Published on: 19 May 2023

Whilst there’s been plenty on, there’s one subject which has really stood out for me amidst the noise this week and that’s the quality of our community services.

It is fair to say colleagues across all parts of our Community and Intermediate Care (CIC) division are highly regarded, rated officially as ‘good’ with elements of ‘outstanding’ by the health regulator the Care Quality Commission (CQC).

This is itself a source of great pride for East Lancashire Hospitals – for the division and its leadership, for myself and the Trust Board and for colleagues across the Trust and in the wider health and social care system, who rely on these teams every day.

We talk a lot about the acute hospital sites and how busy departments are, of course, and especially our ‘front door’ for patients and concerned families which is A&E. The team there do great work under very visible and pressured conditions – with hundreds of people attending for treatment every day. 

In fact, this is probably a good moment to mention that May so far is shaping up to be our busiest month for the number of people attending A&E ever, in the history of the hospital. That’s quite something to recognise and I will emphasise, again, that this kind of sustained demand cannot be underestimated. I know the team is flat out trying to help patients and support each other in very difficult circumstances indeed.

The truth is though, that whilst people see and hear how busy our emergency department or urgent care centres are, managing them effectively is a team effort. If A&E is busy you can bet your house on the fact that all wards, across all hospitals, and all teams, across all settings, are flat out too. 

Working together is the only way we can keep it all moving effectively, discharging those who are ready to leave and making room for those who need to be admitted. It’s a constant balance and battle, every day and night.

Of all the NHS organisations I have worked in, over a fairly long career, ELHT recognises this the most in my opinion and works together to get what needs to be done, done. I will never stop saying thank you to the amazing team of people I have around me for that – and I mean every single person who contributes to the whole.

But all this scene setting and context is designed to bring me back to community services and the importance of them to our performance – which I think can feel unseen or invisible because of the nature of the work, often in people’s own homes.
On Tuesday I was fortunate to hear from the team about an area they have been making tremendous improvements to and in their own preamble they shared some eye watering figures about the number of people they support across all of East Lancashire.

A total of around 300,000 patients are seen each year through our District Nursing Teams and they are in contact with around 26,000 people every month. An incredible number of people – each important in their own right – to manage and support. It is an amazing contribution that I want to share and recognise.

What really struck me though as I was listening to the team was the number of people they look after at the end of their lives.

Now, I know talking about dying might not be the most upbeat topic for a Friday afternoon, but let’s be honest it’s really, really important for us to get right and I am genuinely pleased that we are talking about the last few days of someone’s life more and more.

To this point, I want to quote our Executive Medical Director and consultant urologist Jawad Husain who I thought captured it perfectly as part of the discussion when he said: “A good life should end with a good death.” I agree completely and whilst it might once have been more taboo, we should talk openly about this with our patients and their families.

This is something our district nurses do on a regular basis, as they support around 80 patients a month to die in the way they want to wherever it is possible to do so. This might be in hospital, in a hospice if they prefer or, more often, in the comfort and familiar surroundings of their own bed with family and loved ones by their side.

The district nursing team who, together with our Specialist Palliative Care Team, oversee our ‘outstanding’ community end of life service are taking it even further now. For example, they might ask what position people are comfortable in or what their favourite food or drink was so that they can factor that into the last moments of their care.

I was moved by the observation from one member of the team that she, herself, didn’t like to sleep on her left side and therefore would always rather be made comfortable on her right. She also shared how patients and their families had toasted the lives of their loved one with a glass of prosecco in their final moments and how this taste had been added to their mouthcare routine so that they could be part of it.

To Jawad’s comment, this feels like the epitome of a ‘good death’ if there is one.

That’s the type of attention to detail that people remember for a lifetime when they lose someone and we have to acknowledge that when people pass in less well managed situations, there are scars that often never heal.

I speak for everyone at ELHT when I say we want to avoid that where we can and I do so whilst recalling those very recent and heart-breaking memories made during the pandemic, when many, many families were prevented from being with their loved ones at the end. 

So, I mean it when I say, this type of stuff might seem small and straight forward, but it’s not and we must recognise that the Trust is at the forefront of developing new pathways – in hospital as well as in our community services – to provide as much choice, dignity and support when patients are at the end of their life.

This was played back to me yesterday during a ‘board to board’ session between the Trust and colleagues from the Lancashire and South Cumbria Integrated Care Board, who clearly recognised the strength and impact of our community services for people in East Lancashire.

It was also absolutely writ large in some feedback I shared with colleagues earlier this week, from a long-serving member of the corporate team who had experienced our services for herself sadly when her mum was ill.

She said: “The care mum received from when she arrived via ambulance until she passed away was exemplary. I have worked at the Trust for 25 years and have always felt part of the family at ELHT and proud to work and be part of the team – but events of the last month have really reaffirmed this. We are totally aware of all the staff we did not have contact with but assisted with the journey we received, such as domestics, the catering and housekeeping teams, reception staff on the wards, laundry, pharmacy, support staff in all corporate areas – I feel nervous listing as I am sure I have forgotten many. Without their input – this effective process would not happen.”

This captures the spirit of ELHT perfectly for me and I will say nothing further for fear of dulling its impact. Perhaps not quite the depressing topic I thought for a Friday afternoon in the end. 

Have a great weekend if you’re not working – and thanks to everyone who is doing a shift wherever that might be – in the Trust or elsewhere in our community. 

Remember you are valued and appreciated – and you’re doing a great job – even if sometimes you feel unseen.