Dr Averil Fountain – Palliative care consultant Bridgewater Community Healthcare NHS Foundation Trust/medical director Halton Haven Hospice.
I’ve been working as a consultant in palliative care for over 25 years and have been working in Halton since 2003.
As well as my role with Bridgewater supporting the community palliative care service, I am also medical director for Halton Haven Hospice.
I’m based at the hospice but take referrals from across the community so that can be from consultants and specialist in hospitals, GPs and other health professionals.
Referrals are for patients who have palliative needs, especially those with complex uncontrolled symptoms, patients with complex psychosocial needs, and patients struggling to adjust to their diagnosis.
People often only think of cancer when they talk about palliative care but that is actually only a proportion of patients I see.
It can be any terminal illness such as cardiac or respiratory illness that we provide care and support for.
As a consultant I suppose I am the conductor of an orchestra in many ways, making sure that the service works well and that nothing is missed for the patient.
High quality communications skills are vital in the role and I provide as much time as possible for patients in clinic with an hour for new patients and half an hour for follow ups.
These are some of the most difficult conversations that people will have but if we can get it right we can help make sure that people get the care that they want in the last year of life. It’s important to give people as much of my time to discuss these kind of things as possible.
When patients come to the hospice we try and provide what I sometimes call an MOT process. Our aim is to optimise their treatment and get them ready for discharge to their place of residence with all the support that they require.
That includes medical support such as medication for symptom control – which can be incredibly complex – but also includes advance care planning so that they and their family make decisions around how they want to die and we can support them.
If we don’t have open and honest discussions with families then they can’t get what they want at the end of life.
Although I do think that palliative care is better known and has been better promoted in recent years, a lot of people just aren’t exposed to end of life scenarios.
People are living longer so it’s not uncommon for them to not encounter a close relative like a parent dying until they are in older middle age themselves.
There are a lot of myths still around, mainly from TV and film, about death being something that is dramatic and sudden. In many cases that’s not the reality and people have time to plan, think and prepare for it to happen how they want.
There is still a fear of dying at home and it being seen as morbid, but for many patients it may be the most comfortable place that they want to be.
The hospice or the hospital shouldn’t necessarily be the default.
I also play a role in educating other professionals providing a medical student placement from Liverpool University and in Halton we provide innovative training posts for GP trainees as well.
Spreading good palliative care skills is essential for the future and I am always available to provide a second opinion and expert advice to GPs and other colleagues.
We can look after around 200 patients at any one time in Halton but the impact of our work can be far greater. If we get palliative care right it also a major knock on benefit to the community.
Typically, for every patient who dies it has a knock on effect for five other people, usually close family.
It is a very precious time in our life when we are losing someone and it gives me great satisfaction when we can make such a difficult time as smooth as possible and meet our patient’s wishes wherever possible.
If we can shepherd a patient and their family through their situation and make the experience as peaceful as possible then that is a family that won’t struggle as much in the future.
Many patients and their families in Halton amaze me each and every week with their resilience; it is a fantastic area to work in.