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Palliative Care

In this section we focus on palliative care services in North Wales and sources of local help and support for palliative care patients. More detailed information about palliative care can be found on websites such as Macmillan Cancer Support and Cancer Research UK.

As a Forum, we are aware that patients and carers are often unsure of the meaning of ‘palliative care’.

Palliative care is the relief of pain and other symptoms experienced in serious illness. The aim is to improve quality of life by increasing comfort, promoting dignity and providing a support system to the person who is ill and those close to them.

Palliative care can play an important part of the total care received by patients, families and carers, at a variety of points throughout the cancer pathway. It may be provided from diagnosis, alongside other treatments, and through to end of life care. However, your illness doesn’t have to be ‘terminal’ for you to qualify for palliative care.

General palliative care refers to the day-to-day care and support of patients and their carers and may be provided by the community district nursing service, community hospitals and in general hospital wards.

Specialist palliative care is provided by consultant palliative doctors, palliative care nurse specialists, and other clinical specialists and may be given in partnership with local Hospices, day centres, hospital or community teams and via telephone advice services. All these services work closely together to meet the often complex needs of patients and their families.

 

Specialist Palliative Care Teams

Specialist Palliative Care Teams provide specialist support, care and advice to people with serious illness, their families and carers. They provide advice on pain and symptom management and emotional support. The team will include specialist doctors, nurses (sometimes known as Macmillan Nurses), and other clinical specialists. They provide care in both the Hospital and in the home.

There are three specialist palliative care teams in North Wales. They work 7 days per week, 9.00am – 5.00pm and can also be contacted through the local out of hours services The type of support offered by the specialist teams includes:

  • Support, advice and information for patients and their carers
  • Advice on control of symptoms such as pain, breathlessness, nausea and vomiting
  • Emotional, psychological, social and spiritual support
  • Advice on maximising and maintaining independence and quality of life
  • Support and guidance on decision making regarding your care and where it takes place, including care at the end of your life
  • Signposting to other sources of support

In some areas the team includes specialist physiotherapists and occupational therapists who will help patients to manage difficult symptoms and any practical difficulties that might be experienced as part of daily living at home.

The specialist palliative care team will not routinely provide ‘hands-on’ nursing care.

Referrals to these services are usually made by a member of your healthcare team but it’s also possible for patients themselves to request self referral by contacting the specialist palliative care team directly.

Contact details and information for services in your local area are listed below:

North West Wales (Môn, Arfon, Dwyfor & Meirionnydd)
Bodfan, Eryri Hospital,
Caernarfon,
Gwynedd
LL55 2YE
01286 662775 or 01286 6627756

Central North Wales (Conwy & Denbighshire)
North Wales Cancer Treatment Centre,
Ysbyty Glan Clywd,
Bodelwyddan,
Denbighshire
LL18 5UJ
01745 448720 Ext 7690

North East Wales (Wrexham and Flintshire, bordering with Chester)
Ty Madoc,
Wrexham Maelor Hospital,
Wrexham
LL13 7TD
01978 727177

Drop-in Services

North Wales has two ‘drop-in’ services for palliative care patients. No appointment is needed, although it may be useful to contact the Hospital before attending.

Deeside Community Hospital Palliative Care Drop-in Service
Day Hospital,
Deeside Community Hospital,
Plough Lane,
Higher Shotton,
Deeside
CH5 1XS
01244 834907 or 01244 830461 (ask for Day Hospital)

The palliative care drop-in service at Deeside Community Hospital runs every Thursday, 4.00pm – 8.00pm. Patients and their relatives / carers can refer themselves by just ‘dropping in’ in the first instance. Suitability to re-attend can then be discussed with the Nurse.

The following facilities can be accessed:

  • One to one assessment, treatment, information, support and advice from a specialist palliative care nurse
  • Advice on symptom control.
  • Emotional support.
  • Practical and financial advice.
  • Support for relatives coping with the situation.

