How do you give a dying person a reassuring smile when they cannot see your face behind your mask?

How do you hold their hand, when national Covid guidance says you really shouldn’t?

Just two of a mountain of questions that Dr Tony Blower and the staff at St Michael’s Hospice in Herefordshire had to try to find answers to – and fast.

At the start of the pandemic in Britain the threat was that hospices, along with hospitals generally, would be ‘engulfed.’

Much to his relief, that never happened. Instead the ‘tragedy’ of Covid played out in care homes.

He believes that while much was done across the county by those responsible for people in care homes, ‘nationally there are lessons to be learned’ regarding the needs of vulnerable people in care homes and support for those caring for them.

“I have never seen anything like this. It was very hard. Particularly the responsibility of decision making when you know decisions over services could impact significantly on the lives of patients, families and staff.”

“The hospice’s aims throughout have been, and continue to be, to care for those who need us, evolving how we do this in a way that keeps everyone as safe as possible.

“We work with our professional colleagues and other health and social care organisations across the county to collectively do the best we can in the circumstances for those needing palliative care.

“This continues as we try to evolve our services further to support people over the medium term despite COVID until there is a national vaccination programme.

Emotionally very hard

“It has been emotionally extremely hard for patients, families and those caring for them.”

The first challenge was that new processes had to be put in place to ensure vulnerable patients their families and staff did not become infected while still trying to provide the best possible care.

A Covid team was set up at the hospice and met every day ensuring everything was covered and everyone knew what to do.

The design of the hospice, with its single rooms for in-patients, meant it was well suited to manage the infection risk and it offered to take in more patients than normal.

In fact it didn’t happen as most deaths took place in hospitals, care homes or the community.

Instead the hospice reached out to support the community hospitals, homes GPs and those providing care at home, looking to ensure the highest standards of palliative care were provided in all circumstances.

At the hospice, which has so far cared for three patients with COVID on the inpatient unit, the balance was between ensuring no cross infection – which they succeeded in doing – and allowing access to dying patients by their families.

Covid took away precious time

“Normally, in the last few days, family members stay for days and throughout the nights if wished. This was where Covid had a major impact – it took away precious time and restricted how much time people could have together.

“Emotionally it was very hard for staff who understood the crucial need for people to be together. Thankfully because of the hospice’s building and our robust infection prevention processes we were able to offer much less restriction to visiting than most hospices.

The staff and volunteers have been incredible and highly professional. We have all looked out for each other.

And what were the answers to those two questions?

  • Hands: “We evaluated the risks, explained them to families, and let them decide.”
  • Smiles: “We tried to show the compassion in our eyes, our voice and our actions.”

Given the carers involved, they would surely have succeeded.

The Hereford Times Health and Social Care Awards will recognise and honour staff who have been at the forefront in the Covid battle.

Dr Blower – himself winner of the Palliative Care Award last year – is a big fan of the awards.

“I really enjoyed the event last year. Particularly hearing about all the amazing work done by others across the county.”

This year it will be a digital ceremony, presented by Good Morning Britain’s Dr Hilary Jones, and with a host of celebrity guests popping in with special messages during the live broadcast on October 22.

To say thank you to our carers.