If a call did come in and a patient was really unsettled, really symptomatic, perhaps they didn’t have any care available and they deteriorated quite suddenly then one of the nurses from SinglePoint would go out and assess and see what it is we can do to make things more comfortable and safer at home.

Then as a team we have a morning meeting, and hand over anything to the other multidisciplinary teams including clinical nurse specialists and the other nurses we work with, the medical team, the therapies, bereavement support, psychosocial support, so that’s a really useful part of the day to get everyone’s gist on what’s going on.

Once we’ve done that, we are on the phones taking calls from patients, relatives, carers, paramedics… We’re getting a lot of calls from paramedics at the moment about patients who are in crisis; the paramedics are called because they don’t know what else to do, the paramedics then think, ok let’s call SinglePoint and see if the patient is known to them. We can give advice and support to the paramedic rather than the patient being admitted to hospital, which might not be entirely appropriate.

If a call did come in and a patient was really unsettled, really symptomatic, perhaps they didn’t have any care available and they deteriorated quite suddenly then one of the nurses from SinglePoint would go out and assess and see what it is we can do to make things more comfortable and safer at home.

It might be 2 o’clock in the morning when someone is in crisis. The patient may have become agitated, very restless. For the families that’s really unsettling for them to witness, so they might call into SinglePoint for some advice and support and we would go on a rapid response visit. We’d go with a healthcare assistant to assess the situation; they are specially trained in palliative care so they are very experienced HCAs that can help us. We try to see what might be causing the agitation, whether it’s the fact that it’s their disease progression, or they might be spiritually agitated, or it could be that they are in pain or discomfort somewhere. So we have to go out and do a full assessment, which is a challenge the middle of the night when it’s dark.

If the patient needs a catheter put in in the middle of the night we’ll do that and just sit and talk to the patient and give them support. We’ll give their families support as well because that’s really hard to see their loved one at end of life going through those challenging times. I think families find our service really helpful because they can call us 24 hours a day, and in the middle of the night when there’s no one else to call.

Sometimes when you’ve knocked on the door and they’ve opened it, relief washes over them because they know that someone is finally there to help them take the burden off. Sometimes I’ve been welcomed and it’s quite panicky; you can tell perhaps they’ve been holding it together really well up until that time but when we arrive it’s like ‘oh my gosh, someone else is here to help take the burden’. I think relief is probably the right word.

We could get a call to go out and verify a death at any time of the day. Of an evening and night time is unfortunately when people predominantly die so we do quite often get calls overnight to do a verification. It's very hard when you get those calls when their loved ones say ‘I think they have died’. It's hard for them and when we say ‘we're going to come out and see you’ I think they do feel better knowing that there is somebody that's going to come and give them that support, hold their hand really.

We're really lucky that we don't have time pressures as they do elsewhere. If we do think somebody is very end stage end of their life and taking their last breaths, of course we would stay and sit with them and give that support to the family and also try to explain to the family before that happens. That's a really difficult conversation to have but I think it's really important because if they know what to expect, it gives them that comfort that this is normal and it doesn't cause them so much anxiety.

We start at 7:30 in the morning until 8 at night, which is really good for the patients because if we had a call from them at ten o'clock in the morning and they rang back at two, I would know their story, I would already have built up a bit of a rapport with them so I can follow it through for the rest of the day. But it can be just call after call and it can be quite intense with lots going on.

There’s always got to be someone in the office to answer the phone and you can't just go out and leave during the day but of course at night that is what happens. Night shifts are very difficult when you’ve got just a nurse and a healthcare assistant on because you’re going out and you’re seeing patients but the phones are still ringing, so that is quite hard having to deal with that.

It is really heavy when you’re driving around from patient to patient, you’re giving as much as you can to the patient that needs you there and then… and then the phone’s still ringing from the next person needing help.