The first palliative nurse they met was in A&E

A&E is built for the unexpected: a fall at home, a night when the pain will not wait. It is not, on paper, where you would expect to meet a palliative care nurse.

At North Middlesex University Hospital in Enfield, that meeting now has a roster. Marie Curie has started a two-year trial that places specialist palliative staff inside the emergency department — consultants, a clinical fellow, nurses and healthcare assistants — working alongside the A&E team. The hospital sits under the Royal Free London NHS Foundation Trust.

Dr Antke Hagena, a Marie Curie consultant, began working out of that department in December 2024. In the first six months the service saw 280 patients. For 73 per cent of them, it was their first contact with palliative care.

That figure does most of the work. Hagena told the Enfield Dispatch that many people nearing the end of life still rely on ambulances and emergency departments in a crisis, because they are not known to palliative care services. The wait for the right care, she said, is "deeply distressing for the individual, their loved ones, and the staff who care for them."

Research Marie Curie funded this year, led by King's College London and the University of Hull, estimated that almost one in three people in England die with unmet palliative care need: symptoms and concerns that were not addressed, and not enough help from a GP. That is about 170,000 people a year. An earlier nationally representative survey of bereaved people in England and Wales found that almost half of those who died had been to A&E at least once in their last three months. One in eight had spent more than 30 days in hospital in that stretch.

Gem Davies, Marie Curie's head of nursing and quality for London and the home counties, trained as an A&E nurse. She told Nursing Times that if you pick people up at the front door they need not get stuck on a ward, or pick up an infection they would not have had at home. A plan, a word with the GP, pharmacy advice, a way back to wherever they wanted to be. "Our nurses have time; ED nurses are stretched, they're busy, they're very generalist." The specialist team is not being pulled to the next trolley. That is the job.

There is already a smaller version of this idea at Derriford Hospital in Plymouth, where Marie Curie healthcare assistants sit with the emergency team. North Middlesex is a fuller model, and still a trial. The charity is paying for it. Two years is long enough to gather data, Davies said, and perhaps to make a case to other trusts. It is not a service you can assume will be waiting if you arrive at a different A&E on a Sunday night.

If you want to know what else Marie Curie does, their site is the place to start. What happens when the two years are up remains a local arrangement, paid for by a charity, in one hospital.