Mold Community Hospital Palliative Care Day Group
Day Hospital,
Mold Community Hospital,
Ash Grove,
Mold
CH7 1XG
01352 706704

The Mold Community Hospital Palliative Care Day Group runs every:
Tuesday (9.30am – 1.30pm)
Wednesday (9.30am – 3.30pm)

It is a palliative care day service offering a wide range of facilities and treatments to local people with life limiting illness and their families. Patients can self refer or be referred by a member of their healthcare team. Facilities include:

  • Assessment of needs.
  • Nursing treatment.
  • Physiotherapy (Wednesday only)
  • Occupational Therapy.
  • Speech and Language Therapy.
  • Relaxation.
  • Access to the Macmillan Specialist Palliative Care Team.
  • Pain and symptom control.
  • Psychological and emotional support.
  • Spiritual support.

Lunch is also provided at 12.00 mid-day.

Hospice at Home Services

Hospice at home services provide dedicated day or night palliative nursing care, support and advice to enable patients and their families and carers to be cared for in their own home for as long as they wish. These services work closely with the other services mentioned in this section.

The hospice at home services are available in North West and North East Wales. Further details are set out below:

hospiceathomeGwynedd Hospice at Home (Gwynedd and Môn)
Gwynedd Hospice at Home Charity,
Bodfan,
Eryri Hospital,
Caernarfon,
Gwynedd
LL55 2YE
01286 662 772

The Gwynedd Hospice at Home service is a community focussed charity supported by public and voluntary donations. The service is based at Bodfan, Eryri Hospital and works in close partnership with the specialist palliative care team. It aims to deliver a high quality, accessible community palliative care nursing service, offering:

  • Nursing care and advice to patients and their families / carers
  • Psychological support and advice
  • Symptom management
  • Support to enable discharge from hospital, where the patient has expressed a desire to die in their own home
  • Support in partnership with other agencies during times of crisis for the patient and / or their family / carer
  • A Day Care Nursing Team working in the Hafan Menai Day Hospice provides direct nursing care to patients in a homely and caring environment

North East Wales Hospice at Home (Wrexham and Flintshire)
Ty Madoc,
Wrexham Maelor Hospital,
Betsi Cadwaladr University Health Board
Croesnewydd Road,
Wrexham,
LL13 7TD
01978 727 177

The Hospice at Home Service in Wrexham and Flintshire works in close partnership with the local specialist palliative care team. It aims to provide high quality, accessible day and night community palliative nursing care, support and advice to patients and their families, in the last months/weeks and days of life, enabling patients to die in a place of their choosing.

The service is led by an experienced Palliative Care Nurse and nursing care is provided by Health Care Assistants who are specially trained in palliative care.

Referrals can be made by any healthcare professional but must be supported by the patient’s GP and District Nurse. The hospice at home service offers:

  • A combination of psychological and practical support, nursing care and advice, which is supplementary and complementary to the existing community services.
  • Support to enable the rapid discharge home from hospital of patients who wish to die in their own home.
  • Support in partnership with other agencies during times of crisis of either the patient or their carer.
  • Support to reduce the likelihood of untimely or unnecessary admission of dying patients to acute hospitals through the provision of care, advice and support to patients and their families/carers.

Hospices

Hospice care helps those with an incurable illness to focus on making the most of whatever time is left. Support is also offered to those close to the patient, and many hospices offer bereavement support.

Hospices are no longer just for the last days of life and in North Wales they offer a range of support which can be alongside active treatment for an illness. The focus of modern hospice care is on helping people to live well until they die – to help relieve the effects of serious illness, both emotional and physical.

The principles of respect, choice, flexibility and dignity underpin the hospice movement. High staffing ratios and the involvement of volunteers allow families the time and space to address what’s troubling them. This is rarely possible in a busy hospital ward.

A patient may be admitted to a hospice for help with a particular problem such as pain or nausea, or may be admitted for a short period to give family members a break. Hospices also offer expert care at the end of life. Dying in a hospice can bring families peace and allow a closeness which isn’t always possible at home, where there may be other distractions.

