and Critical Care have additional skills to assess and support patients nearing their end of life, including access to additional medications. Find out more about our Advanced Paramedics.
2. Non-Emergency Transport Service (NETS) who are commissioned to transfer patients near end of life. Please contact the HCP line for further information.
3. Our Integrated Urgent Care Centres (NHS 111) have clinicians who can offer advice immediately and refer on to out of hours GP services. They also use star lines for care homes.