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Working across the wards of University Hospitals Plymouth (UHP) NHS Trust 365 days a year, there’s a team small in number yet dynamic and consistently compassionate in the face of pressure, who swiftly stepped up to help strengthen the hospital’s emergency response when the pandemic hit hard earlier this year.

Now, with the number of COVID-19 patients on the rise locally as well as nationally, our hospital team is again giving its support to NHS colleagues, fortifying the frontline so that patients who are dying from complications of the virus receive the compassionate end of life care they need. As part of one big team at the hospital, our hospice staff are not only lending their expertise on the COVID red wards though – just as before, they’re pulling out all the stops to continue their usual work as well, ensuring that right across the hospital patients whose time is running short are as comfortable and at ease as possible.

Explaining how St Luke’s stepped up to help the hospital respond in the early months of the pandemic – and how it feels to be back supporting NHS colleagues dealing with the challenge of another influx of COVID-19 patients – St Luke’s nurse Julie Ayers said:

“Ordinarily, our team is involved in looking after up to 40 hospital patients at any one time, ensuring they receive the highest calibre care and giving emotional support to their families, too. While we are a small team, we are also flexible so when the gravity of the COVID-19 situation brought huge extra pressure to bear on the hospital, we were able to adapt quickly as part of its response to dealing with the emergency.

“It was about more than just providing specialist care and advice for patients with complex symptoms caused by the virus. We were also there supporting hospital staff who suddenly needed to have difficult but necessary conversations with patients’ families. This was especially hard for colleagues who’d never done it before, in some cases because they’d only very recently qualified as doctors and nurses. We drew on our experience to build their confidence and help them do this with kindness and sensitivity while not shying away from clarity because it’s so important to be open and honest with families in these situations.

“In addition, when inpatient and outpatient cancer treatment temporarily transferred to nearby Nuffield Hospital, we were there to provide specialist training for staff at the facility, many of whom were completely unused to looking after people with terminal illness because that’s not what their usual work involves. We continued to provide support for them until cancer care returned to UHP NHS Trust in August.”

“When I look back at that time now, which felt so relentless, I also recall how daunting it was, especially in those first few weeks because it was such an unprecedented time and none of us knew what to expect. I felt really anxious at first, especially with so many news reports about healthcare workers dying from COVID-19, but I think those fears are only natural.

“What’s really helped  – and what’s really stood out to me – is the level of support we’ve given each other. It’s been phenomenal, not just in our tightknit St Luke’s team but more widely across the whole hospital. We are really there for each other because we all recognise the importance of what do and at the same time empathise because we’re all juggling our work with the personal challenges everyone is experiencing due to the pandemic.

“We had to adapt the way we worked really quickly because things were changing not just daily but sometimes by the hour. We just got on with it though because that’s what we do. I’ve worked in palliative and end of life care for most of the past 20 years and have been back with the St Luke’s team for the past three – it’s simply where I feel I belong.”

Julie, who is married with two teenage daughters living at home, appreciates the unswerving support her family has given her as she’s continued to deliver vital care for patients week after week.

This time around, she feels she and the team are much better placed to meet the challenges of working on the frontline of hospital care, looking after patients who include those struggling with symptoms of COVID-19.

She said: “I think because of what we’ve already weathered, we know a lot more about what to expect as COVID cases continue to rise, though of course we can never get complacent.

“I still feel some trepidation – my biggest fear would be to have the virus, be symptomless and pass it on to one of my family – but with all the strict infection control measures in place, the hospital does feel a safe place to work.”

“I really want to emphasise the safety aspect because the rising number of deaths in the community points to people with terminal illness putting off hospital treatment because they’re afraid. I want to say to them, please keep your appointments. Or if you’re worried something might be wrong, don’t put off contacting your GP. It’s so important that people don’t delay what could turn out to be life-saving treatment.”

“Despite all the challenges and the emotional toll my work can take, I still love what I do. Although my role can be very sad at times, it is nevertheless really rewarding as I know I make such a difference to people’s lives.”

St Luke’s Hospice Plymouth provides specialist palliative care to people with life threatening illnesses and support to their families and carers, in partnership with others. The care is not just medical and nursing but incorporates emotional, social and spiritual support as well.

We are always interested to hear from people with the knowledge, skills and motivation to help ensure that as St Luke’s evolves, we continue to make wise decisions that mean we can meet the challenges ahead, including reaching underrepresented groups who sometimes struggle to be heard.