In this section we provide details of Hospice services in North Wales and Chester. In North East and North West Wales Hospice services work alongside Hospice at Home services. All hospices work in close partnership with the local specialist palliative care teams.

hafanHafan Menai Day Hospice
Penrhosgarnedd
Bangor
Gwynedd
LL57 2DH
01248 354 300

Hospice services in Gwynedd and Anglesey differ from other hospice organisations in that 80% of the work involves caring for people in their own homes. The remaining 20% is made up from care provided in the Hafan Menai Day Hospice and the community based complementary therapy service. In a largely rural area, caring for people in their own homes better meets the needs of the local population.

The Hafan Menai Day Hospice is located on the Ysbyty Gwynedd site in Bangor. It is an integral part of the specialist palliative care team and Hospice at Home nursing service based at Bodfan Eryri Hospital.

The nursing staff at Hafan Menai offer individual support to meet physical, psychological, spiritual and social needs including:

  • Symptom management e.g. control of pain, nausea, vomiting and breathlessness.
  • Support and advice about your illness, medication etc.
  • Nursing procedures e.g. change of dressing.
  • Access to additional services e.g. dietician, social worker, welfare benefits and specialist nurses.

A physiotherapy team offers:

  • Exercise programmes
  • Acupuncture
  • Mobility assessments
  • Mobility aids (tripods, splints, neck collars etc)
  • T.E.N.S. machines
  • Management of fatigue
  • Management of breathlessness and chest physiotherapy
  • General rehabilitation
  • Access to hydrotherapy pool at main hospital

In order to provide a more comprehensive service to a largely rural area Hafan Menai supports local Complementary Therapy clinics and offers transport services for patients to attend day centres.

Patients can self refer to be assessed for any of these services or can be referred through a member of their healthcare team.

For more information about Hafan Menai Day Care and about the Hospice at Home (Gwynedd and Anglesey) services please follow the link to:

Hospice at Home Gwynedd and Anglesey

stdavidsSt. David’s Hospice
Abbey Road,
Llandudno,
Conwy
LL30 2EN
01492 879 058
www.stdavidshospice.org.uk

St David’s Hospice provides care, free of charge, for adults who have a life limiting illness. Support is also offered to families and loved ones. Hospice Care is planned with the patient,, meeting the needs of the individual, be they physical, emotional or spiritual, in a safe, homely environment.

Services include:

The Day Unit admits 10 people per day Tuesday to Friday. Mondays offer individual appointments and bereavement counselling. Patients attend the Day Unit for a variety of reasons – specialist medical and nursing care from a full, professional team, the chance to meet others in similar situations or simply to allow their carer some respite for one day a week.

Therapies are provided by qualified therapists and have been shown to improve patients’ feelings of well-being, reducing stress and anxiety, thus aiding relaxation. Aromatherapy and massage are but two on offer.

The Inpatient Unit has an 11 bed facility providing 24hour professional care. Patients may be admitted to help with symptoms of serious illness, to provide a brief period of respite for carers, or they may choose to spend their last days of life at St David’s.

Other services include support from a senior social worker, counselling services and spiritual support.

Referrals are usually made from health care professionals but the Hospice’s clinical team can be contacted directly if patients and families wish to enquire regarding referral.

Further details of the wide range of services offered by St David’s can be found on the website:
www.stdavidshospice.org.uk

nightingaleNightingale House Hospice (North East Wales)
Nightingale House Hospice,
Chester Road,
Wrexham
LL11 2SJ
01978 316 800
www.nightingalehouse.co.uk

Nightingale House provides specialist palliative care services, completely free-of-charge, to patients and their families across a wide area stretching from Wrexham, Flintshire and East Denbighshire to Barmouth and the border towns including Oswestry and Whitchurch.

Services include:

The Day Unit offering specialist short term therapy over a period of 6–12 weeks. The Day Unit provides care that is holistic and life enhancing, helping people to adjust to illness and to increase their self confidence. People who come to the Day Unit will be given care and support from professionals and also from other people who may be in, or have had experience of a similar situation.

