Justin Trewen Q&A: Improving end of life care for people with cancer

Published: 26 November 2020

We caught up with Justin Trewren, a Macmillan End of Life Care Facilitator, to learn about his work to speed up discharge processes for people living with cancer at the end of life, which won him a Macmillan Professionals Excellence Award.

Can you tell us about your career so far?

I qualified as a nurse around ten years ago, after looking after my Grandad at the end of his life. He didn’t have the best death in hospital, but there was an end of life care facilitator there who made everything easier for us as a family. She inspired me to train as a nurse and care for people at the end of life.

I worked on medical and rehabilitation wards in Berkshire, and then in Brighton, with a focus on end of life care and care for the elderly, which has always been a passion. I then joined the discharge team at Royal Sussex County Hospital, and loved being involved in complex discharge planning for patients.

'The role came at the right time for me'

I relocated to Yorkshire, working in the discharge team at Pinderfields Hospital, which is part of the Mid-Yorkshire Hospitals NHS Trust. I always knew that I wanted to come back to end of life care. About three years ago, the Trust applied to Macmillan to fund an end of life fast track discharge facilitator, who would develop a rapid discharge process for people at the end of life.

The role came at the right time for me and encapsulated everything from my previous experience. We developed the process working with stakeholders from across the district, including hospices, nursing homes, pharmacists and ward managers. We stripped back lots of inefficiencies and made the process much simpler and more streamlined. That experience led me to apply for the role of end of life care facilitator for the Trust. We still have a fast track facilitator in place, and we work closely together.

What is the main focus of your work at the moment?

My role is to try to improve care for people who are dying in hospital, and this can involve lots of different projects. For example, I’m excited about the ‘Taste for Pleasure’ project, which aims to dispel ‘nil by mouth’ culture and introduce some of the patient’s favourite tastes if appropriate when providing mouth care. We’re also looking into using volunteers in end of life care, who can spend time with people who are dying on the wards, and also offer respite for friends and families.

What achievement are you most proud of?

Research conducted prior to the fast track facilitator project found that, from the time someone was diagnosed as dying, it took about 13.8 days to discharge them from hospital to their preferred place of care. Of the sample of patients I looked at, 80% died on day eight in a hospital bed. I’m very proud that, as a result of our new pathway, people at hospital in Wakefield who are diagnosed as dying and want to be at home with carers can now get home within six to eight hours.

This was a really successful project and we were runners up at the Patient Experience Network National Awards last year. I also won the Macmillan Quality Improvement Excellence Award in November. This national recognition helped secure continued funding for the role from the Trust, to embed this work further across our hospital and two others. But the real achievement is the fact that the project is working, and the impact for people at the end of life is immediate.

What does being a Macmillan professional mean to you?

I think the public often have Macmillan in their hearts, so that affiliation helps us gain patients’ trust and make sure they feel safe. We have also used the training available from Macmillan, and received the grant funding to pay for some advanced communications skills courses.

'The impact for people at the end of life is immediate'

What changes do you hope to see in future practice and end of life care?

I think the thing that really matters to people is communication. If you know what you are facing, you can face it. The main thing for me is offering hospice care within the hospital. I think having volunteers can help with that. For example, volunteers who can spend time doing things such as hair and nails or providing complementary therapies.

We are also embedding the Gold Standards Framework for end of life care into four wards. I would like to see that rolled out across the Trust. We know the NHS is under such huge pressure, but in an ideal world, I would like to see end of life care given greater recognition as a key priority.

Are you interested in becoming a Macmillan Professional? Why not take a look at our latest vacancies on the NHS Jobs website today?

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