Palliative and End of Life Care

Palliative and End of Life Care (PEoLC) in Coventry and Warwickshire focuses on supporting people to live well and comfortably up until the end of their life. It prevents and relieves suffering by means of early identification and comprehensive holistic assessment and treatment to meet their physical, psychosocial, spiritual and cultural needs. Care homes are an important provider of PEoLC for their residents and those important to them. PEoLC affects us all, at all ages; the living, the dying and the bereaved.

Living well / Dying well

Being able to live as well as possible until we die is something that we all value. The needs of people of all ages who are living with dying, death and bereavement, their families, carers and communities, must be addressed, taking into account their priorities, preferences and wishes.

In Coventry and Warwickshire, our vision is to provide PEoLC for all of our diverse communities, which enables patients and their loved ones to live as well as possible, supported by their own communities.

We want to enable fair access to professional PEoLC and support, when this becomes necessary, in the setting of choice for the individual and those important to them, in a planned and pro-actively supported way.

PEoLC may be provided by the person’s usual care providers across primary care, secondary care, social care (including care homes) and the Voluntary, Charity and Social Enterprise (VCSE) sector, or specialist services (such as hospices), all working together to provide integrated care and support for the individual and those important to them.

Generalist palliative care service teams

GPs and their teams
District Nurses
Urgent Response Teams
Out of Hours services

Specialist palliative care service teams

Consultants
Nurses

Personalised Care and Support Planning

Many people feel uncomfortable talking about their wishes for the end of their life, yet not talking about it denies the person the opportunity to fully participate in discussions and decisions about their current and future care. Personalised care in the last year(s) and months of life will result in a better experience, tailored around what really matters to the person, and more sustainable health and care services.

Every person living in a care home (unless they indicate otherwise) has the opportunity to express their care preferences and to develop an Advance Care Plan (ACP). They must also have regular opportunities to review and revise these plans. It supports a personalised holistic approach through understanding a person’s preferences and gives them confidence that their care and treatment will focus on what matters most to them if, at a future point, they cannot fully participate in decision-making. Those important to the person can be involved in ACP decisions to the extent that the person wishes.

Should a person wish to access independent support to express their wishes, a range of Advocacy Services are available via Coventry City Council website and Warwickshire County Council website.

Every person living in a care home should have the opportunity to express their wishes, feelings and values, which may include their wishes and decisions should they be unable to make decisions for themselves and document a Personalised Care and Support Plan (PCSP), including an ACP (in accordance with the universal principles for ACP). ACP covers emergency care and treatment plans (e.g. the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process), and future care preferences at end of life.

Identification of concerns

Best practice is that care home staff are supported in identifying patients who could benefit from a palliative care approach and delivering PEoLC by the Multi-Disciplinary Team (MDT) and partner organisations, including secondary care, hospice and specialist palliative care services, as needed.

People identified as benefiting from a palliative care approach should be included on their GP’s palliative care register.

Each Place/Locality will have a range of Palliative and End of Life Care services.

These can include:

Generalist palliative care teams
Specialist palliative care teams
Hospices
Voluntary and Charitable organisations
Social Care

These teams will be able to support:

Deterioration at the end of life & recognising the dying resident
Symptom control
Anticipatory prescribing

Contact details for all Community Teams are via the Single Point of Access:

Warwickshire – 01926 600818 (08:00 – 20:00, 7 days a week, thereafter calls are diverted to 111)
Coventry – 0300 200 0011 option 2 (08:00 – 20:00 7 days a week)
An Out of Hours GP service is also available by calling 111

Equipment:

If special equipment is required, Coventry and Warwickshire Integrated Community Equipment Service (ICES) can be contacted on 024 7678 5353

Escalation and Response

An essential part of supporting any resident within a care home is ensuring they are safe and well and that any changes in their presentation are recognised early and responded to in a timely way.

Within Coventry and Warwickshire, we want to offer all care home residents and their carers the right tools and training to recognise any changes, but more importantly the help and support that may be required as a result of these changes through health and social care services.

We have worked with the West Midlands Academic Health Science Network (WMAHSN) team and health and social care partners to provide care homes with a set of tools and pathways to respond to deterioration and more importantly get the right care at the right time for residents.

Care Home Information Pack – Coventry City Council

Useful documents

Policy and general information

Education & Training

Care home staff should have access to education and training on PEoLC knowledge and skills, delivered in partnership and collaboration with health and care providers and the VCSE sector. This should include recognition and assessment of symptoms, communication skills, ACP, supporting a person and those important to them, and recognising the procedure and support required after death.

Advanced Care planning

Bereavement support

Other information

Best Practice (Staff Bereavement)

When we read the final blog from Wendy Mitchell, dementia campaigner, who died after Voluntary Stopping Eating and Drinking (VSED) in February 2024, we were struck by her words ‘The last cuppa tea…my final hug in a mug, the hardest thing to let go of’. https://whichmeamitoday.wordpress.com/2024/02/22/my-final-hug-in-a-mug/

We had held more traditional Death Cafes, but some people questioned and didn’t understand them so we often struggled with attendance. Many of the staff were the age where they were losing parents, children were going off to university, precious pets had died, menopause and the effects of losing residents were felt. We were conscious that staff were sometimes coming to work sad due to their losses, but we still expected them to be able to support residents and families in their struggles, sadness and grief.

Jane, the deputy manager at Galanos House, decided to try a different approach and start a ‘Hug in a Mug’ session. An informal monthly meeting where there is tea, biscuits and cake and the opportunity to talk and share. 15 of our staff have completed the Bereavement First Aid course from Cruise and felt comfortable to facilitate sessions. A poster goes up and it is an open invitation to all staff.

I think that the most important thing about Hug in a Mug is that it gives people a safe space, we promise to listen, we ensure confidentiality from the meeting, we agree respect and patience and are non-judgemental. In care there has traditionally been the emphasis on ‘being professional’ closing down displays vulnerability or emotion. However, if we want our staff to be their authentic selves, we need to be open to those vulnerabilities and emotions and give them space. Understanding the impact grief and loss can have mentally, physically and emotionally can enable workplaces to prepare, manage and support staff members.

Some staff just come to one meeting, that’s enough for them but others may need longer term support. Often staff will return when there is an important anniversary or date, a birthday, mothers or father’s day, a wedding anniversary. Grief can come back at anytime and it’s essential for us to remember and acknowledge it. We also have an EAP scheme where staff can access formal counselling if they need it.

It's important to remember that we all experience loss in our lives at some time and everyone navigates the grieving process differently but staff have told us that knowing there is somewhere safe at work to bring that vulnerability and emotion has made them feel more confident and less anxious to be at or return to work.

“I know that without the understanding and support from my colleagues, I wouldn’t have coped so well after losing my mum. Going to Hug in a Mug and realising other people were going through similar things and felt the same, gave me the strength to talk about things I never had. Sharing is very powerful and has strengthened our teamwork and friendships. Sometimes being at work is the safest and easiest place to be” MG staff member

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