Facing down the challenges to hospice care

Greenwich & Bexley Community Hospice is a charity dedicated to providing free, high quality, compassionate care and support for people with terminal illnesses, their families, and their professional carers in the London Boroughs of Royal Greenwich and Bexley. The hospice cares for more than 2,500 people each year in the community - in their homes, care homes, in hospice beds, hospice-based clinics, local prisons and the local hospital.

The hospice sector as a whole has faced great challenges. The double whammy of a global pandemic and the evaporation of charitable funds due to the shut down of non-essential retail and restrictions on events means it will have been the worst few years that many hospices will have ever known. Couple this with the ongoing effects that have been entrenched within care, and across the sector we have a recipe for crisis and, at the very least, burnout of both staff and supporting families.

However, at GBCH we remain optimistic. What we do, particularly within the community, is stand as a pillar of support for those who need palliative care and those connected to them.

Emergency preparedness

In terms of lessons learned at GBCH, we’ve learned that you can never plan too much! The work that we carried out in advance to support our emergency preparedness was incredibly helpful to give us a structure to prioritise, make decisions and communicate. Advice from NCVO early on gave us a system to follow for reporting to the board and providing necessary assurance.

Personally, the support of my chair was really important in ensuring a robust response through all of this. She did a great job providing a sounding board and helping to think about governance when the rest of the management team and I needed to focus on managing operational challenges.

I also can’t emphasise the importance of partnership working. Our good connections and networks, built before the pandemic took hold, were vital to ensure we got support and information in a timely way. This meant we were able to influence wider issues of care across all settings for people dying from all causes including Covi. These wider issues were related to the workforce and making sure we targeted our staff to areas of greatest need, access to essential supplies of PPE and access to earlier testing and vaccination.

The most important golden thread we found was engagement and communication throughout. We took the decision to be incredibly focused on communication and staff wellbeing. We found the best policy was to be as transparent and helpful as we could to everyone we encountered.

Standing as one

There’s a lot to be said for getting out there within your own community, and that’s something we’ve managed to spearhead in the past 18 months. By reaching out and standing alongside those in the same location or who have similar operations to you, there’s a sense that you can lean on each other and work together to achieve a greater good.

We have been integral in setting up the Palliative Care End of Life Network for Southeast London. The network we are creating there will emphasise the importance of striving for high quality care for all, innovating and improving the standard of care that exists across this area.

Through the network, more than 30 organisations are coming together, made up of a broad range of disciplines and experience. The group will share best practice and work together to address gaps, so strengthening communication between NHS trusts, hospices, local authorities, other charities and care providers and those needing our care.

Focusing on the same goals

Working together to improve palliative care in the area will help us to focus on the same goals of having a workforce which is confident and resourced to provide care to people facing end of life, and a community who have services which are appropriate and responsive to their needs and who are able to access support in a timely way.

Palliative care is truly holistic. Taking into account everything that affects how care is administered and treated along the patient journey is truly something which we can work to improve together as a network. To ensure the views of individuals are included is important and will help us build a better understanding and picture of what we want to achieve.

Remaining grateful

What’s become clear to us over this difficult time is that you can never say thank you enough, and the fact you have to celebrate the small successes. There have been some difficult times when staff were prepared to take some really scary personal risks, and it’s important to hear their worries, talk them through and allow them to step up, knowing they have support, if that is really what they want.

It’s become even clearer that you cannot make assumptions about people – some of our most vulnerable staff surprised us and wanted to step into face to face roles, and it would have been wrong not to let them. However, they had to do it with their eyes open and with the right protection. Early on it was hard to get the right PPE for example, and I saw that as my most important responsibility.

They needed to know what support would be there too, so getting our policies out quickly to let them know how we would manage periods of sickness and any other crunch issues around the time was incredibly important.

One way of remaining effective

The opportunities to try new things have been forthcoming, and we’ve grabbed the chance to embrace them. As we’ve adapted, we’ve continuously assessed whether the changes implemented are a good idea or not. Therefore having measures of success is integral to improvement. Getting user feedback on virtual consultations, for example, allowed us to be bolder about this, but also to target support and be more specific about who did and didn’t get virtual, compared to face to face.

We will be stronger as a result of the pandemic, and although everyone is tired, it feels like we are much clearer about our mission and core purpose – it’s been an opportunity to refocus on our values and really live those. As a result, we have a much stronger foundation on which to build for the future.

Self-care too

Finally, self-care is essential. I pretty much fell over back in January. Looking back, it’s clear I should have taken more breaks and at an earlier point. As ever, it’s easy to say and less easy to do. However, importantly, I felt appreciated and cared for by my board. Mental health is a real concern for many coming out of this pandemic and my chair has checked in with me regularly and been a huge support.

Although the fear and anxiety over the actual transmission and treatment of coronavirus are easing, the trauma and emotional baggage that has followed many people out of these past two years is real and will take time to heal.

It’s important as a charity that we recognise the signs of burnout, lasting trauma and depression that may have crept in subtly as we have been too busy to stop and think. Mental health is a buzz phrase at the moment, but those who take action to address it and help those suffering are the ones that will retain staff and really make a stamp on overall improvement.

We’ve had great support from our partners across Southeast London in this regard, and run our own wellbeing programme too. I think that has helped, but it can’t just be a one-off. We have to keep going and staff wellbeing is a cornerstone of our evolving strategy.