I was appointed as Clinical Senior Lecturer in Palliative Medicine in 2009, and am based at the North Wales Centre for Primary Care Research in Wrexham. I am a senior hospice and palliative medicine specialist with an interest in quality improvement, an accomplished educator with experience of working at national level, and a researcher with a track record of securing UK National Institute for Health and Care Research (NIHR) funding. My particular areas of interest are care in the last days of life for home-based people (including in rural areas), and how best to prepare relatives/carers for the dying process. I am a strong advocate for the benefits of roles integrating clinical work, education and research.
I was co-Chief Investigator on an NIHR-funded study of the feasibility of (unpaid relative/)carer-administered as-needed medication for symptoms in the last days of life in home-based patients. As co-author on the rapidly developed All-Wales policy in the pandemic context, I have led on clinical implementation since April 2020. I obtained my PhD qualification on the topic in April 2022. Through our work, we have influenced implementation of the intervention across the UK, and I am founding co-chair of the national Community of Practice.
Supported by infrastructure funding from PRIME Centre Wales, our unit's research programme focussing on community palliative care in the last days of life is gaining pace. I am co-lead for the PRIME work package on Supportive and End of Life Care. We have also built strong research links with Australian partners, where strategies to deliver rural palliative care are of utmost importance.
Between 2013 and 2019 I was a panel member of the NIHR HTA Panel A.
2022: Co-Chief Investigator. BCUHB Specialist Palliative Care (Welsh Government funding allocated via the End of Life Board). Understanding the cost-effectiveness of the CARiAD intervention in North Wales. 1/4/2022 for 4 months.
2019: Co-applicant. Welsh Government: Health and Care Research Wales. Wales Centre for Primary and Emergency (including unscheduled) Care Research (PRIME Centre Wales). 1/4/2020 for 5 years, £4.8M. Work Package (WP) (Supportive & Palliative Care) co-lead with Professor Annmarie Nelson.
2019: Co-applicant. BCUHB Specialist Palliative Care grant and Macmillan. Understanding Advance Care Planning in North Wales: Exploring patients and carer views. 1/4/2019 for 15 months.
2018: Co-applicant. BCUHB Specialist Palliative Care (Welsh Government funding allocated via the End of Life Board). Understanding Advance Care Planning in North Wales: A focus group study of health care professionals. 1/8/2018 for 8 months.
2018: Co-Chief Investigator: Betsi Cadwaladr University Health Board Specialist Palliative Care grant (Welsh Government funding allocated via the End of Life Board) for ‘Six Steps Evaluation’, 19/3/2018 for 3 months.
2018: Health and Care Research Wales Clinical Research Time Award (CRTA-17-03) (awarded 19 January 2018), 2 sessions per week for 3 years commencing 1/4/2018.
2016: Co-Chief Investigator: Betsi Cadwaladr University Health Board Pathway to Portfolio (C003027 F006926) Grant (awarded October 2016) for ‘Noisy breathing at life’s end: preparatory work’, 1/10/2016 for 9 months.
2016: Co-Chief Investigator: NIHR HTA Project (15/10/37) Grant (awarded August 2016) for ‘CARer-ADministration of as-needed sub-cutaneous medication for breakthrough symptoms in home-based dying patients: a UK study (CARiAD)’, 1/11/16 for 30 months.
2011: Principal Investigator: NCRI Lung Cancer Supportive and Palliative Care Research Grant subcontract (awarded January 2011) for ‘Cordotomy in mesothelioma-related pain: a systematic review of the literature’.
2008: Co-investigator: NCRI Lung Cancer Supportive and Palliative Care Research Grant (awarded June 2008) for ‘The role of cordotomy in the management of mesothelioma-related pain in the United Kingdom (The INPIC pilot study) (Invasive Procedures in Cancer Pain)’, Principal Investigator: Dr Matthew Makin.
I hold a post-graduate qualification in education (PGCPD in HE, obtained in 2011). In addition to delivering many teaching sessions over the years on palliative care topics to a range of (postgraduate) healthcare professionals in a range of education settings, I have had much involvement in education coordination and design in the region.
I am an appraiser for fellow consultants (specialists) in the region and a Designated Supervising Medical Practitioner (for ANP/non-medical prescribing training). Until recently, I was educational supervisor for the palliative medicine specialty trainees in North Wales, as well as for a range of other junior doctor clinical and academic training grade posts. I have experience of mentoring trainees, and dealing with those in difficulty.
I held the national position of Chair of the Wales Deanery Specialty Training Committee for Palliative Medicine for 4 years until my term expired in October 2017, and on a UK-wide basis I was a question writer for the Specialty Clinical Examination in Palliative Medicine (the knowledge-based exit examination for those sub-specialising in Palliative Medicine in the UK, and a pre-requisite for completion of specialty training) until 2021.
I am a Fellow of the UK Higher Education Academy.
In January 2022 I took up the post of co-Clinical Director of Palliative Care for Betsi Cadwaladr University Health Board (BCUHB).
Since February 2009, as part of my clinical sessions, I have had joint hospice and community care appointments across several localities in the large geography of North Wales, giving me a clear understanding of the functioning of both National Health Service (NHS) and independent (charity) sectors. Hospice care includes leading ward rounds of hospice inpatients, providing senior managerial input to the medical/Advance Nurse Practitioner team and supporting the Clinical Effectiveness programme. Community specialist palliative care support is provided by integrated medical and nursing teams, and we work in concert with primary care teams (general practitioners and district nurses) to support people with palliative care needs at home. Both clinical roles come with the associated supporting professional activities including support for colleagues involved in quality improvement projects. In terms of non-malignant palliative care, my interest lies in heart failure palliative care, and I have had much involvement in regional service development for this patient group. I provide cross-cover for clinical colleagues in the hospital specialist palliative care team, as well as out-of-hours telephone advice to clinicians across North Wales as part of a regional on call rota.
On a national (all-Wales) level I am academic lead for the Care Decisions for the Last Days of Life project, a well-established project providing dedicated guidance to support last days of life care irrespective of setting, with a national feedback system providing outcomes on care.
I am a Fellow of the Royal College of Physicians, London and have been trained in Quality Improvement (IQT Silver, NHS Wales).
Originally from Namibia, I studied Medicine at the University of Stellenbosch (Cape Town, South Africa), obtaining my primary degree cum laude in December 2000. In 2001, I moved to the United Kingdom. I concluded junior doctor training in November 2004 after achieving membership of the Royal College of Physicians, London by completing general internal medicine specialty examinations. I sub-specialised in Palliative Medicine (Completion of Specialty Training, October 2008) and was offered a full-time permanent senior clinical academic appointment (50% clinical, 50% academic, North Wales campus of Cardiff University, then Bangor University) which commenced February 2009.