St Helena Hospice agreed with the Suffolk and North East Essex ICS to take on a leadership and coordination role for all end of life care delivered outside of hospital in North East Essex during the pandemic.

Mark Jarman-Howe, chief executive of St Helena said, “The COVID pandemic has brought huge challenges to community palliative and end of life care. In North East Essex, St Helena Hospice coordinated the community end of life response on behalf of the North East Essex Health and Wellbeing Alliance, creating a hub and spoke model. Non-urgent hospice visiting ceased and community specialist nurses, rehab and family support teams joined the single point of access team to create an enhanced community rapid response hub. Continuing health care funding resources were allocated through the hub, and local voluntary services coordinated relief services for those on the palliative care register. We created a 24-hour non-medical prescriber rapid response service in partnership with Anglian Community Enterprise to enhance overnight nursing capability and offered bereavement services across the community.

“We created integrated spoke teams with weekly virtual meetings between primary care, community nursing and the hospice, and developed a single caseload between the providers to enhance care coordination.

“We developed our electronic palliative care coordination system to capture advance care planning discussions about COVID and gained access to it for care home staff. We rewrote anticipatory prescribing guidance, verification of death procedures, created patient group directives, wrote policies to allow hospice medications to be taken into the community for urgent visits and supported carers to learn to administer subcutaneous medication. We expanded the hospice inpatient unit and also a virtual ward in collaboration with a local care provider and merged community hospital and hospice beds into an integrated community bed base. We taught colleagues across the community about symptom control and advance care planning. We ate a lot of cake and spent a lot of time on Microsoft Teams.

“Three months later, what do we know? We learned, like many others, that a crisis created more inter-organisational co-operation in two weeks than years of previous meetings. We learned how many more people can be cared for in the community at the end of life when organisational barriers are dismantled. A crisis made us do it differently and showed us what can be achieved when organisational barriers are broken down and service is driven by the needs of the patient.”