By Dr Joseph Hawkins, Consultant in Palliative Medicine, Clinical lead for End of Life Care, Ashford and St Peter’s NHS Foundation Trust. Twitter: @JoeHawk75825077
Why every hospital deserves a ward for Palliative Care
In December 2022 I wrote about our palliative care ward 1– it was just one year old at the time. When I last wrote about it our ward was a young concept, and one that we’d not planned for months in advance, but instead had come upon us in a rush of good intentions and hasty writing of Standard Operating Procedures. At the time I wrote about the concerns we had of providing a space that would seem like a hospice within the hospital and that it may de-skill wards eager to get dying patients out of their bed spaces.
Why a Palliative Care ward should be part of every hospital.
In the modern crisis of bed shortages every space in hospital must declare its purpose and value or sit at risk of being re-purposed. It may therefore, seem a strange choice to have beds for dying people when dying seems the antithesis of the intent of an acute hospital-that of preserving and saving life. Yet it is a universal truth that people in hospital don’t always get better. Very sadly the numbers speak for themselves regarding the commonplace of activity that is dying in a hospital setting; in 2023, 44% of the population of England died in hospital2. On an average day NHSE estimates that 77% of people spend time in hospital in the last 6 months of their life-spending approximately 7.7million days in hospital every year3. Almost half (48%) of all care provided for patients 85 years and older in hospital is for the last year of their life.
Dying is an indisputably big part of hospital care, but despite this it can seem like a niche part of what is provided. At St Peter’s hospital there has been an aspiration to make the hardest part of life better than it might otherwise be. The provision of a palliative care ward has inspired a quiet revolution in managing the last part of life for many of our patients.
How our ward has evolved.
We have had changes in how we manage our patients. It became increasingly clear that a palliative medicine consultant wasn’t required for every patient. Providing the medical plan was clear patients could benefit from staying under their other team: surgical or medical who were managing the patient prior to their move. In this way the majority of patients have their day to day care managed by the ward MDT and should they require specialist palliative care support this is requested as it would be on any other ward. In addition to this a smaller cohort of patients are under the direct care of a palliative medicine consultant-usually patients who have complex symptom control needs; pain, breathless or total distress, for example. This has helped to ease the sense of taking people away from their former team. It improves continuity of care and it also uses our specialist palliative care resources more equitably across the hospital.
There are challenges that remain – recognising dying in a timely fashion is still a challenge at times in other wards. As can be understanding that dying doesn’t necessarily start in the last hours and days. However, despite this we have seen a huge effort from a workforce that has been put under historic pressure. I know that when I walk on to any ward I work with others who want the best for their patients and our palliative ward has helped us to provide a calmer, better environment. Whether it is for those with symptoms best managed by specialist palliative care in our pain specialist role, or those who are dying and best managed by generalists with support where needed, the palliative ward is an integral part of how our hospital serves its community in every aspect of their needs.
References:
- https://blogs.bmj.com/spcare/2022/12/02/1787/
- https://www.strategyunitwm.nhs.uk/sites/default/files/2024-01/A%20Picture%20of%20End-of-Life%20Care%20in%20England.pdf
- https://fingertips.phe.org.uk/documents/peolc_patterns_of_care_factsheet_2021.html
Also by this Author:
Flowers in the dark
The meaning of Regret
10 Golden rules of palliative care on how to manage a dying person – you’ll never guess number 4!