Sadly, it is a fact of life that death comes to us all. But how and where we die is important and when asked, the majority of people asked would choose to die at home; but, for many reasons, that may not always be possible.
In managing end of life care for its patients, the Royal Berkshire NHS Foundation Trust is a national leader, and the best locally.
Once it is recognised that a patient is nearing the last few hours and days of life, the care that they can expect to receive is based on five essential aspects of care, set by clinical teams and recognised nationally. These are :
The care that patients receive from this point onwards should be in line with the needs and wishes of the patient. Where ever possible, these are discussed with the patient and often their families and carers before nearing the end of life.
In an audit looking at national end of life quality indicators in March 2016, the Trust achieved scores between 82% and 96% where the National average was between 56% and 84% across 5 indicators. The End of Life Care – dying in hospital audit was led by the Royal College of Physicians.
Susi Lund is the Trust’s End of Life Care lead. She puts the Trust’s performance in this emotive area down to the Trust staff’s focus on delivering excellent quality of end of life care. Mindful that every patient is someone’s loved one, the Trust has invested in end of life care training across clinical and support staff. There is a close relationship with local community health and social care providers (including GP and district nursing, palliative care teams and hospice care providers), to give patients who do want to die at home, the chance to do so.
For those whose end of life care is in a hospital setting, it is not always possible for patients to die in quiet rooms off the wards (and some patients may not want to). Strategies for managing this are in place and being developed further. We recognise that care does not stop when a patient dies and ensure consideration of family requirements in a suitable environment.
Comfort bags, now known as Jimmy’s Bag, are provided as required, giving toiletries and care essentials for patients who have come in as an emergency or for the families who are staying overnight in the last hours of a patient’s life. These are generously funded by bereaved families.
Explains Susi, “Ultimately, when you lose someone close to you, you remember the people around you in hospital at that time and it is important to those who work at the Trust that we are remembered for our compassion, and our care, for the patient and for the families.
“Our End of Life Governance Group includes clinical, pastoral and support staff. The group focussed on what we thought was important at the end of a person’s life and the care we would want to see given. That is the standard we set ourselves: what care would we want for ourselves or our family.”
Director of Nursing, Caroline Ainslie, added: “It’s been a lot of very hard work, led by the palliative care team, but these figures show us that we are doing this work well.”
The Trust has good Hospital Standardised Mortality Ratios (HSMR) which means that fewer people die at the hospital than would be expected according to the last reported annual data for 2015/15.