*Dr Sam Edward was acting chief executive of North London Hospice when the pandemic hit in March*

North London Hospice medical director Dr Sam Edward on how the charity has adapted to the pandemic this year

This year has been extraordinarily challenging for North London Hospice, like so many other charities.

The week prior to the lockdown in March, I was acting chief executive. The situation developed rapidly and the rate of change was at times overwhelming. I was managing our planning, while trying to deliver frontline care too.

The biggest challenges we faced at the hospice during the pandemic were around visiting and the safety of patients, volunteers and staff. Central to end of life care is supporting people to have those close to them around in their final days. For the last six months we have not always been able to provide this and that’s been heartbreaking. Even now, visiting is restricted, but it has eased and we’re learning to operate in this new way of life.

We are constantly trying to strike the right balance between following guidance to limit contact and keep everyone safe, while enabling people to be together and see their loved ones. During the first weeks on our 18-bed ward we tried hard to admit as many patients as we could from hospitals to ease the pressure on them.

In the community, many of our patients were shielding, and it was a priority to find ways to maintain their support while keeping them, and our staff, safe. There was rapid change to our services and we introduced consultations by video and adapted them according to preference and needs. We continued to visit people at home and also provide supported carers, patients and professionals with a 24/7 telephone advice service.

The issues over PPE (personal protective equipment) were on the news daily, and we faced the same challenges with obtaining stocks as other healthcare providers did. The supplies weren’t coming through and we were rapidly running out.

I remember the relief when we got our first national drop of PPE – it was long-awaited but many of our orders had arrived without masks or aprons. It was really hard to see how we could keep going without this essential equipment. We had no choice but to ask our community for help, and it was this generosity in those first weeks that enabled us to continue supporting patients. I would like to wholeheartedly thank everyone who responded.

PPE has made communication with patients difficult, however. We realised how much we read through facial expressions. At North London Hospice, doctors and nurses on our inpatient unit now have a photo on their name badges to help share their faces more clearly. I am used to greeting people with a handshake or holding someone’s hand at the end of their life, for many it is the image so often shared in relation to compassionate hospice care. The lack of physical contact creates distance that we’ve spent our whole careers breaking down – but we just have to do it in other ways now. It’s taken a long time to get used to.

The learning curve has been steep – professionally, personally, and as a team – but the transformation in the way we deliver our services has been huge.

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