In this blog, taken from the RCP Cymru Wales report, Cancer at the front door, Dr Gwenllian Mair Davies, clinical lead for palliative medicine in Swansea, Dr Gemma Lewis-Williams, co-clinical director for palliative medicine in north Wales, and Dr Idris Baker, national clinical lead for palliative and end of life care discuss how specialist palliative care can work more closely with acute oncology services to improve patient experience and end-of-life care.
Specialist palliative care should be part of every acute oncology (AOS) team: a lot of AOS patients sit across both services, especially malignancy of unknown origin (MUO) patients, many of whom are essentially palliative from diagnosis. In fact, many palliative care teams were often doing something that looked a little bit like acute oncology before acute oncology had ever been thought of, and the AOS service in Swansea was partly modelled on what we’d been trying to do with palliative medicine in the acute hospitals.
For a small specialty, our national network is strong. There is a palliative and end-of-life care national clinical lead and a pan-Wales implementation group. Because palliative medicine is connected with almost every specialty, it’s difficult to organise structured engagement with any one area of medicine. Palliative medicine is not just about cancer: clinically, more patients have palliative care needs that don't have cancer than the ones that do, and we don’t always meet those patients’ needs because we struggle with staffing and resource.
We need to help more people understand what acute oncology is. It causes a lot of confusion, especially when the service is not staffed properly so you can’t rely on having cover every day of the week. Agreeing a standardised model of care will be helpful in achieving parity of care everywhere. A hub and spoke model might work as long as the outreach is strong enough and it’s clinically led.
At a national level, we've had years of underinvestment in the NHS and it's really showing now. We need updated facilities, more beds, more staff, better social care. We've got a situation that's just not working, but everybody's trying their best. Basically, we need huge capital investment. At a local level, we need health boards to recognise that end-of-life care should be a key priority for investment, and better health economics support with data collection, audit and quality improvement projects. How can we show that we’re providing value-based healthcare without the data analysis to back it up?
We need to get better at asking what will make a real difference to the outcomes and experience of a patient and their family. AOS should be about improving patient experience. How can palliative medicine and AOS come together to agree the outcomes we should be measuring? We have a growing workforce crisis in palliative medicine, but with better data, we could make more informed decisions and better use of the limited number of staff we have.
Palliative medicine goes where the patients are. It’s the outlying hospitals, the community patients, they are the ones who AOS needs to reach. Around a quarter of acute hospital beds are occupied by people who have some sort of cancer-related problem, and a lot of those admissions might have been avoided with more proactive AOS community care. Closer working between AOS and specialist palliative care teams in acute hospitals is so valuable: it should be embedded in the design of acute oncology services.
Dr Gwenllian Mair Davies
Clinical lead for palliative medicine
Swansea Bay University Health Board (UHB)
Dr Gemma Lewis-Williams
Co-clinical director for palliative medicine
Betsi Cadwaladr UHB
Dr Idris Baker
National clinical lead for palliative and end of life care
Swansea Bay UHB