Palliative care at home 

This video follows Liz Clements, a palliative community care matron, during a typical working day. Clements is part of a special end-of-life care service in Oxfordshire. The service looks after people who would like to be cared for at home rather than in a care home or hospital. It also provides support for their families. Note: Oxfordshire PCT ceased to exist in 2013. The programme is now run by the Oxfordshire Clinical Commissioning Group.

The end of life care guide

Transcript of Palliative care at home

(man) Liz Clements' job is to help people

when they decide they want to die at home.

We're going to see a patient who lives the other side of Oxford.

(man) It's a pioneering new role

that's transformed end-of-life care for patients here in Oxfordshire.

The PCT and Sue Ryder developed the idea

in response to requests from terminally ill patients and their families.

The service covers all conditions for which palliative care may be necessary.

(sat nav giving instructions)

Hello?

So how have you been, Chris?

Sickness. Well, not...

(man) Liz is a palliative care community matron.

Christine Boundy was diagnosed with a chronic obstructive pulmonary disorder

four years ago.

Liz has made it possible for her to be cared for at home.

When someone comes to the last stages, they're dying,

there's quite a lot involved in the way of support,

in the way of maybe nursing input, care of the family,

who may be feeling quite frightened.

The patient may be quite frightened, they may have complex needs.

- You have lost some. - Yes.

It's so much better. It's informal, you're in the comfort of your own home.

You feel more at home and you're not taking up the beds.

(man) Liz's advanced training allows her to prescribe medicines on the spot.

When Liz goes into the house, if a patient is in pain

and there isn't appropriate medicine,

Liz can examine that patient with her expertise

and can prescribe the medicines which can be obtained there and then

from the local pharmacy.

It cuts that waiting time, it stops the patient suffering.

(man) She also teaches patients how to use the medicines,

such as antibiotics, themselves.

If I start some symptoms, which I know are the start of a chest infection,

I take the antibiotics and usually it knocks it out

and I have no need to go to the hospital.

And I feel happier and obviously I get better quicker.

- Bye. - Bye.

Sometimes it's the last wish a person has, where they can die,

and the majority of people, research indicates, would like to die at home,

and actually we don't achieve that.

So one of the drivers for the role

was to improve the numbers of patients being able to achieve what they wanted.

(man) When a patient expresses the desire to die at home,

the hospital will call on Liz.

I want to talk about the family. They're keen to have him home.

Obviously it's going to need to be a big input from you guys.

- Does he want to go home? - Yes. The wife's very happy...

If they want to get out quickly

because they're really poorly and want to go home to die,

I will look at the equipment needed, I will look at the funding we need,

the care we need, the medication that's needed, and really drive that.

(man) Typical of those Liz helps is Penny Jarvis.

Her husband Colin died two years ago.

(Liz) I remember that day,

we were both gowned up, doing a mini surgical operation...

(Penny) I can remember, in my lounge, Dr Paul going for it.

(Liz) How are the girls, Penny?

They've not been too bad, actually.

They are piecing their lives back together.

(man) Penny's husband was initially in hospital

but he was desperate to go home.

Everything about him, he just went downhill.

His attitude, his mood, everything was, "I don't want to be here."

(man) Sue Ryder had already referred Liz to the family

and she arranged for Colin to come home.

We got home and he was just so elated to come in.

The kids were here and it was like,

"This is my surroundings, this is where I should be."

By this time Liz was coming every day then,

she was coming in to see us every single day without fail.

I don't know what I'd have done without her

because she was there, she was my rock.

(Liz) It was what he wanted and Penny was able to achieve that last wish.

She'll remember forever the fact that, however awful it was that Colin died,

he died where he wanted to,

at home, with Penny, with the children round him.

(man) The family have made a memorial to their husband and father in the garden.

The reason for setting this service up

is the huge benefit it provides for patients and families.

It's a better use of NHS money too.

It's estimated that the service saves �60,000 in a single year.

That's lovely, Penny.

(indistinct dialogue)

(man) It's a highly successful example of local innovation.

It's been fabulous for us and we would like to see it replicated nationally.

It's a huge benefit because the person who really benefits is the patient.

Look, Colin, it's Liz. Look at her, she's still around.

She's just come to say hi.

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Care at home

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