Consultants Message
South Tipperary Hospice Movement - Celebrating 25 years serving the community
by Dr. Emmet Walls
Change is a process that is variously defined but essentially means “to become different”. Whilst we in the home care team are now organized differently to when founded by the STHM, our core values and objectives remain constant and consistent with theirs. Our main objective continues to be to support people who have progressive life limiting illnesses so that they can lead as independent and productive a life as possible, regardless of their life expectancy. Over time this has expanded to include non cancer progressive life limiting illnesses. In addition, of course, we endeavour to support the person’s significant others.
Growth more aptly describes our development. From the very outset the STHM has been open and outward looking. They have nurtured extremely close working relationships with GPs, Caredoc, Public Health Nursing, the community based Allied Health Professionals, the Community Hospitals, Nursing Homes, the Acute Hospitals, the cancer society night nursing services, the Irish Hospice Foundation funded night nursing service for non cancer sufferers, many HSE managers / officials, and many more (an exhaustive roll call is off the point).
The National Clinical Programmes set up by the HSE, of which we are part, have consolidated and clearly defined what Specialist Palliative care services (the home care team) do, how we should do it and who we should do it for. As above, people of all ages with challenges arising from progressive life limiting illnesses, both cancer and non-cancer, are eligible to be considered for referral. People in the community can only be seen by us with the consent of their GP.
So then, for example, when that person’s GP in their current place of living or care (community or hospital) wants to refer them to us there is a clear “National referral Form” that supports a standard in information transfer. Obviously, in urgent cases, the relevant information is shared over the phone in the first instance. People are then seen in their own homes or community inpatient units by the Clinical Nurse Specialists (CNSs) / home care nurses of the STHM. Sometimes people have already been seen by other branches of our service in, for instance: South Tipperary General Hospital (STGH) or University Hospital Waterford (UHW) and the home care team will be aware of them and their needs in advance of their discharge. As we are fully integrated with all the Specialist Palliative Care services in the Southeast the home care team communicates very closely with the hospital services as patients are admitted there, seen in OPDs or day wards and at the time of their discharge to the community.
People are generally seen at a time when they are not well and / or have other challenges arising from their illness. Some people are discharged from the home care team when these challenges are adequately resolved. Others need our support lifelong.
When a person is referred to us we gather all the information relevant to their case (in addition to the referral form) from the services that have been involved in their care thus far. We stay in very close contact with these services, as appropriate, ensuring through our care that the care provided by these services is also optimized (e.g. Oncology / Neurology / Cardiology…).
Obviously the person’s GP is the central doctor throughout. The CNSs discuss the people they attend with the GP. An ongoing major resource to people under the care of our service is the availability of the home care (CNS) team to them 24/7, 365(6). The nurses in turn have “all times” access to the Consultant in Palliative medicine 24/7, 365(6). All clinical records are now computerised providing ready access for all the nursing team at all times. Once weekly the entire CNS team on duty and the CNSs from STGH meet with the Consultant in Palliative Medicine and the Occupational Therapist (OT) to review all the cases under their care. This is our Multidisciplinary Team (MDT).
So there is a constant collaborative flow of communication within the MDT and between it and the other health services caring for the person. Collaboration with GPs, PHNs, the hospitals and the many others alluded to already is central and crucial to getting the best out of us all for those who need us. In the course of a person’s illness then, they can frequently arrive into circumstances where they need to be reviewed in hospital or the community by any or all of these professionals.
As yet we don’t have a social worker on our MDT and rely heavily on the CNSs to fill this position which they endeavour to do with determined commitment. This is particularly evident in the bereavement support they provide.
Of particular mention are the hospice “Support Beds” in St. Bridget’s in Carrick, Clogheen and Cluann Arann. The facilities, skills and outright professional generosity of these services are a source of great pride to us by association.
Various members of our team are involved in teaching all grades of nurses and doctors both undergraduate and postgraduate. Team members have completed or are currently completing Masters Degrees in Palliative Medicine / Care whilst others are supervising these or other research projects with their students. In undergraduate medicine we are affiliated with the Royal College of Surgeons and University College Cork. In undergraduate nursing we are affiliated with the WIT BSc nursing degree course. In postgraduate medical training we are an integral part of the national training programme for Consultants in Palliative medicine with the Royal College of Physicians in Ireland and the regional training programme for General Practitioners. We have team members involved nationally working on standards and developments with various national bodies.
As a team and individual professionals we are committed to our own learning and development attending regional, national and international meetings and conferences as appropriate. The Nurses on the home care team receive “clinical supervision” which is directed at promoting their professional wellbeing enabling them to continue to provide people with the highest quality of care.
The Future requires that we develop our skills and MDT. Other disciplines: designated social work, physiotherapy and others will need to be added / resourced.
The model of “support beds” does need to be grown further and replicated in Clonmel town, at the least, for local people.
Technological advances in electronic communication e.g. with secure email to GPs is already far advanced. These and associated advances will enhance our connectivity with all the services caring for the person as that person is the centre of it all.
The Specialist palliative Care Unit in UHW will, at times, be a crucial “port in the storm” for our patients. It will allow us to get timely regional specialist assessments and interventions for them so that they can “lead as independent and productive a life as possible, regardless of their life expectancy” back at home with us in support.
The HSE part funds some of the CNS’s posts and fully funds the Consultant and OT post. In addition the HSE has embraced the integration of our service into their regional and national clinical frameworks, with all that entails.
