All resources


This resource is aimed at professionals working across the palliative care sector and in migrant centres and related organisations.


This booklet will guide you through a series of questions and ideas for you to think about. The booklet is yours and you can show it to whoever you decide needs to see it. Just ask your nurse if you would like one or download and print it off below. If you have any other questions, we hope you will talk them over with a member of staff who will be glad to help.


If you need advice or support please call us on 02087684582

Your call and brief details will be taken by a member of our admin team and forwarded to the appropriate team. A member of the team will ring you back on the same day. Please leave a number that we can easily contact you on.

An opportunity to better end of life care for older people

Report by Caroline Nicholson and Heather Richardson


Anticipatory prescribing refers to charts and, where appropriate, medications that are left in a person’s usual place of residence for use by visiting clinicians should problems arise with uncontrolled symptoms.

  • Patients are most vulnerable to these in the last days of life and when they are no longer able to swallow
  • The common ones are pain, nausea and vomiting, distress and agitation and respiratory secretions
  • The guidance below covers these.

There has been controversy over the best practice for clinicians to adopt following the widely publicised Gosport Enquiry.

  • General, national guidance and policies are currently under development and several members of the clinical team at St Christopher’s are closely involved with this work
  • Our current guidance reflects the developing thinking, is subject to regular review and scrutiny and will be modified as further evidence emerges around the best and safest practice to adopt
  • Our 24 hour specialist advice and support is there to back up this general guidance to ensure, as far as possible, that clinical decisions are individualised and safe.


Anticipatory Prescribing Guidance for Frail Elderly Patients (PDF) Anticipatory Prescribing Guidance for Adults (PDF) Pan London Symptom Control Medication Authorisation and Administration Record (MAAR) (PDF)

Bereavement support | Helpline

Practical advice

0800 634 9494 (9am-5pm)

When someone who is important to us dies it can feel unbearable, as though our whole world has changed. As unique individuals, our response to loss is also likely to be unique, and can be affected by the relationship we had with the person who died. There is no right or wrong way to grieve.


  • Support for symptoms including breathlessness, fatigue, and fluid build-up. A full holistic assessment will be carried out, and referrals on to other services including rehab where appropriate
  • Support for psychological wellbeing- an assessment will be carried out and linking with other services including emotional support, complimentary therapies, spiritual support, carer assessment and support
  • Welfare support
  • Assessment for equipment and care
  • Advance care planning and creation of Universal Care Plan
  • Assessment for and guidance around use of sub-cutaneous furosemide to aid hospital avoidance
  • Coordination of care and close working alongside GP’s / DN’s and cardiology/ heart failure services to optimise treatment.
  • Support and coordination around deactivation of internal defibrillators as appropriate

Patients who are registered with either a Bromley or Croydon GP- including those in nursing homes:

Confirm that the patient meets at least one of the following referral criteria- if unsure please call to discuss:

  • Symptomatic (e.g. breathless at rest or minimal exertion) despite optimal treatment (NYHA III or IV)
  • Heart failure patients when hospital admission may not be the best/ only/ preferred option, or for whom palliative care (Hospice, hospital inpatient or community care) may be of benefit, either immediately or in the future
  • Optimal therapy but continuing or deteriorating physical and/or psychological symptoms.  Where only psychological issues are present consider referral to clinical psychology
  • Patient has advanced heart failure and their family or carer(s) would benefit from support, either immediately or in the future (including bereavement)
  • The patient has had two or more previous admissions for heart failure within the last 6 months.

GP referrals

For routine referrals to the palliative heart failure service please use the standard pan london form clearly highlighting it is for this service

For urgent referrals please mark it as urgent and it will be triaged by our spoc team accordingly.

GPs in Bromley: If you are not certain about a Heart Failure diagnosis and treatment options and whether someone is suitable for palliative care input you can refer in to the monthly palliative heart failure MDM for discussion with a heart failure consultant and the palliative care team – see link above.

Heart failure team referrals

Referrals will also be taken direct from the relevant heart failure teams.

Routine referrals:

The GP sends the referral form via EMIS

The referrals team will contact the patient/carer and discuss the referral and aims of our input- highlighting any issues that need addressing

The heart failure service will book in to see the patient/ carer at home or in the hospice as an outpatient if able.

The patient will either stay under the heart failure service depending on the level of complexity or be handed over to the community team for ongoing support if appropriate.

For urgent referrals:

The GP should use the standard referral form – these will be triaged by the team and contacted.

The community team will be the first team to see the patient and will refer into the heart failure service if needed

The heart failure service can also be contacted for advice.

Parents and carers want to do the best for their children, and it is very hard to know what is best for them when a death has happened. You are trying to come to terms with what has happened, cope with painful and difficult feelings, and there are so many decisions and choices to be made.

This leaflet has been written to help you think about your children and the funeral, why they should have the chance to go, and how to answer some of their questions.


St Christopher’s has been providing bereavement counselling to patients’ families for over 50 years.

St Christopher’s Candle Child Bereavement Service extends this support to all children, young people and their families in the south east London area, covering the boroughs of Croydon, Bromley, Lewisham, Southwark and Lambeth. Any parent, carer, teacher or healthcare professional can make a referral to the Candle Child Bereavement Service. Young people aged over 16 can refer themselves.

We also offer a specialist training, advice and consultancy service to schools and other agencies working with children facing bereavement.


Bereavement support | Helpline

Helpline (9-5pm)

0800 028 8840
Bereavement support | Helpline

A dedicated helpline that offers support to anyone affected by the death of child of any age, under any circumstances however recent or long ago

0800 282 986 or 0808 800 6019
Bereavement support | Helpline

24 hour support line for under 25 years and their relatives

0800 1111 (24 hour support line)

Decision-making tool and prescribing guidance


Age UK is the leading charity for older people. Visit Age UK for help, information and advice.

