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End of Life

Palliative, CMC and end of life care resources

Follow this link for resource pack for managing patients with palliative or end of life care in community/care homes created by The End of life Executive Group (CCG leads, BHRUT palliative care team, Saint Francis Hospice, NELFT) and local BHR GP's (Dr M Goyal, Dr R Crowley and Dr Rai). This link takes you to the NELCA Coronavirus GP intranet.

Coordinate My Care (CMC) 

CMC is a clinical NHS service that supports patients in urgent care situations. Together with their clinicians, patients may record their preferences and wishes within an electronic personalised urgent care plan that also includes clinical information and relevant medical history. This care plan can be viewed by all the healthcare professional teams involved in the patient’s care twenty four hours a day, seven days a week and ensures that the patient is at the heart of their own healthcare. For more information go to the CMC page within this intranet.

St Francis Hospice - update on services for patients and their carers as a result of COVID-19

Referrals Hub - Referrals are all received electronically (not by fax), via a generic nhs.net address: NELCSU.saintfrancishospicereferrals@nhs.net. The referral form is on their website  https://www.sfh.org.uk/refer-a-patientThe form is at the bottom of that page. Referrals are pick up seven days a week. Between 9:00am-4:00pm the referral will be read within two hours. They try to make contact with anyone who is at home within 24 hours, but please indicate URGENT on the referral if the patient is in crisis/rapidly deteriorating, and supply key clinical information on the form/attach recent clinical information to help us prioritise. Recent blood results, drugs and allergies really help. 

Inpatient Unit – They have kept 16 beds safe and operational, and can stretch more if someone is in need but able to mobilise safely/independently. The IPU is being heavily used so that there can be a wait; but reviewed every day in an effort to identify the person in most need and to ensure help for those who have to wait. They allow visitors, though visiting is limited and careful. When they need to adjust, they ensure they know. The average length of an inpatient stay is 12 days, but they have seen many more people needing short interventions, and more discharges back home. They cannot be a long stay option due to bed pressures, and for the same reason they have no pure respite beds. 

Specialist Community and Crisis Support - Their specialist Advice Line is, as always, open, 24/7. The number is 01708 758643.  Please do ring for any palliative/end of life care advice or support; they are happy to give advice and support whether or not they know the patient. The CNSs are doing more by phone due to the huge volume of referrals and advice line calls, as well as for COVID-19 safety reasons, but their CNSs and doctors are still home visiting, focussing on crisis situations and on those who just cannot manage connecting by phone. A few have prescribing ability now. In a crisis situation, if they can help by prescribing crisis symptom control medications they will. As always, our District Nurse colleagues are key partners in care. They visit care home residents if they are in difficulty, with the support of the care home.  

What we do

Saint Francis Hospice is a centre of excellence in the care of those with life limiting illnesses.  Our team of specialist consultants, doctors, nurses and health care assistants provide practical and emotional support for adults of all ages and give specialist bereavement support to family members from as young as 20 months.

Most of the people we care for like to stay in their own homes, therefore we provide support that allows them to do that.  At times when this is not possible or when patients prefer the comfort of being in a clinical environment, we bring them into our hospice for specialist care and control of symptoms; over half of these patients are able to return home again. 

Our teams provide care in the home, inpatient care at the hospice, day care at our centre together with a full range of therapies and treatments.  This care extends beyond physical treatment of symptoms; we consider the emotional, psychological, spiritual and social needs of our patients, their families, children and carers.

Please see downloads for GP update leaflets from the Hospice.  

Age UK end of life service 

Age UK Redbridge, Barking and Havering are offering a service to support end of life patients. Details of what the service offers and how to refer your patients are included in the below letter for GPs and patients, if you think they will welcome the support. If you have any questions please contact Andreea Albu at Age UK on 020 8220 6000 or via email

Child Bereavement UK support services

Child Bereavement UK offers face-to-face support for families where a baby or child has died or where children and young people (up to the age of 25) are bereaved. The charity supports families who are facing bereavement, where a child isn’t expected to live, or where children and young people are facing the death of someone significant in their lives. The services are provided free of charge and are offered by trained bereavement support practitioners. GPs can refer patients and families can self-refer. For more information call 020 8519 7025 or email

Please follow this link to the dedicated Coronavirus GP intranet for the latest End of life updates and information on COVID-19 related issues.

Download this useful guide

NELFT quick reference guide - prescribing, contacts and support for staff

 Please find links below to a series of video’s produced by Guy’s and St Thomas’ NHS Foundation Trust

This video explains Cardiopulmonary Resuscitation (CPR) and DNACPR orders

  • CPR is rarely successful and can be harmful.
  • It is the medical team's responsibility to assess a patient’s health and to decide if it is right to make an attempt at CPR. If it is felt that CPR will not work, the medical team will make a decision to withhold it (a DNACPR decision).
  • The medical team will always involve the patient or their carer in decision making about CPR.
  • If a patient or carer disagrees with a decision that is made, they can request a second opinion.
  • A DNACPR decision applies to CPR only. Patients with a DNACPR order can still come into hospital and receive all other forms of treatment. 

This video is intended to support patients' and carers' understanding of treatment escalation planning and options for preferred place of care.

  • Many illnesses can be managed where the patient usually lives by accessing community healthcare professionals and equipment.
  • If you plan to have your care at home, you can still come into hospital if you change your mind.
  • Critical care is highly demanding on the body and the mind. It is important to consider if care in this area is in the patient's best interests.
  • In addition to supporting patients at the very end of life, hospices provide short stay admissions to patients experiencing challenging physical, emotional or social symptoms. 

This video explains what is meant by uncertain recovery and advises patients and carers to consider what is most important to them, including place of care and acceptable levels of treatment.

  • There are times where we may give a treatment to a patient but are not sure if this will work. There is a chance that the patient will improve but also a risk that they could die.
  • In patients who are facing uncertain recovery it is really important to consider preferences for care and treatment to develop the right plan with the healthcare team. 

This video aims to help patients and carers understand how decisions are made when offering treatment and how a patient's capacity to be involved in decision making is assessed.

  • The healthcare team are responsible for assessing a patient's health and offering treatments based on best available evidence.
  • It is always assumed that a patient can make decisions about their care unless there are concerns about their ability to do so. A patient's capacity is assessed by looking at the their ability to understand, weigh up, retain and communicate information.
  • A patient can refuse any treatment that is offered to them but cannot insist on treatments if the healthcare team do not think that these will help or if they will harm the patient.
  • Patients should be supported to seek a second opinion if they disagree with a plan of care. 

 

© 2022 NHS Havering Clinical Commissioning Group.