Trustee, Charles Hackett, said: “Being a trustee at St Luke’s supports my personal development but more importantly allows me to use my skills to help, in some way, the community in which I live.”

Being a trustee with St Luke’s can be rewarding for many reasons, including a sense of making a difference with a well-respected charity that touches the lives of local families to gaining new experiences and forging new relationships. (For an insight into our recent work, take a look at our latest impact report.)

Fiona Field, who sits on the Organisational Risk and Audit Committee and chairs the Health & Safety Committee, said: “I give about one day per month on average, this is divided between being a member of the board, chairing the health and safety committee, visiting teams across St Luke’s and taking part in some of the fundraising activities. I have regularly attended the Open Gardens in the summertime, sold programmes on Plymouth Hoe at the Firework Championships and walked the Elmer Trail.

“I find the work interesting and rewarding and I am always proud to talk to others about the brilliant work that everyone at St Luke’s does for such a worthy cause. I am keen that the services St Luke’s offers continue to be of the highest quality possible for our patients and their families locally.”

For more information on getting involved, please contact us by e-mailing info@stlukes-hospice.org.uk

When your vital work caring for terminally ill people already takes its toll on you emotionally, how do you cope when it is made so much more challenging by the pandemic and its impact on not only the families St Luke’s serves, but the welfare of you and your own loved ones, too?

Selina Rogers and Becci Stafford are Healthcare Assistants (HCAs) with our End of Life Urgent Care Service, which runs seven days a week. In partnership with Marie Curie, it provides co-ordinated, bespoke end of life care and support to patients who need this at home during a time of crisis or change in their condition. The team’s remit extends across Plymouth and out as far as Salcombe, Tavistock and the moors, too.

As HCAs, Selina and Becci are central to the high-calibre care the team provides, ensuring our patients are as comfortable as possible – and their loved ones as at ease as possible – in the midst of very challenging circumstances. The ‘storm’ of the pandemic has meant that their sensitivity and compassion have been even more critical than ever, with the past few months seeing them pull out all the stops to remain the reassuring presence families desperately need, all while managing their own anxieties and concerns around COVID-19.

Selina said: “Helping to look after people who are dying is not an easy job, but we do it because we understand what a difference it makes to patients when their dignity is respected and they feel understood. We know how hard it is for their family members, too, who are often shouldering a lot of the caring responsibilities for the person who is terminally ill.

“That’s why we’ve been determined to maintain the outstanding service so many rely on, despite the many challenges of carrying out our work during the pandemic. As with NHS frontline staff, we’ve had to use all the necessary PPE and though we understand how essential it is, it has been very tough knowing patients can’t see our smiles, or feel the warmth of our hugs or the reassurance of our hand on their shoulder.

“It goes against our natures not to be tactile, so we’ve adapted by telling them when we’re smiling, and even saying to them, “It’s right now that I’d have given you a hug”, just to make sure they know how much we care.”

Even more difficult has been the shock of seeing their patients die much more quickly than in pre-pandemic times. Whereas normally patients live for up to around 40 days from the team’s initial visit, giving time for a comforting familiarity to build between them, many have sadly passed away within just one or two days.

Becci said: “It has felt really hard comprehend at times, especially seeing them looking reasonably healthy one day and finding out that sadly, they have died the next.

“We understand the reasons for this – many people have been getting referred to us much later than they normally would because of the difficulties they’ve had accessing their GP during lockdown, or deteriorating more rapidly due to the pandemic delaying their hospital treatment – but understanding it doesn’t take away the shock and sadness we feel.

“As a team we’ve all had to pull together more than ever to help each other through because every one of us has found it very hard-going.”

Of course, as well as their care and concern for their patients and the families around them, our clinical teams have also faced making tough personal sacrifices to reduce their own loved ones’ risk of contracting the virus.

Becci, who has young children, made the heart-wrenching decision to live separately from them for seven weeks, taking them to live with their father to help protect them while she cared for two patients diagnosed with COVID-19.

“I felt huge guilt in choosing to stay apart from my children, and although I knew it was the right thing to do, I struggled. It’s at times like that I appreciate the team around me even more. At various times, we’ve all been close to breaking point due to the fear of the virus, anxiety and fatigue, but we’ve got through by being there for one another, laughing and crying together. As a unit, we’re stronger than ever.”

