Dr Anshuni Kaneria is a Speciality Registrar at Royal Trinity Hospice. Anshuni joined Trinity in October 2020 and works mainly in the community team where she is the main doctor.

“The most visible thing about Trinity is the hospice building, but it would be a mistake to think that caring for patients in the building is the main way we make a difference. Most of our patients are looked after in their own homes, by the community team.

Map of Royal Trinity Hospice's London Catchment Area

Working with patients in their own homes involves careful coordination and work with GPs, hospital teams, district nurses and the network of health and social care professionals involved in someone’s care. GPs and District Nurses are generalists so are amazing at doing a little of everything. Trinity’s nurses and doctors have specialist knowledge and training to help patients at the end of their lives or manage life limiting illnesses. This means that we can help patients with special interventions that District Nurses and GPs may not be as familiar with, for example managing pain.

Palliative care doctors are quite holistic, we try to see the big picture, and that helps us find a solution based on each individual patient. My role often involves trouble shooting when things haven’t quite worked along typical regimes. It can be amazing to see how much improvement you can make with the smallest actions. A suggestion that doesn’t feel especially ground-breaking can sometimes make the biggest difference for that patient.

Working in the community really makes you realise that we cover one of the most diverse areas at Trinity. When I am privileged enough to visit a patient with one of the community team nurses, I see how skilled they are at adapting to people and their needs. By needs I mean anything from symptoms to culture, language, family dynamics, wealth, and age too. People often think of palliative care as something for elderly and frail people, but we see the full spectrum of ages.

In a single day I’ll go from stepping over dogs and cats visiting someone in their one-bedroom council flat at the top of a tower block to a multi-storey townhouse in Chelsea followed by a house where there’s a three month old baby crying in one room and their young parent dying in the other. It’s such a broad spectrum. If you spend the morning in Putney and Tooting and the afternoon in Westminster and Fulham you expect to come across big differences in patients and their needs.

Providing the best care, personalised to what each patient needs at that time is what we mean by individualised care. It’s about giving the same quality of care and expertise in every environment.

People sometimes think of medicine as being an exact science but it’s not like that at all. It’s about tailoring your approach to what you see in front of you. What may be right for one patient with a brain tumour may not be right for another, even if they look the same on paper.

We’re really good at picking out what’s important to somebody and building a plan that works for them. Often a visit is just the start. Then there’s the follow up; making sure every professional involved understands the plan or ensuring the drugs will arrive on time and that they’re able to take them.

We’re so lucky in this country that we have an amazing free healthcare service, but the left hand doesn’t always talk to the right hand. At Trinity though, we’re good at keeping everyone in the loop. It’s a hugely logistical role, which I don’t think is always obvious. On a ward as a doctor, you write something in the notes and you know it will happen. But, when you’re working in the community, it’s your responsibility to make sure that all of the things you said are going to happen actually happen, and it may require input from a lot of different services to achieve.

Our individualised approach to care doesn’t end with the patient.

Before Covid-19 we’d see people in their homes and their families would be there, listening and asking questions. Now, we’re working hard to ensure families are kept in the loop by finding ways to involve them remotely when they can’t physically be there. There’s a lot of anxiety for families who can’t see changes or worry a lot about their sick relatives and it’s important for us to try to reduce that anxiety where we can.

The whole world’s mental health has probably deteriorated in this period and in line with that I think we are seeing more distress. I have particularly noticed this among patients’ families. They can’t be together in the same way and many feel like they’re letting people down or putting on a brave face so those around them aren’t burdened. A big role of the community team, especially the nurses, is acknowledging and allowing space for that and they are brilliant at it. The nurses develop relationships with both patients and their family. They are incredibly good at allowing people not to be ok. It’s a huge privilege to be in that position of trust.

Because Covid-19 has put so much pressure on hospital services, people aren’t getting screened as thoroughly for cancer or have access to routine appointments for chronic diseases as much as they were. We are seeing a lot of people getting sicker, faster. Even as the pressure on the NHS from the pandemic eases, I think we’ll keep seeing this for some time to come. It’s sad and hard to see but at least we’re still in the position where we can respond.

I think we can be very proud at Trinity, not just of how we have adapted over the last year to the practical demands of visiting less and phoning/video calling more, but also proud of how hard we have worked to make sure our care has remained personalised and tailored to each patient’s needs."

Find out more about the care Trinity provides for patients living at home

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