Outpatient facilities are available and include physiotherapy, hydrotherapy, occupational therapy, medical outpatient clinics and complementary therapies.

The Inpatient Unit offers 12 in-patient beds providing 24-hr specialist care, symptom control, assessment, terminal care and on-going emotional and spiritual support for relatives and carers including bereavement support for families.

Further details of the wide range of services offered by Nightingale House can be found on the hospice website:
www.nightingalehouse.co.uk

stkentSt. Kentigern Hospice
Upper Denbigh Road,
St Asaph,
Denbighshire
LL17 0RS
01745 585 221
www.stkentigernhospice.org.uk

St Kentigern Hospice provides a comprehensive palliative care service including pain and symptom control, psychological, spiritual, social and terminal care.

Holistic care and support is provided for adults living along and around the North Wales coastline who have been diagnosed with cancer and other life limiting illnesses, and also for their families, in a caring supportive environment. All patients are cared for according to their individual needs.

Services include:

The Day Unit provides care for patients and their families between 11am and 3pm Monday to Thursday.

The Unit has a very active and vibrant programme. On Mondays the emphasis is on physical reconditioning with the support of the physiotherapist. Tuesday is a mood management day. Wednesdays offer a varied programme of outside speakers such as the ‘house of colour’ and a beauty therapist. Thursdays are set aside for meeting the general support needs of day care patients.

The Day Unit team aims to provide relief of symptoms such as pain, nausea and vomiting, breathlessness, constipation and other complications arising from illness or the treatment.

Care is given unconditionally to those who need it irrespective of age, gender, race, religious beliefs or sexual orientation, and is without charge.

The Family Support Team is available to support patients and families with the wide range of practical and emotional needs that may be experienced through the course of illness.

The Inpatient Unit is a nurse led facility supported by a palliative care consultant and a general practitioner. There are eight single bedrooms, 6 of which have en suite facilities.

Patients are referred to the inpatient unit by a health care professional. This can be a GP, District Nurse, any member of the community palliative care team and any other medical practitioner. The inpatient unit offers symptom control, continuing care, rehabilitation, respite care and end of life care. Symptom control may be of a physical nature such as alleviating nausea and pain. High quality emotional support is also offered to patients and families. Patients may be referred for continuing care from the acute hospital in order that our expertise is used to enable patients to return home.

The Hospice has a respite bed to which patients can be referred by a health care professional.

For more detailed information on the wide range of services offered by St Kentigern Hopsice please follow the link to the Hospice website:
www.stkentigernhospice.org.uk

shepherdHospice of the Good Shepherd
Gordon Lane,
Backford,
Chester,
CH42 4DG
01244 851 091
www.hospiceofthegoodshepherd.com

The Hospice of the Good Shepherd provides care to people living within the catchment area of Chester, Rural Cheshire, Ellesmere Port and Deeside that have incurable, life-limiting malignant or non-malignant disease.

Services include:

The Day Therapy Unit provides care and support one day a week for a short period of usually no more than 6-10 weeks. This gives staff the opportunity to help a patient manage their symptoms with the aim of giving them more control of their lives. Symptoms such as:- pain, nausea/vomiting, reduced mobility, breathlessness, anxiety and psychological needs can be helped by the following:

  • Relaxation therapy
  • Aromatherapy/massage/guided visionary exercises
  • Exercise programmes / breathlessness management
  • Anxiety management
  • Nursing assessments using a holistic approach
  • Creative work
  • Welfare rights and benefits support
  • Carer support

Referral to the Day Therapy Unit can be made by any care professional involved in the patients care. Please contact your district nurse or GP if you feel the Hospice can be of any help to you.

Outpatient Clinics offer initial and follow up appointments with a Consultant or Specialist Doctor to review symptoms and the patient’s general condition. A wide range of complementary therapies are also available within the outpatient setting. Specific rehabilitation sessions are provided by a physiotherapy & occupational therapy team.

