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Angela Bokota – End of life care

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Recently retired following a 37-year nursing career, CQC specialist advisor Angela Bokota, 56, values the opportunity to raise the profile of end of life care in the hospital system.

"Like the vast majority of people who’ve worked in the NHS I was aware of CQC, but hadn’t personally experienced an inspection. It wasn’t until a radio programme mentioned that the CQC was looking for specialist advisors that I became interested in getting involved.

I’d taken early retirement in 2013, but still felt I had a great deal to offer – and the CQC role seemed a great fit.

During my 37-year nursing career I’d worked as a nurse practitioner, community matron and nurse prescriber and gained a wealth of experience in cancer and haematology nursing at a senior level, both in primary and secondary care.

For example I was part of Poole PCT’s Community Cancer Nursing Team, a unique and nationally recognised service to support people with cancer, and following on further innovative nurse-led clinics in primary and secondary care.

Joining CQC

Once accepted as a specialist advisor in November 2013, I wasn’t sure how many inspections I’d be asked to go on. I’ve since been involved in 19 around the country, sometimes up to two a month. I work as a specialist advisor for nursing, mostly on the end of life team.

Throughout many trusts, there’s real lack of understanding of – and often resources for – end of life care. It often doesn’t hold the same priority as waiting times for A&E or surgery.

However, it’s vital that trusts view caring for the dying patient and their loved ones as a priority.

Last year the Leadership Alliance for the Care of Dying People published the new directive One Chance to Get it Right, which details five clear priorities to coordinate care. Put simply, the message is that we only have one chance to ensure a person has a good death.

As a specialist advisor my role will ensure that trusts are always working towards achieving these five priorities.

Inspecting end of life care

Since end of life care occurs throughout a trust, and on nearly every ward in a hospital, judging this speciality is a huge job.

Not only do we look at specialist palliative care services for patients with high level needs, but we also cover more general end of life care given on wards. Plus, we cover the multi-faith facilities provided, bereavement service and mortuary.

Yet, despite this, we’re usually a very small team – sometimes just myself and one CQC inspector. Realistically, I feel we need a minimum of three people on every end of life care team.

By its very nature, caring for a patient at the end of their life is physically and emotionally challenging. It’s not uncommon for a member of nursing staff to burst into tears when they’re being interviewed because they’re under so much pressure and feel they don’t have enough time to provide the care they’d want to.

End of life care isn’t just the final days

There’s a general lack understanding around the definition of end of life. It is often viewed as the last few days, when it is actually the last year of a person’s life.

On inspections we aim to ascertain staff understanding and education around palliative care and end of life. We track patients who are in the last few days of life to ensure care is individualised.

We also track patients deemed to be in the last year of life to identify if theirs and their loved ones’ wishes have been taken in account, and advance care planning has been applied (for example around preferred place of death).

Being able to take action

Staff work very hard to provide excellent end of life care despite the many current challenges in the NHS. Unfortunately, it’s not uncommon to identify issues that haven’t been addressed.

Recently, I met a patient with high level needs who was being cared for on a ward where their needs couldn’t be met.

I discovered they were on chemotherapy, plus suffering from a critical condition that could have worsened without the right care. I felt the staff lacked sufficient understanding of these issues.

My first step was to discuss the case with nursing staff and let them know I’d highlighted the finding. The inspection lead and I returned to the ward together and discussed an appropriate plan of care with the staff. The next morning I went back again to support the staff through the plan.

The staff were upset, and recognised they hadn’t been able to properly care for that patient but I felt we’d helped them by identifying the issue on a CQC inspection. Without us, they may not have been able to address the case and take vital action for that patient.

What I’ve gained from inspections

Although I’m now retired from full-time nursing, I feel that working as a CQC specialist advisor has helped me develop professionally. I’ve received very positive feedback from inspection leads about my high standards and ability to identify issues and take immediate appropriate action.

I also enjoy being part of a team full of people who are enthusiastic, motivated and keen to do a good job for the patients we care about."

Last updated:
29 May 2017


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