Welsh Ambulance pilot scheme helping patients at the end of life

A new initiative to further support patients at the end of their life is being piloted by the Welsh Ambulance Service.

The Trust’s new rapid response service enables palliative care paramedics to better support patients with advanced and terminal conditions who contact 999 in crisis.

It is designed to improve the patient’s experience in their preferred place of care and reduce avoidable hospital admissions, which can be stressful and unwanted in the patient’s final days or hours.

“Ambulance services across the UK are regularly supporting patients who are nearing the end of life and experiencing a crisis event,” said Ed O’Brian, the Trust’s Palliative Care Lead.

“We are committed to ensuring that everyone who contacts 999 in these circumstances is cared for with the utmost dignity, compassion and respect.

“We’ve had palliative care paramedics in Wales for a couple of years now, and they do an amazing job of delivering specialist care to patients in the community and in a hospital and hospice setting as part of a rotation arrangement with Swansea Bay University Health Board.

“The rapid response service goes a step further again, ensuring that patients with a palliative care need who access 999 are getting the best possible support by deploying an experienced palliative care paramedic to these 999 calls whenever possible.”

The pilot has supported more than 150 patients in the Swansea area since its inception in April.

Paramedics are dispatched in one of two ways; by an Advanced Paramedic Practitioner Navigator based at Morriston Hospital’s Same Day Emergency Care unit, or by identifying patients themselves from the 999 ‘stack’ who might benefit from their skills and expertise.

They are also available over the phone for other ambulance clinicians who require advice and support with decision-making.

“If the paramedic believes the patient is likely to experience a further deterioration in the near future as a result of their palliative condition, and there’s no planning in place for that deterioration, they can start that process with the patient’s permission by having conversations about how they would like their care to look going forward,” explained Ed.

“The paramedic can then make any necessary referrals.

“Hopefully this will reduce the likelihood of a future crisis event – or, in the event of a crisis and the patient is unable to communicate, the patient’s wishes will have already been captured and those wishes can be respected by the attending clinician.”

The rapid response service pilot runs until November 2024.

Chair Colin Dennis, who recently observed palliative care paramedics in Swansea, told yesterday’s Trust Board meeting: “I would just like to commend publicly the work that they do – it’s absolutely extraordinary.

“They do an amazing amount of work to keep people in their homes, rather than convey to hospital, when they are at end of life.

“They’re doing amazing work in the pilot which is going on in Swansea and what we hope is that when the pilot ends in November, we’ll be able to persuade other health boards to embrace the same initiative as well.”

The Welsh Ambulance Service appointed its first palliative care paramedics in 2021 and was the first UK ambulance service to do so.

It was also the first to introduce ‘Just in Case’ medications on its emergency vehicles, allowing paramedics to better manage the symptoms that may be experienced as terminally ill patients become more unwell.

Meanwhile, its End of Life Care Rapid Transport Service provides transport for terminally ill patients to their preferred place of death, and has made more than 4,500 compassionate journeys since its introduction in 2017.

And last year, the Trust was presented with a Who Cares Wins Award from then Prime Minister Rishi Sunak for its Wish Ambulance initiative, which enables patients at the end of life to have a memory-making experience before they die.