Back to the Future – Part IV – Supporting Innovation

Categories: Leadership and People & Places.

The three former chief executives of St Christopher’s interviewed all describe a similar aspiration that St Christopher’s serve as a centre of innovation in end of life care with a particular ambition to increase equity of access to high-quality support.

They describe efforts to increase the reach of the hospice in recent years as an important means of achieving this; also ongoing efforts to create new and different relationships with people who live in local communities who can augment a professional response.

There have been moments, particularly since the development of a Community Action Team and during the recent pandemic, when the hospice worked particularly well with community activists and their ambitions for an amended approach to supporting people coming to the end of their lives, rather than seeking to impose a managed approach to their involvement.

These responses to redressing inequalities has served to attract some staff to the hospice, in particular those with a commitment to social justice.

The approach to innovation adopted by St Christopher’s gives priority to research as the basis for developing practice/improving care, then investment in training to disseminate best practice.

Once established, there is strong evidence that pioneers have then generated new global communities and networks to support replication and further development of ideas.

Examples over the years include the world-renowned Childhood Bereavement Network, the Leadership Fellowship in Palliative Care, centres of innovation in other countries and more. New efforts to refine the specialism of palliative care to reflect particular needs, for example those related to neurological illness, were also ignited within individuals whilst working at St Christopher’s.

I’d made it clear to Cicely when I first discussed the hospice with her, that I would like to use it as a test bed in which I could try out some of the implications of my research… I was quite surprised when in the early days of St Christopher’s, we never had time to do it, or other people didn’t think it was a good thing to do. It would upset people, they were afraid that if we started talking to people about their bereavement, they might start crying

Dr Colin Murray Parkes Former Consultant Psychiatrist, St Christopher’s Hospice

The hospice has played an important role as a testbed for new ideas. The inter-relationship between cutting edge practice and original research are highlighted in many of the stories. The opportunities afforded to other organisations to learn from St Christopher’s, and then to contextualise, replicate and upscale new approaches are prevalent in the stories.

The model of bereavement care, initiated in 1967 developed significantly in 1973 with the recruitment of Bereavement Volunteers, expanding the service. Leaders around the world describe a similar process of experimentation – taking the notion of hospice and integrating it into hospital settings by way of example.

Over the years, funders have supported such innovation, an approach considered brave and forward thinking. The Wives Fellowship, now known as Women in Fellowship, for example, has funded work at the hospice over many decades, confident that St Christopher’s could help shape hospice and end of life care across the UK and beyond through its innovatory efforts. Relationships such as these are reflective of a belief that St Christopher’s serves as a leader in the sector.

Finding the right place in the system to innovate has not been straightforward and people describe a recurring tension related to the degree of integration on the part of St Christopher’s within the NHS.

On one hand the independence of the hospice from the bigger health system has allowed it to innovate at speed. On the other, this position of separateness has arguably denied the hospice the opportunity to influence policy and practice in the NHS.

Contributors to the history recall deliberation on the part of Cicely Saunders and other leaders in relation to the question of how
St Christopher’s should position itself to have maximum impact. According to recent leaders, how near or far it sits in relation to the NHS will determine the degree to which it serves primarily as a clinical service.

Its alternative role as a bridge to the community positions it quite differently and makes an ask of the organisation to locate its leverage within further systems and a wider context.

The position of the hospice is an issue of concern beyond internal headship. A national leader, reflecting on the history of St Christopher’s confirms the ongoing importance of the independence of hospices in relation to the formal systems of health and social care as they seek to respond to the needs of people who are dying or who face loss in a flexible and timely way. Also, their relationship with the communities who support them and who can guide their future role and priorities if given the opportunity.

Recent examples of testing and refining new approaches exist. These include a model of care focused on improving care for people with frailty approaching the end of their life, new developments in community action and the place of memorialisation in helping people live with their grief.

There are stories of innovations beyond hospice care which began their life at St Christopher’s. One staff member, heavily influenced in her practice at the hospice has subsequently gone on to establish strong innovative practice related to the work of care homes in relation to practice, education and research. Staff confirm that they were explicitly encouraged to replicate advances in practice beyond St Christopher’s, and invited to move on to other institutions to spread new learning.


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

Part I – Introduction

Part II – Being Prepared to be Radical

Part III – Responding to the Experience of Suffering





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