To achieve its vision of delivering the highest quality holistic care for every patient and family it supports, Greenwich & Bexley Community Hospice works closely with other partner organisations, including Oxleas NHS Foundation Trust.

Together hospice staff and the community teams at Oxleas work tirelessly to ensure seamless nursing care is provided for people living with life-limiting illness in local communities across the two boroughs. Here Charlotte Steward, lead nurse for endof-life care (Greenwich) and Karen Smith, lead nurse for end-of-life care (Bexley) at Oxleas, explain how working in close collaboration with the hospice is paying dividends for patients, and their families.

When you work in the field of end-of-life nursing care only one thing is certain – that no two patients are the same.

Forging strong links between the organisations that provide this seamless care is crucial, especially when you’re dealing with complex cases. It’s definitely good to talk, and that’s exactly the approach that both the clinical teams at Greenwich & Bexley Community Hospice and the community nursing teams at Oxleas NHS Foundation Trust take.

Within Oxleas community service the two London boroughs are supported to develop their palliative and end of life care by Charlotte and Karen. Charlotte having joined the role in March 2021, and Karen started this April, both have extensive backgrounds in District Nursing.

There are six district nursing teams working in Bexley, and four in Greenwich, with additional ‘twilight’ team nurses who work from 5 to 11pm, and overnight cover in Bexley.

“To do the job you need empathy, compassion and to be a great listener, also to have a good knowledge basis and experience in end-of-life care,” Karen says. “The nurses don’t just care for patients but for their families as well. It is our district nurses who provide most symptom management and pain support, in conjunction with the hospice.”

Charlotte explains: “The relationships have always been good between our wider nursing team and the hospice community team. Good communication is key. Our district nurses can always call the hospice community nursing team with a specific question or for reassurance, and vice versa. The teams support each other.”

Both Oxleas and the hospice community nursing teams attend regular meetings with all local organisations involved with end-of-life care across the boroughs. This group, which is chaired by Graham Turner, Director of Care and Service Transformation at the Hospice, includes Queen Elizabeth Hospital, the local Clinical Commissioning Group, social services and GP leads for end-of-life care. Charlotte and Karen also hold regular meetings with the hospice’s hospital discharge coordinator about patients being discharged home.

“Managing all the different facets of a patient discharge can be tricky,” Karen reveals. “A few months ago, we had a lady who lived alone and had concerns about whether she would be well enough to call if there were changes in her symptoms”.

“But by working together we can ensure an appropriate care plan is in place”.

“All our patients are on different journeys when we meet them – but we’re led by what they want when we provide care at home, working together enables us to focus on what matters

most to them. Having the knowledge that the hospice community nurses can be easily contacted and provide support to us when it is needed is most reassuring”.

With both the hospice and Oxleas’ nurses working on the front line across Greenwich and Bexley during the pandemic, it’s fair to say that COVID strengthened the bond between them even further.

“It was challenging, and we were seeing an increase in patient numbers.” Karen says. “Emotionally it was a difficult time.”

“I remember seeing six patients back-toback who all needed syringe drivers in one day,” Charlotte says. “I’d not had that happen before, but with the support of the hospice nurses we were able to ensure seamless care to the patients.”

Working in partnership can also be beneficial when the nurses are confronted with a difficult situation.

“We had one young patient who was finding it difficult to accept how serious her diagnosis was. She couldn’t accept that she was dying,” Karen says. “Our nurses needed help and one of the hospice specialist nurses arranged a joint visit to support us with this difficult situation, as a result of our visit this lady was able to die at home, which was her wish.”

“When we’re all on the same page it empowers patients.” Charlotte concludes: “What matters most to each patient varies, and that’s why our care is so important, because it is organised around the person so they can have the best experience possible.”

“By working closely together as a team we can get people talking more about death and break down the taboo surrounding it.”

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