When Pembridge inpatient unit was suspended in 2019 NW London committed to completion of the review prior to any decisions were made on the future of this unit. It is regrettable that the period of time where we have focused on Covid response and recovery has impacted on the timeline for completing this work. Whilst acknowledging the local frustrations on the lack of clarity for the future, we remain committed to do this review properly so there is a clear process and transparency on next steps.
Pembridge Palliative Care services during Covid pandemic waves one and two
As part of a system response to support Covid-19 patients the Pembridge inpatient beds were designated to support the rehabilitation and care of Covid positive patients.
- During the first wave the inpatient unit was opened on 20 April 2020 and closed again on 30 July 2020.
- During the second wave the inpatient unit was opened on 16 November 2020 and closed on 26 March 2021.
Other service elements of the Pembridge Palliative Care Services were operating as follows:
- The community specialist palliative care team continued to offer a 7 day a week service running 8.30am to 5pm Monday to Friday, 9am to 5pm Saturday, Sunday and Bank holidays. The community team were prioritising patients with uncontrolled complex symptoms that have not responded to previous treatments, and actively dying patients with no previous plan of care in place.
- 24/7 advice line including specialist palliative care consultant support.
- Day hospice and patient attendances to the hospice were suspended. Patients known to the service were receiving telephone advice and support from the clinical team.
- The social work and bereavement team suspended visiting and outpatient sessions, but continued to operate, receiving new referrals and providing telephone advice and support.
- The Pembridge teams moved to video conferencing services where possible to further support patient care.
Pembridge Palliative Care service now
The Pembridge Palliative Care Services inpatient unit remains suspended, but the following other services elements continue to be provided:
- Community specialist palliative care nursing team, seven days a week visiting service 8.30am - 5pm Monday to Friday, 9-5 weekends (Saturday and Sunday) and Bank Holidays;
- 24/7 advice line including palliative care consultant support
- Rehabilitation team support -visiting and virtual from Occupational Therapist (OT), Physiotherapist (PT) and Rehabilitation Assistant five days a week (Monday – Friday);
- Social work and bereavement support, five days’ week (Monday –Friday);
- Day Hospice Services Monday – Friday during Covid as many of these services as possible were offered virtually.
NW London ICS End of Life programme team monitors the number of patients who would have been eligible for inpatient care at Pembridge and instead are supported in a different unit. During 21/22 (extrapolated from nine month’s data) this was 25 patients. Largely, these patients receive care at St John’s Hospice which is part of the St John and St Elizabeth’s Hospital and located in St Johns Wood, with a much smaller number at Royal Trinity Hospice. Further work needs to be undertaken to understand if the service closure has resulted in a fall in the number of patients accessing inpatient beds, as well as the impact of Covid-19 across all hospices as a whole.
Over the recent Covid outbreaks our NW London hospices and other community specialist palliative care services have shown considerable flexibility and joint working to provide system support, such as flexing criteria to support discharges. We have consistently had capacity in NW London hospices (with the exception of a short period during the recent Omicron variant where staff sickness impacted across health and social care services).
In July 2021 prior to relaunching this North West London wide review of community – based specialist palliative care, a number of palliative medicine consultant vacancies arose across three of our palliative care providers, including Pembridge Palliative Care Service, St John’s Hospice and Imperial College Healthcare NHS Trust (ICHT). We undertook project work with these providers to review the service requirements for their consultants and how these might be met through new models of consultant service delivery for specialist palliative medicine within community, hospice and hospital domains to ensure a more resilient and sustainable workforce collaboratively. As part of this work we looked to identify if there was, two years on any other potential solutions to the Pembridge consultant workforce challenge to support safe running of the inpatient unit.
Through this work we engaged with a number of NHS Trusts and hospices, both inside and outside of North West London on their consultant models. We learnt that flexibility, rotation between care domains, career progression, being part of clinical network and organizational culture are all important in attracting and retaining consultants. It was also noted that across London and nationally there are palliative care consultant workforce vacancies and shortages, with many organisation struggling to fill and retain these posts.
Despite substantial input from all partners on this work, at that time we could not identify any collaborative solutions that did not destabilise one service to stabilise another. The outcome was that each organisations proceeds to recruit independently to the posts, as the solution would need more dynamic transformation work to address the palliative care workforce challenge, which is not just synonymous to these three organisations. This issue would therefore best be addressed within the North West London wide Community-based specialist palliative care review programme and development of a new model of care, including palliative care workforce.
We reiterate that no decision has been taken on the long-term role of Pembridge and as part of this review the important function that is inpatient palliative care will be addressed. We also recognise the impact this has on individuals and families of those who need to use alternative services elsewhere.