The Inpatient Unit offers short term facilities only. It has 12 beds, including 4 single rooms and two rooms of 4. Patients are admitted for a variety of reasons including management of pain and other distressing symptoms such as nausea and vomiting, psychological support and terminal care.Referrals can be made by any healthcare professional caring for a patient. Please contact your district nurse or GP if you feel the Hospice can be of any help.

For more detailed information on the wide range of services offered by the Hospice of the Good Shepherd please follow the link to the Hospice website:
www.hospiceofthegoodshepherd.com

Marie Curie Services

mariecurieMarie Curie Services
Marie Curie Nursing Service,
Unit W3,
Morfa Clwyd Business Centre
Marsh Road,
Rhyl
LL18 2AF
0800 716 146 (Monday to Friday, 9.00 am to 5.30 pm)
www.mariecurie.org.uk

The Marie Curie Nursing Service helps people who are approaching the end of their lives to remain at home if they wish to, through its nationwide network of Marie Curie Nurses who provide nursing care at home. They also offer practical and emotional advice and support for the patient and their family. Services are free of charge.

There is a difference between Marie Curie Nurses and Macmillan or other specialist nurses.

Marie Curie Nurses care for people in the last few months or weeks of their lives. Macmillan Nurses care for people with cancer from when they are first diagnosed. Marie Curie Nurses generally spend several hours at a time in a person’s home providing nursing care and emotional support, often overnight. Macmillan Nurses usually spend up to an hour in a person’s home providing advice on pain management and symptom control together with emotional support.

The core service, provided across North Wales, is a planned service supporting end of life patients and their families at home overnight. This service is delivered by a registered nurse or senior health care assistant usually between 10.00pm – 7.00am.

If you would like a Marie Curie Nurse, you should contact your District Nurse (sometimes called the community nurse) who coordinates your care at home. Your GP’s surgery will be able to tell you who your local District Nurse is and how to contact them. Your District Nurse will decide whether to request a Marie Curie Nurse; what periods of care are required and whether to request a Registered Nurse or Senior Healthcare Assistant (depending on you and your carer’s needs).

Information about shifts of care that have been requested / booked can be accessed by contacting Marie Curie Direct. This Free phone number will also offer patient information and advice from trained advisors.

0800 634 4520 (7 days a week, 9.00am-10.30pm)

In Conwy and Denbighshire the planned service is supplemented by a reactive service which is ‘short notice’ care. A nurse can be reserved and put on stand by to attend through the night to patients with urgent needs and provide support to carers requiring short notice professional advice.

A rapid response service is available in Conwy, Denbighshire, Wrexham and Flintshire and offers urgent home care at short notice. The service aims to prevent crises and unnecessary hospital admissions. It is offered from 10pm – 7am, 7 days a week and can be accessed through the GP ‘out of hours’ service. Calls are assessed and then forwarded to the Rapid Response Team who will decide whether to send a Marie Curie nurse, a healthcare assistant or offer support over the phone.

Telephone Help Lines

If you have concerns about your care, or if you are seeking advice as someone caring for a family member / friend, then your healthcare team should be your first point of contact. This may be your GP, district nurse or a member of your hospital based team. Every cancer patient should have a ‘key contact’ who they can get in touch with if they have questions / concerns.

There are a number of National telephone help lines offering general help and support from trained advisors to people affected by cancer. Details for some of these can be found in our section on National Organisations.

There is also a locally based help line offering information specifically for patients and families who have palliative care needs.

Dying Well Matters
0300 100 2011 (10am to 10pm)

This is a help line providing a single point of advice for concerned families of patients who are nearing the end of their lives. It offers a ‘one stop shop’ to support both families and relatives who may have concerns or questions about how their loved one is being treated. The help line is not just about health care – it can also offer information about wider matters such as benefits and financial support.

The helpline, called Dying Well Matters, will be hosted by the Betsi Cadwaladr University Health Board and will be available across Wales.

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