Q. Can you tell me about the LAS end-of-life pioneer service?
A. Last year, London Ambulance Service brought in three new Macmillan Cancer Support-funded posts, aimed at helping to educate ambulance service staff in end-of-life care. Macmillan has invested £467 400 in funding over a 2-year period, to enable the ambulance service to recruit three new roles, including a Macmillan Paramedic Programme Lead, which will support ambulance teams working with terminally ill patients, ensuring their wishes are respected, and unnecessary and distressing admissions to emergency departments are avoided.
Q. What is the ambulance clinician's role in end-of-life care?
A. Palliative and end-of-life care has traditionally not been part of the role of paramedics and other ambulance clinicians. As an emergency service, our traditional training has focused upon immediate medical interventions and the preservation of life. Considering those patients who may be more appropriate for palliative treatment is a shift in both our education and culture. Our programme aims to improve the decision-making skills and confidence of clinicians in ambulances and in our control room in end-of-life care.
Q. What training and education are required as part of the programme?
A. Macmillan supporting this programme allows us to explore the self-identified gaps in London Ambulance Service staff knowledge and skills, as well as practical and welfare issues, that arise when caring for this patient group. The education provided includes how to manage symptoms in patients nearing the end of life including pain and breathlessness as well as supporting families and having difficult conversations. This information, along with involvement from patients and carers, will allow us as a team to develop sustainable initiatives to improve the care and services provided to palliative and end-of-life care patients across London.
Q. How does having the end-of-life strand of the service at LAS impact the patient's experience?
A. In collaboration with palliative care specialists and teams, this will enable us to provide the most appropriate response and care that meets each individual's needs. Macmillan will also work with other healthcare, third-sector and social care providers and patient representatives throughout the capital to ensure patients' care plans are linked into the system, so their wishes can be respected throughout the process.
Support from Macmillan allows us to develop a wide-ranging programme which will benefit our patients and their relatives in every area of London. We also want to support our staff, both professionally and personally, when affected by cancer situations.
Q. Anything you would like to add?
A. Macmillan and the London Ambulance Service are committed to giving every patient the best care and support at the end of life, ensuring they are treated with compassion and respect.
With a greater understanding of end-of-life care needs, we believe that ambulance clinicians will be better enabled to offer the care and support that patients need, and potentially avoid unnecessary and distressing emergency visits. Additionally, we can reduce some of the pressure on the overstretched emergency departments.
Although Macmillan has launched local ambulance partnerships in the South West and North East of England with similar roles designed to upskill the paramedic workforce, this partnership is a first for the capital.
London Ambulance Service is the busiest emergency ambulance service in the country, with Londoners facing a higher number of emergency hospital admissions in the final 90 days of their life, compared with the England average. We have a large and growing population, and anything we can do to alleviate pressure on busy emergency departments by providing high-quality home care where possible has the potential to deliver a huge benefit.
Combining Macmillan's expertise with the London Ambulance Service workforce will have an impact on people when they need it most. Macmillan wants everyone approaching the end of their lives to receive personalised care, be comfortable, and have their pain controlled no matter where they are being looked after, and has called on the Government and local health leaders to make end-of-life care a priority. An estimated 347 000 people will be living with cancer in London by 2030—this is greater than the population of Cardiff— and one in two of us will be diagnosed with cancer during our lifetimes.