Specialist Palliative Care Services

The Specialist Palliative Care Services is based at Queen’s and King George Hospitals. We work to support our staff to care for any patient with a life-limiting illness who has complex physical, psychological, social or spiritual issues. We can see both inpatients and outpatients.

Our team assists with patients with complex palliative needs; 

  • symptom control,
  •  complex discharge planning,
  • arranging rapid discharges for end-of-life care,
  • support patients to plan for the future; advance care planning,
  • end-of-life care support and associated education and training.

Advance Care Planning

Advance Care Planning (ACP) is a voluntary process of discussion about future care between an individual and their care providers, friends and family. These discussions should be documented, reviewed regularly and communicated to key persons involved in their care. Decisions are made when someone has capacity and only come into effect if the individual no longer has capacity to make decisions for themselves.

Coordinate My Care (CMC)

Coordinate My Care (CMC) is the live electronic palliative care coordination system (EPaCCS) used across London for the documentation of Advance Care Plans.

The CMC record contains the key elements of the patient’s care (support, medications, etc.) and wishes about their future and end-of-life care. This includes preferred place of death, and the emergency treatment plan. Research identified that 80 per cent of patients who had a CMC plan died in their preferred place of care.

myCMC

In addition to healthcare professionals creating CMC records, patients are also able to create their own records using myCMC, but this will need approval by the clinician or GP looking after their care.

You can now start your own CMC plan online

Links

CMC website: information for Patients and their Carers [pdf]

CMC website: information for Patients and Carers in additional languages

Advance Decision to Refuse Treatment (ADRT)

This is a legally binding document which allows patients to refuse specific treatments, in specific situations, if they lack capacity to make decisions at the necessary time.

NHS website advice on advance decision to refuse treatment

Lasting Power of Attorney (LPA) for Health and Welfare

You can give someone (an attorney) the legal power to make decisions on your behalf about things like:

  • your daily routine, for example washing, dressing, eating
  • medical care
  • moving into a care home
  • life-sustaining treatment

It only comes into effect if you’re unable to make your own decisions at the time.

Lasting Power of Attorney (LPA) for Property and Financial Affairs

Use this LPA to give an attorney the power to make decisions about money and property for you, for example:

  • managing a bank or building society account
  • paying bills
  • collecting benefits or a pension
  • selling your home

It can be used as soon as it’s registered, with your permission.

NHS website information on power of attorney

Cardio-pulmonary Resuscitation (CPR) Decisions

Clinical Decision Making

As a part of the natural dying process, the heart and lungs will eventually stop working. Medically, this is also called cardio-pulmonary arrest and occurs at death.

Cardio-pulmonary resuscitation (CPR) may be attempted to restart the heart and lungs at other stages of life, but when someone is near or at the end of their life, it is highly unlikely to work.

Legally, patients may decline a treatment but they cannot insist on one if healthcare professionals think it is clinically inappropriate. This also applies to CPR. The decision to offer CPR or not, is a clinical decision. If it is felt that CPR is unlikely to be successful, or will not provide overall benefit to the patient (e.g. would not result in a length or quality of life acceptable to the patient), then it should not be offered.

A Do Not Attempt Cardio-pulmonary Resuscitation (DNACPR) decision made by healthcare professionals should be discussed with patients and their relatives. A DNACPR decision does not mean that other forms of care or treatment will be stopped. This can be a difficult topic for some. If you would like more information, you can discuss this with a healthcare professional or visit the following website:

Resuscitation Council UK website advice on CPR Decisions, DNACPR and ReSPECT

Daisy Volunteers

We believe no patient should die alone unless it is the patient’s choice to do so. We aim to support our imminently dying patients and their relatives or carers with a specialised team who are specifically trained to provide comfort and support at a difficult time.

Our hope is to enhance the support we provide our patients approaching the end of life, not just medically, but emotionally and spiritually too. Daisy volunteers sit with patients who are on their own or fill in for relatives/carers to support them to have a break. 

Hospice and Community Palliative Care Teams

Saint Francis Hospice (SFH) is the local hospice that covers the Trust area. Referrals for an inpatient stay are made by the Specialist Palliative Care Team (SPCT) for patients who have ongoing complex symptom control or emotional/ family support needs. Transfers to Saint Francis Hospice are done on a clinical need when beds become available.

If there is an ongoing specialist palliative care need once someone is discharged from hospital, they can be referred to a Community Palliative Care Team (CPCT).

Specialist Community and Crisis Support Team – based at St Francis Hospice for patients in Havering, Barking and Dagenham and parts of Essex.

Macmillian Specialist Palliative Care Team (for patients in London Borough of Redbridge)

Patients must be known to the District Nurses prior to Redbridge CPCT involvement.

Tissue donation

We are proud to be an NHS Blood and Transplant (NHSBT) Alliance site. Our Trust supports tissue donation and we want to give all families the opportunity to fulfil patients’ wishes.

Donated tissues such as eyes, skin, bone and heart valves can save and dramatically improve the quality of life for others. As many as 50 people can be helped by the donation from one person.

What does this mean?

All adult patients who die in our hospitals are considered as potential tissue donors. When a patient dies, nursing staff must give the patient’s family the tissue donation leaflet and let them know that they may be contacted by a Specialist Nurse if their relative could be a potential tissue donor.

Tissue donation gives many families the opportunity to make a difference to others and the Specialist Nurse will be able to answer any questions the family may have. If a patient has already expressed a wish not to donate tissue on the organ donation register, the family will not be approached.

NHS Blood and Transport website

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