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Teresa Tate – End of life care

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With 25 years in end of life care, as a palliative care consultant and also focusing on end of life strategy at the Department of Health, Teresa Tate, 63, sees her role as a CQC specialist advisor as a way to try to ensure good end of life care is practised everywhere.

"Most of my career has been about trying to improve care at end of life. When I transferred from radiotherapy to palliative care in the mid 80s, end of life care was just starting to be discussed as a specialism. I was lucky that in London I was able to lead much of what happened in the field.

Over my 25 years' experience as a consultant in palliative medicine, I've been a medical advisor for Marie Curie. I've also worked at the Department of Health with Professor Mike Richards (now CQC Chief Inspector of Hospitals) as his deputy national clinical director of end of life care.

One project was to produce a proper end of life care strategy, but the work was put on hold with the NHS restructure in 2013.

Although I retired from full-time work in 2013 I didn't want to see the work half done. How we treat people towards the end of their lives is an important issue, but not yet properly embedded into care in this country.

I still continue to work with NHS England and Public Health England as well as a locum consultant in palliative medicine.

And through my role as a CQC specialist advisor I have another chance to try and push for good end of life care nationally. Mike has put renewed emphasis on the importance of end of life care at CQC, which of course is a positive.

A change of approach in end of life care in hospitals

Even though many individual people are concerned about end of life care, there often aren't robust processes in place – particularly within hospitals.

I believe proper end of life care means a change of approach for doctors – particularly senior and older ones. When most doctors realise they can't do anything more to cure a patient, it's often hard to alter their approach. The overwhelming focus on medicine is about curing, after all.

Recognising when someone is dying, and that it's no longer a good idea to continue with active treatment for the disease – as well as being able to discuss that with the patient and their family – is a skill that takes time to develop.

We need good leadership on end of life care

On inspections I often meet ward sisters or senior staff nurses who are truly committed, and despite a huge workload go the extra mile for terminally ill patients and their families.

Sadly, what I find less frequently is good leadership around end of life care, and the sense that the care being provided on ward level is really understood at trust board level.

If trusts focused more on supporting and praising ward staff who are doing it well, they'd find the whole organisation benefited.

Inspecting end of life care is a huge job

Before an inspection, we have a briefing phone call and receive a data pack. However, there's usually scant data relating to end of life care and I often need to ask CQC analysts to get more information from the trust.

As a specialist advisor I work in a team which ideally includes myself, a specialist palliative care nurse plus a CQC inspector (who may or may not have had specific experience in end of life care).

Once on the actual inspection, we'll aim to visit as many hospital wards as possible. This includes the general medical and general surgical wards, plus other places where more patients tend to pass away, like respiratory, acute respiratory and care of the elderly wards.

We'll talk to staff, patients and families, try and observe practice and think about whether what we're seeing looks at if people are receiving good care or not.

As well as spending time on wards we want to meet the specialist palliative care team within the hospital. Although they're not responsible for the end of life care delivery, they'll often educate and support staff on the wards. Plus we'll visit the chaplaincy, the mortuary and the bereavement service.

Even though we're inspecting for four days it's an extremely busy time and we can only really get a snapshot of what's going on.

I've now done six inspections in total, and all have been fulfilling but absolutely exhausting. If I feel I've accurately observed what's going on with a trust's end of life service I feel professionally – and personally – satisfied.

End of life care isn't an acute issue or saving lives. But it's something that all of us will need at some point – and it's so important to work to get it right."

Last updated:
29 May 2017


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