Selina concurs: “It’s been an emotional rollercoaster, but we have so much empathy for each other and we’re like a family now. We’ve had superb leadership from Sharon Mayer throughout and all our nurses have been amazing, too. It gives you great faith in your team, knowing the resilience that’s been forged through what we’ve all been through.”

Listening to Becci and Selina, it’s clear from the emotion in their voices that they’ve been so tested in recent months yet remain completely dedicated to those in their care.

Becci said: “When a family thanks you for being alongside them from the very first visit to the last, saying how that continuity was made such a big difference to them, it’s incredibly fulfilling. It feels really special.”

In May, at the height of the pandemic, Dr Doug Hooper, Consultant in Palliative Medicine in the St Luke’s team at Derriford, shared how it felt to be ‘in the eye of the storm’ at the hospital, with this specialist team extending their work to support the hospital in caring for COVID-19 patients. Nearly two months on, with such admissions steadily decreasing, two of his colleagues – nurse Linzie Collins and Dr Roger Smith – explain how the experience has been for them, and how the team is adapting as it moves into this new phase.

Linzie, who joined the team in February 2019 after nursing patients at Turnchapel, said: “I think what’s been most remarkable is the way everyone – both in our team and across the wider hospital – has pulled together, supporting each other and quickly adapting to the huge amount of change that’s had to happen quickly due to the gravity of the pandemic.

“It’s been tough at times with new changes daily, sometimes even hourly, but what’s always been at the forefront of our minds is making sure we’ve all been as well equipped as possible to give our very best care to patients who are in their last weeks, days and hours of life.

“Not only did the hospital undergo a complete transformation, with many wards moved or designated as COVID-specific – and Oncology being temporarily relocated to the nearby Nuffield hospital to free up capacity – there was also the redeployment of many staff, including nurses from other specialities who were assigned to our team to help us cope with the anticipated surge in patients needing end of life care. Now that we’re seeing less people with the virus, they’ve been able to return to their usual roles.

“My work has included covering the COVID wards as well as looking after non-COVID patients, which has given me some low-level anxiety because I’m always aware of the risks involved, but it’s been so helpful that this responsibility is shared with my colleagues.

“What’s struck me is how positive and supportive everyone has been, despite the undeniable fatigue that set in coping with the crisis. We’ve all pulled together, and I especially want to thank St Luke’s Clinical Admin, who’ve continued to be a lifeline for us, handling calls and making sure things run smoothly, despite having to do all their work off-site at home.”

Linzie’s colleague Dr Roger Smith is working with St Luke’s as part of his training in palliative care.

He said: “Fortunately, Plymouth has not seen the very high number of COVID-19 cases some other cities have had, but we’ve seen a steady stream of people admitted to the hospital because of the virus, and this has been over a prolonged period. We’ve done really well as a team to manage it, thanks to excellent teamwork and the strong leadership we have, but I won’t deny it’s been challenging at times.

“Not only have we been working with the uncertainty the crisis has brought, it was difficult using the necessary PPE with FFP (filtering face-piece), which looks a bit like a gas mask and can feel hot and uncomfortable.

“Of course, there is the emotional side, too. We’ve been supporting relatives whose loved one is dying without them by their side. However, we’ve been grateful for technology such as phones and iPad screens that’s meant that at least some could maintain some sense of connection. Nonetheless, it’s been heart-breaking to see.

Looking ahead, Roger is uncertain as to what future weeks might bring, given the number of tourists and second-home owners expected in the region soon with lockdown restrictions easing.

He said: “While it is good to see a steady decline in cases, I think our popularity as a holiday destination could make us more vulnerable than some other areas, so we need to remain vigilant. We also need to be well prepared in case of a second wave of cases in the winter months, when traditionally NHS resources are already more stretched.”

Both Roger and Linzie are also concerned that currently at Nuffield they are already seeing an increased number of cancer patients who need palliative care.

Linzie said: “It seems some people are presenting later than they normally would, perhaps because they haven’t been able to access the treatment they need due to the pandemic or because of wanting to avoid what they regard as them placing ‘additional pressure’ on the NHS. We want to reiterate the NHS’s message that it’s vitally important you don’t put off seeking medical help if you’re concerned about your health, and that you don’t miss your appointments.

“The past few months have been emotionally and physically tough, but we will manage whatever lies ahead by making sure we look after ourselves and each other, including taking some much-needed annual leave to bolster our resilience.

“We’ll continue to be here for those who need us, and do whatever we can to make such a difficult time that little bit easier for them and their loved ones.”