Back to the Future – Part II – BEING prepared to BE radical

Categories: Leadership and People & Places.

“It struck me then as being exceedingly odd why Cicely Saunders was going into medicine. I had gone into medicine to cure people, as everybody had. Yet this extraordinary woman had gone into medicine to care for the dying. I had never heard of anything like that before…

and if you had asked me at the time whether I thought anything would come of it, I would have said without any doubt ‘no of course not.’”

Dr Mary Baines Former Hospice Consultant, St Christopher’s Hospice

“[When facING our financial crisis] we had to quickly re-vision in order to preserve what we thought were the essential services…and try to take staff and volunteers with us…a complete revamp of governance, much better financial controls, a really hard look at data, what we captured, how we were used. And we committed to shifting the centre of gravity from the inpatient unit to the community… partnering differently with the NHS”

Barbara Monroe DBE Former Chief Executive, St Christopher’s Hospice

Stories told about St Christopher’s in the oral history confirm that its life began well before 1967 when it first opened its doors to patients and their families. Cicely Saunders had begun her quest to understand and change the experience of end of life in the early 1950s, including a sustained period of employment at St Joseph’s Hospice in east London.

Cicely Saunders made strong connections with like-minded friends and colleagues who subsequently worked alongside her at St Christopher’s to make her vision a reality. Those pioneers tell stories of selfless engagement, often across a seven-day week, with ambitions to reshape medicine, its priorities and provide training related to the emerging speciality of palliative care.

They are clear that this work was not without potential sacrifice – moving into palliative care at that time was considered to be ‘professional suicide’. In addition, they were driving a counter cultural development – championing the needs of individuals ignored by contemporary healthcare and society, an enduring role for hospice and palliative care services today.

This counter-cultural approach to the care and support of dying people focused in placing value and finding utility in the lives of people, even when their condition could not be cured. This was practical in nature, as well as philosophical. One nurse, for example, talks about early work to negotiate opportunities for organ transplantation with patients dying at St Christopher’s in order that they could make some contribution to the life and wellbeing of others despite their impending end.

The progress of those early pioneers is well documented within the history and elsewhere. Looking back, it would be easy to think the initiative straightforward given the strength of concept and its persuasive underpinning aspirations.

Stories from the oral history tell it differently.

In reality, it took those early pioneers many years to generate the plans, find funding, build the hospice and put together a team to lead the hospice and its work. This is encouraging for leaders today who face similar challenges that call for unrelenting effort.

The acts of being radical and pioneering were a counter-cultural approach to care in the early days and took real courage.

This characteristic remains prevalent in stories of life at the hospice in subsequent years. Most recently, staff describe how colleagues responded to people dying in the COVID-19 pandemic and tell of brave and sustained efforts.

Clinicians and others working for St Christopher’s made themselves available to respond to the needs of dying people right from the outset. Nurses describe uncertainty on their own part and that of their colleagues as they explored what role to play in supporting people dying at this time, and how to keep themselves and others safe. Other staff talk of the challenges of learning new skills and responding very rapidly to a context quite uncharted.

Another recent example of the radical nature of the hospice was its decision to appoint two individuals to the role of chief executive in 2014 to replace Dame Barbara Monroe. This is cited within the history as the first such partnership within the sector and it has proved successful by all accounts. Today there are a number of other hospices following a similar model.


This is the second in our serialisation of “Back to the Future – Reflections on an Oral History of St Christopher’s Hospice”

Part I – Introduction – can  be found here.

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