Gemma del Toro

My current role is clinical lead nurse specialist (service manager) for the Derbyshire Dementia Palliative Care Team. The service was set up after I commenced work across the system to highlight the need to improve palliative and end of life care for people living and dying with dementia. The Dementia Palliative Care Team was established, in pilot, to contribute expert clinical support at the outset of the pandemic, responding to the significant volume of need for people within their own homes or care homes. The primary goal of the team is to enable improved palliative care for people living with dementia, with mental and physical health needs. The team is focussed on ensuring the person remains at home (wherever home is) and avoiding unnecessary acute care. The pilot has been and continues to be a huge success with recognition on a national level and has now received substantive funding.

The access to palliative care approach is for people living with dementia, with symptoms consistent with approaching end of life, or with another terminal condition or with multiple comorbid conditions that complicate care and comfort. Members of this group are consistently denied appropriate end of life care due to diagnostic overshadowing, poor recognition of symptoms and polypharmacy. The model combines clinical approaches found in palliative care, dementia specialist care and person-centred care.

The service has proved to be a valuable care provision in meeting palliative care needs of people living and dying with dementia, the support of families, symptom control, advance care planning and end of life care planning for people with dementia across Derbyshire.

I am now in the fortunate position to be leading and managing a service that has rapidly grown after proving need and outcomes across the system for the last 2 years. The service has grown from being a sole professional delivering a service to leading a team of 24 staff. This rapid growth means that for me to step back, reflect on my leadership skills and knowledge would be of ‘absolute’ benefit to taking the service and staff within onwards and upwards towards the shining future it deserves.

Throughout my nursing carer I have always been someone who sees a gap, an issue or need of change and facilitated thinking ‘outside the box’ to ensure barriers reduced and needs are meet. This has then led to change across teams, organisations and systems but I have never completed a programme that is focused on me as ‘leader’. This programme will support and allow me to develop my own leadership skills and knowledge and continue to support a ‘change and caring culture’ within the ongoing development of the Dementia Palliative Care Team, the work with NHS E/I to build the ‘gold standard’ national model but most importantly the staff within the service and the patients/family/carers we support.

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