It does continue to be the case that the vast majority of the funding required to deliver this service is received directly from you, our community, through your charitable ventures and donations. Whilst this is a burden for you there are benefits. For example: you can block the reduction of services, you can highlight and expeditiously grant aid further service developments, as you have done, with every single advance and growth initiative thus far.
Growth more aptly describes our development. From the very outset the STHM has been open and outward looking. They have nurtured extremely close working relationships with GPs, Caredoc, Public Health Nursing, the community based Allied Health Professionals, the Community Hospitals, Nursing Homes, the Acute Hospitals, the cancer society night nursing services, the Irish Hospice Foundation funded night nursing service for non cancer sufferers, many HSE managers / officials, and many more (an exhaustive roll call is off the point).
The National Clinical Programmes set up by the HSE, of which we are part, have consolidated and clearly defined what Specialist Palliative care services (the home care team) do, how we should do it and who we should do it for. As above, people of all ages with challenges arising from progressive life limiting illnesses, both cancer and non-cancer, are eligible to be considered for referral. People in the community can only be seen by us with the consent of their GP.
So then, for example, when that person’s GP in their current place of living or care (community or hospital) wants to refer them to us there is a clear “National referral Form” that supports a standard in information transfer. Obviously, in urgent cases, the relevant information is shared over the phone in the first instance. People are then seen in their own homes or community inpatient units by the Clinical Nurse Specialists (CNSs) / home care nurses of the STHM. Sometimes people have already been seen by other branches of our service in, for instance: South Tipperary General Hospital (STGH) or University Hospital Waterford (UHW) and the home care team will be aware of them and their needs in advance of their discharge. As we are fully integrated with all the Specialist Palliative Care services in the Southeast the home care team communicates very closely with the hospital services as patients are admitted there, seen in OPDs or day wards and at the time of their discharge to the community.
People are generally seen at a time when they are not well and / or have other challenges arising from their illness. Some people are discharged from the home care team when these challenges are adequately resolved. Others need our support lifelong.
When a person is referred to us we gather all the information relevant to their case (in addition to the referral form) from the services that have been involved in their care thus far. We stay in very close contact with these services, as appropriate, ensuring through our care that the care provided by these services is also optimized (e.g. Oncology / Neurology / Cardiology…).
Obviously the person’s GP is the central doctor throughout. The CNSs discuss the people they attend with the GP. An ongoing major resource to people under the care of our service is the availability of the home care (CNS) team to them 24/7, 365(6). The nurses in turn have “all times” access to the Consultant in Palliative medicine 24/7, 365(6). All clinical records are now computerised providing ready access for all the nursing team at all times. Once weekly the entire CNS team on duty and the CNSs from STGH meet with the Consultant in Palliative Medicine and the Occupational Therapist (OT) to review all the cases under their care. This is our Multidisciplinary Team (MDT).
So there is a constant collaborative flow of communication within the MDT and between it and the other health services caring for the person. Collaboration with GPs, PHNs, the hospitals and the many others alluded to already is central and crucial to getting the best out of us all for those who need us. In the course of a person’s illness then, they can frequently arrive into circumstances where they need to be reviewed in hospital or the community by any or all of these professionals.
As yet we don’t have a social worker on our MDT and rely heavily on the CNSs to fill this position which they endeavour to do with determined commitment. This is particularly evident in the bereavement support they provide.
Of particular mention are the hospice “Support Beds” in St. Bridget’s in Carrick, Clogheen and Cluann Arann. The facilities, skills and outright professional generosity of these services are a source of great pride to us by association.
Various members of our team are involved in teaching all grades of nurses and doctors both undergraduate and postgraduate. Team members have completed or are currently completing Masters Degrees in Palliative Medicine / Care whilst others are supervising these or other research projects with their students. In undergraduate medicine we are affiliated with the Royal College of Surgeons and University College Cork. In undergraduate nursing we are affiliated with the WIT BSc nursing degree course. In postgraduate medical training we are an integral part of the national training programme for Consultants in Palliative medicine with the Royal College of Physicians in Ireland and the regional training programme for General Practitioners. We have team members involved nationally working on standards and developments with various national bodies.
As a team and individual professionals we are committed to our own learning and development attending regional, national and international meetings and conferences as appropriate. The Nurses on the home care team receive “clinical supervision” which is directed at promoting their professional wellbeing enabling them to continue to provide people with the highest quality of care.
The Future requires that we develop our skills and MDT. Other disciplines: designated social work, physiotherapy and others will need to be added / resourced.
The model of “support beds” does need to be grown further and replicated in Clonmel town, at the least, for local people.
Technological advances in electronic communication e.g. with secure email to GPs is already far advanced. These and associated advances will enhance our connectivity with all the services caring for the person as that person is the centre of it all.
The Specialist palliative Care Unit in UHW will, at times, be a crucial “port in the storm” for our patients. It will allow us to get timely regional specialist assessments and interventions for them so that they can “lead as independent and productive a life as possible, regardless of their life expectancy” back at home with us in support.
The HSE part funds some of the CNS’s posts and fully funds the Consultant and OT post. In addition the HSE has embraced the integration of our service into their regional and national clinical frameworks, with all that entails.
It does continue to be the case that the vast majority of the funding required to deliver this service is received directly from you, our community, through your charitable ventures and donations. Whilst this is a burden for you there are benefits. For example: you can block the reduction of services, you can highlight and expeditiously grant aid further service developments, as you have done, with every single advance and growth initiative thus far.