The stories told about St Christopher’s describe a complex picture related to change in the daily life of the hospice and its work. According to some, it is a place that finds substantial change difficult, particularly where professional aspirations and personal investment are closely intertwined.
Whilst some elements of the hospice have changed significantly over the last 60 years or so including its physical appearance, the services on offer and the shape of its workforce, there is a view that some elements are enduring – namely connection of the hospice with its communities and the commitment of the organisation to the wellbeing of those who receive care from the hospice and individuals working on behalf of the organisation.
There are many different narratives about change at St Christopher’s and the degree to which such change marked progress.
One of the changes mentioned many times relates to the religious life of the hospice and amendments over time to daily Christian practices in response to changing preferences of an increasingly diverse and secular group of users.
Some nurses reflect with concern on the historical practice of prayer time on the wards and the lack of a more individualised approach to this aspect of organisational life. Others see it simply as a sign of the times, and more recent changes (for example the refurbishment of the chapel to a multi-faith space) as evolutionary, reflective of shifts in society. They note how this aspect of St Christopher’s life has changed over the years and highlight the symbolic change it represents towards a more-inclusive and less-religious approach to holistic care for those dying and their families.
There are a number of references in the stories told about changes in the physical environment of the hospice, and their significance.
Stories of the hospice confirm how the buildings and their utilisation were constantly amended to draw in children, to better provide for older people who need long-term care and to educate and train more people.
Some changes have been seen as moments of advance and for celebration. The opening of the Anniversary Centre, the new Centre for Awareness and Response to End of Life (CARE) and similar mark positive and exciting developments in the work of the hospice.
Other changes in the physical environment have been experienced as distressing particularly when they signalled the end of a service – for example, the closure of Drapers Wing or the nursery. They mark the end of an era, a point of divestment in which people felt strong personal as well as professional investment and commitment.
The symbolism of particular physical changes is particularly notable in the minds of some – for example, the move of day hospice into the Anniversary Centre marking an advance that reflected the needs of the local community, rather than the availability of a physical space.
The personal and professional requirements of nurses and others recruited to work at the hospice is also a changing picture – to reflect emerging needs on the part of patients and those close to them.
It is interesting to read of new groups of people who become part of hospice life – school children invited to make relationships with patients and their families, arts students and more, the development of innovative services such as a personal care service in response to the needs of people who were frail and living at home. These were highly evaluated and successful in many respects.
On occasions St Christopher’s failed to move sufficiently fast to meet emerging needs for its care. Mention has already been made of tardy or reluctant responses to care for people with HIV and, more recently, dementia. As the picture of end of life continues to change further – calling for new approaches to palliation for people living and dying in late old age, with frailty, multiple conditions and disability, the hospice has an opportunity to redress this.
Contemporary reflections collected in the history confirm a much more proactive approach to identifying and responding to such needs in recent years.
Seminal work on the part of the hospice to address the anxiety of dying people through a dynamic partnership with psychiatry, its innovative service in Bromley for people living with frailty, a programme of support for people living and dying with heart failure are strong examples.
A restlessness to keep advancing practice, to draw in new and different skills into the workforce and to engage in research that ensures high quality care are themes within the interviews that confirm that St Christopher’s continues to change with the times and is committed to doing so.
“Hospices continue to have a responsibility to provide integrated end of life care… But the best ones will also have mobilised the local community in a way that embraces the richness and diversity of people’s experience”
Shaun O’Leary Former Chief Executive, St Christopher’s Hospice
Hospice care is so human. Everybody dies, everybody needs care… we shouldn’t waste our time on horrible, pointless interventions when we could actually make people comfortable
Min Stacpoole Former Nurse Lecturer in Palliative Care, St Christopher’s Hospice
This is the eleventh 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
Part IV – Supporting Innovation
Part V – Hospice as a Way of Life
Part VI – Building and Nurturing Relationships
Part VII – Being True to the Founding Values
Part VIII – Creating a Committed and Talented Workforce
Part IX – Investing In a strong multi-disciplinary Team Approach
Part X – Being generous with learning