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.
Personalised care planning
The NHS aims to provide personalised care based on what matters to you. Care planning enables your wishes and individual care and support needs to be communicated digitally with your healthcare professionals across London.
A care plan can be created following a conversation between you and your healthcare professional (such as a doctor or nurse). Your healthcare professional will listen to you, understand your needs and make notes about:
- What is important to you in your day-to-day life
- Your preferences or wishes about your care, such as where you prefer to be cared for
- What support you need and who is best placed to provide this
- Information about others who may be involved in your care, such as relatives
Based on your conversation, your healthcare professional can document this information using a digital system*. Your care plan can be continuously updated throughout your life, depending on your needs and wishes.
Your healthcare professional will document a clinical recommendation, should you need emergency care. Information on your care plan is visible to all health and care services who are involved in your care. This may include the London Ambulance Service, 111 and Out of Hours GP services who may see you in an emergency.
*From July 2022, a new digital system called the Urgent Care Plan will take over the digital system that is currently in place.
Patients – Urgent Care Plan (onelondon.online)
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.