There is no right or wrong way to feel when you or someone close to you has a terminal illness. You may experience a range of emotions, at different times. You may feel shock, fear, anger and resentment. Or you may feel helpless, sad, frustrated or perhaps experience relief and acceptance. You may also feel isolated and alone, even if you have family and friends around you.


Bereavement support

Connecting you with help for your mental health
Bereavement support | Helpline

Nationwide Bereavement Support

Cruse provides support services for people across the UK who have been bereaved. The helpline offers listening support and practical advice related to bereavement, including dealing with an estate, debt and arranging a funeral.

0808 808 1677

End of Life Journal was a free, online, peer-reviewed journal that published articles on all aspects of nursing practice relating to end-of-life care.

The journal was primarily aimed at generalist nurses working in hospital, community and care home settings. Many articles will also be of interest to the palliative care nursing audience as well as members of the wider multidisciplinary team.

The journal focused on care for patients with both malignant and non-malignant disease and their family and friends.
Bereavement support

Therapist finder from BACP
Bereavement support | Helpline

0808 802 0111 - Monday to Friday 9am-9pm

When a patient is nearing the end of their life, health care professionals should be aware of those who have internal cardiac defibrillators and should be considering deactivation in a timely manner to prevent inappropriate shocks at the end of someone’s life, which are painful and distressing for the individual and those close to them. 

Palliative care can help with starting these conversations and coordinating the process. If someone is too unwell to attend the hospital for formal deactivation we have magnets available to take out for those who are dying and have an active device. 

If you have a patient with an active internal defibrillator ( either an ICD or a CRT-D) in situ and you are concerned they are approaching end of life- please consider referring to palliative care for support with conversations around deactivation. If the patient has a Bromley or Croydon GP please consider referral to the Palliative heart failure service at St Christopher’s.  Please see the guidance that we follow and if you have questions or are unsure whether to refer someone please call the hospice for advice.

Guidelines for deactivating implantable cardioverter defibrillators (ICDs) in people nearing the end of their life


Alternative video (no introduction):

Watch video
Weblinks and Resource Lists

Cruse provide a helpline and other support for young people aged 12-18 following a bereavement. 

Help in bereavement
Bereavement support

Providing support and advice services for the bereaved people living in the Borough of Lewisham
Bereavement support

Living On helps and supports Children, Young People and Families in the Bromley Area to cope through the grieving process

The Living Well at Home Team consists of therapists and volunteers working towards your goals with you in your own home. They can support you to try to improve your mobility, cope with breathlessness or fatigue, avoid falls, or enable you to better manage your activities of daily living.


A short guide to doing your lying exercises safely and effectively.

You may also wish to watch our lying exercises film.


This website hosts the PANG Palliative Care Guidelines developed by a collaboration of UK Health organisations. Additional material is provided by Dr Ian Back.

GPs in Bromley can refer into the monthly palliative heart failure MDM if they’re uncertain about a patient’s diagnosis and whether there is a need for sub cut furosemide to help direct correct treatment.

Email and the referral will get processed by the MDT co-ordinator for discussion.

A pressure ulcer is damage that occurs on the surface and underlying tissues of the skin due to the lack of blood and oxygen supply. You may have known them as pressure sores or bedsores, but they are now called pressure ulcers.


Bereavement support

Re-engage exists to support older people who live alone and find it hard to get out in normal times

Tips for residents, families and care staff to help enable independence.


Bereavement support | Helpline

24 hour support line

For anyone at anytime for any reason

116 123 (24 hour support line)
Bereavement support | Helpline

Free confidential helpline after death of a baby

0808 164 3332

A short guide to doing your seated exercises safely and effectively.

You may also wish to watch our seated exercises film.


Bereavement support | Helpline

24 hour support line for the over 70s

0800 470 8090 (24 hour support line)

If you have recently been bereaved by suicide, the South East London Suicide Bereavement Service is here to provide support from both a practical and an emotional perspective. The staff team includes Suicide Bereavement Support Workers, Community Chaplains and a Bereavement Counsellor.
Articles | publications

St Christopher’s CARE is home to our library and bookshop.


A short guide to doing your standing exercises safely and effectively.

You may also wish to watch our standing exercises film.


Bereavement support

Bereavement support for 18-35 year olds from
Bereavement support | Helpline

0300 111 5065 (9am-9pm daily)
Bereavement support | Weblinks and Resource Lists

Tell Us Once is a service that lets you report a death to most government organisations in one go
Bereavement support | Weblinks and Resource Lists

This service is specifically designed to remove from databases and mailing files, the names and addresses of people who have died.
Bereavement support | Helpline

0345 123 2304 (Every day 10am-4pm, 7-10pm)
Bereavement support

A Low cost counselling agency.

Greenwich-based charity that promotes emotional health and wellbeing, and offers a range of therapeutic services.

Bereavement support

The Good Grief Trust aims to find the bereaved, acknowledge their grief and provide reassurance, a virtual hand of friendship and ongoing support
Bereavement support

Providing free bereavement support for loss to Cancer or Covid-19
Bereavement support | Helpline

0808 802 6868
Bereavement support

Support for young widows
Weblinks and Resource Lists

Winston’s Wish delivers support services to children who have been bereaved in the UK. As well as in-depth therapeutic help in individual, group and residential settings, they run a national helpline and have resources for children to help them through their bereavement.

This leaflet offers advice about which services are best to contact in different situations.


We collect a lot of personal information from and about you, your family and from other services. We need this information so that we can provide you with highest quality care and treatment.


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