The Covid-19 outbreak has made it more challenging to enable people to have a good death.

The work of the Palliative and End of Life Care Network has provided the foundation for good care. They have augmented this in the present pandemic by, for example, giving advice on the planning requirements for NHS Nightingale Hospital North West.

The Network has co-ordinated education for staff and supported an offer of a 24/7 on-call rota of palliative and end of life care consultants to provide telephone advice to the medical team. 
 
The rapidly escalating pandemic required major adaptations in working practices. To addres this, the team launched two virtual meetings running weekly with key palliative and end of life care clinical staff, including consultants, clinicians, educators, commissioners and GPs, to discuss latest issues and Covid-19 resources, including national and regional guidelines and educational resources. High and continuing attendance indicates the value placed on these meetings by the participants.

The network has also developed a Covid-19 information section on the NHS Future Platform and the Six Steps Care Homes website; explored a joined-up approach to supporting care homes and home care; worked with hospices to offer peer support, education and training; and have given specialist clinical input to a project with Health Innovation Manchester to update an electronic Palliative Care Coordinating System (EPaCCS) data set which will allow GPs to have instant access to electronic information on the care and personal preferences of the person at the end of their life.

The Network became aware, early in the pandemic, that ill children were not presenting to the health service when they had severe, or potentially severe, illness or injuries.

In response, our staff and clinical leads played a leading role with the Royal Manchester Children's Hospital in working with the paediatric system to launch a communications campaign to encourage parents to seek medical advice if they are concerned about their child’s health. This included the production of videos showing clinicians from across Greater Manchester offering advice, which were distributed across social media channels.

Despite fewer children presenting to paediatric services, the pandemic was having other impacts that were putting pressure on the services. This led the Network to establish weekly calls with clinical directors and heads of nursing for paediatrics across GM to assess pressure on children and young people services, identify challenges and solutions and highlight risks and best practice in light of national guidance and any Covid-19 updates.

A new weekly paediatric newsletter has been produced and sent to acute, community, primary care and commissioning colleagues, that brings together all the local and national guidance.

The team established a paediatric bed management call system that takes place twice a day, 7 days a week, to collect data from each of the paediatric units across GM, providing an overview of where the pressures are in the system.

They have also been working with the Greater Manchester Health and Social Care Partnership's Urgent and Emergency Care Team to develop an offer of support with specialist paediatric advice for parents, which will be accessed through the GM Clinical Assessment Service and NHS 111.  

(Photo above right: Dr Steve Playfor, paediatric intensive care consultant, appearing in one of the videos). 

Pregnant women and their babies have been at risk of the coronavirus. Whilst this has led to relatively few deaths, it has still created pressure on the services. 

The Network established new weekly calls with the heads of midwifery and university midwifery leads  to share good practice and monitor risks across the system. Weekly calls were also established with Greater Manchester and Eastern Cheshire’s Maternity Voices Partnership leads to understand the needs and concerns of women, partners and families which ensured two way communication with service users and maternity providers.
 
The Network has developed information to support the maternity system in their communications to women across the system, outlining service changes during these times. A special ‘Coronavirus and pregnancy’ page has been set-up on the Local Maternity System’s My Birth, My Choice website with a series of questions and answers. They are also developing antenatal education materials to be used by all providers to supplement the current maternity offer, to meet the needs of Manchester's diverse population.
 
Our clinical lead midwife, Eileen Stringer, supported these messages with an interview with BBC Radio Manchester, and a press release was issued to the local media. You can hear part of Eileen's interview here  (around 2 minutes 10 seconds into the recording).

The Network supported the transfer of maternity services following the temporary closure of Macclesfield Maternity Unit to in-patient childbirth and midwifery services, making sure all mums-to-be had a safe transfer of care. 

This was hugely helped by improvements previously carried out to harmonise several clinical pathways, as well as strong working relationships with Saving Babies Lives Champions, heads of midwifery, clinical directors, higher education providers and commissioners.

The huge reduction in deaths following myocardial infarction as a result of percutaneous coronary interventions was in danger of being reversed by patients not presenting in a timely manner, due to understandable concerns of being in a Covid-19 rich environment, and the difficulties in providing a safe service.
 
This led the Cardiac Network to provide guidance and support to frontline staff in response to the coronavirus outbreak, including:
 
- establishing a multi-disciplinary WhatsApp group, comprising of clinicians, specialist nurses, coordinators, NWAS staff and managers, to ensure communication channels are always available due to guidelines, pathways and protocols changing so rapidly
- carrying out Zoom conference calls with key people to ensure that decisions can be made quickly and and adapt to changing circumstances
 
This enabled the:
- development of  an agreed protocol for Guidance for Treatment of Acute Cardiac Syndrome and Primary Percutaneous Coronary Intervention (PPCI) during the Covid-19 pandemic for patients within the Greater Manchester area
- provision of new pathways of care so that patients could still have access to important procedures and surgeries. This was done in conjunction with colleagues at Liverpool Heart and Chest Hospital
- agreement that the laboratories at Wigan and Fairfield hospitals should carry out PPCI for their own patients.
 

The pandemic has risked the good management of long-term conditions and helping people to self-manage their diabetes is an important way of mitigating this risk. 

The Network has arranged for people with diabetes across GM to get free access to a website with e-learning courses, where they can get information to better self-manage their diabetes at home.

The website is called Diabetes My Way, providing remote access to educational material. There are six courses for people with type 1 or type 2 diabetes, teenagers with type 1 diabetes concerned about implications as they grow-up and people thinking of switching from injections to an insulin pump.
 
Please encourage friends and family with diabetes to sign-up to the service.