Pam McClinton has spent 10 years at North London Hospice – four years as Nursing Director and six as CEO. As she prepares to retire this month, she looks back at a decade at the forefront of end of life care provision at the hospice, and the developments she has witnessed in end of life care throughout her career.
I started working in palliative care in the late eighties as a community Macmillan Nurse. It was the start of a real expansion of specialist palliative care services. I had been a District Nurse prior to this appointment, and I can clearly remember the mantra of our new Macmillan team: if we do our job well and share our expertise with other professionals, then we should do ourselves out of a job as everyone will increase their knowledge.
That philosophy of sharing knowledge and expertise still rings true, the difference is that the specialty has continued to grow and develop to what we know it as today. It has been amazing to experience that growth and work with some wonderful people.
Of course, things have changed, in particular the management of symptoms and the growth of hospice and hospital palliative care. From the start I’ve been driven by the realisation that good end of life care can make a real difference to patients and their loved ones. As I leave the sector over 30 years later I still feel this passion, and this is what has kept me going
When I look back at the last three decades, the sector’s overriding achievement is that we are supporting more patients than ever before. At present, at North London Hospice that’s more than 900 people at any one point in time, and more than 2,600 patients a year overall.
It’s fair to say that none of us will ever forget 2020. It’s been the most physically and emotionally challenging year I can remember. But like so many other healthcare providers, our doctors and nurses, social workers, bereavement support staff, and all those that work hard to deliver our services, rose to the greatest of challenges during the Covid-19 pandemic. We faced difficulties with PPE, changes to face-to-face care provision and severe restrictions to home visits and accessing our ward, as we aimed to protect patients and staff, which was immensely difficult for all.
I have felt strongly how tough these last few months have been on all of us, in many different ways. On a few occasions it has been overwhelming when I have started to think of what could have happened as many colleagues began to get sick. The term’ Health and Safety’ has taken on a totally new level of meaning, and the saying ‘keep safe’ that we were all using took on hugely emotive implications. We are constantly thinking: how do we keep staff and patients safe? How do we maintain our services and our income? Hospice care and the hospice philosophy is needed now more than ever; how do we keep this in balance?
This sense of the need for safety has been present from both a clinical and a financial perspective – economically, income from shops and fundraising events have taken a hit. This mirrors the issues that the country is facing, in finding a balance between public health and the economy.
I have been very aware of the need for safety and security during this pandemic, which has reminded me of Maslow’s hierarchy of need. This basic need has been severely threatened. Personally, I’ve experienced a desire for certainty, to bring a sense of control that could balance the anxiety of the situation. The certainty is not always there and I have found this hard when I have not been able to give assurance. This has certainly knocked me down Maslow’s ‘pyramid of need’, and the awareness that this will have happened to others has emphasised the need for well-being and resilience strategies.
We, as a country owe a huge debt of gratitude to all frontline workers, and locally in North London, just as we support our communities, they supported us once the pandemic took hold in March. Donations of PPE flooded in when we asked for it; food supplies and treats to keep our spirits up arrived daily, and despite people’s own financial difficulties, our supporters are still giving what they can.
The pandemic has provided a steep learning curve for us all. We have become more adaptable and nimble. We’ve begun seeing communications technology as our friend. Patients have used iPads to stay in touch with loved ones and we’ve been able to conduct consultations and run some of our wellbeing services thanks to the power of Zoom.
Technology can never replace being at a bedside or holding someone’s hand as they reach the end of their life, but it can help us stay in touch and ‘be there’ even if we cannot be physically.
This road will be long and there are still challenges to come. As a charity it costs £13 million a year to run our organisation and we rely on our community to raise £9 million of that cost. Just as every other charity in the UK had to cancel and adapt their spring and summer fundraising events programme, so did we, and we are left working harder than ever for every £1 we receive. In turn, this means we have to ensure that money helps those that need it most.
New ways for people to support their local hospices are emerging, charity shops are starting to reopen, events that enable much-loved annual fundraisers are resuming, but differently. I hope for all our sakes that the 200+ hospices across the UK will weather this storm and emerge stronger than ever. To lose even one hospice as a result of the pandemic would be a travesty.
I will miss being part of North London Hospice, what it stands for and the people that I have had the privilege to work with over the years. The importance and significance of good palliative care has been with me throughout my nursing career, and it has been an honour to be a part of North London Hospice’s history, and to continue its fundamental purpose to improve and enhance the quality of life of those it touches.
For more information visit North London Hospice
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