Ending the postcode lottery in rural Wales

Categories: Care, Featured, and People & Places.

ehospice speaks to Trystan Pritchard, CEO of St David’s Hospice in Llandudno, about improving access to hospice care in rural North West Wales.

Last year St David’s merged with Hospice at Home Gwynedd and Anglesey. Why was this decision made and what have the benefits been so far?

We were both charities based in North West Wales covering a fairly similar patch. St David’s was inpatient only, but we were offering very similar services, very often to the same patient, and we decided it was better to combine our efforts so we could hopefully achieve more for patients rather than carry on as separate entities. St David’s is quite a lot bigger in size than Hospice at Home, but the geographical patch it covers is really quite vast.

What has end of life care provision been like historically in this part of Wales?

In North Wales you had the northern coast which is quite well served by hospices, but if you went further into North West Wales there was really nothing at all apart from some Hospice at Home services. To use a buzzword it was a bit of a postcode lottery in terms of what hospice services you could access, mainly because of rurality and travel times to the hospices which had inpatient services.

What are the main needs of patients that need to be addressed?

For 20 years inpatient beds for the whole of North West Wales were in the seaside town of Llandudno, and you could travel 50 miles further west into the further reaches of Anglesey and the further reaches of North West Wales and you had nothing at all. So inpatient beds was definitely something we wanted to look at.

The Hospice at Home team were really good at what they were doing, but what we were finding from families we were in connection with was a real lack of respite care, which when families are at their most weak and vulnerable, sometimes gives them the lifeline they need to continue caring afterwards. That’s a focus for us now, how we can do respite care sustainably in a rural area which has difficulties in terms of travel times.

What are the main challenges the hospice faces in the few years?

Like most hospices it’s well known there are financial challenges. There’s a low level of support from the NHS and from the government for hospice care in Wales, it’s about half what hospices in England receive. It’s a question of what we’re going to look at as core end of life care services that the NHS should be providing, as opposed to what extra services hospices provide, that we believe we are here for.

What are your thoughts on the announcement of the extra £25 million in funding for hospices in England?

It’s a start. Thinking of all the hospices in England it’s not going to go very far, but at least it’s recognition from the top levels of the government in Westminster that something needed to be done to restore the balance of funding. We would hope that is only the start of a major reworking of the way hospice care is financed over in England.

You have a new site opening in the autumn, what facilities will it have?

It’s going to be great for us because it’s a really innovative project looking at areas that have a great need for inpatient care. It’ll be a satellite unit for us, located about 50 miles away from the main hospice so geographically it makes sense. It will have four inpatient beds, and will be primarily nurse-led but with support from our existing medical team using the main hospice, so either face-to-face or via telemedicine depending on the clinical need.

It has been established in an underutilised NHS ward so we are putting some capital funding into it supported by the Big Lottery to provide single rooms and all the things that you might expect to see in a modern hospice. We will staff it and pay for the staffing from then on, which is going to cost us about £400k a year. The Big Lottery support to get us going has been very much appreciated, and then we’ve had all kinds of other contributors locally and nationally.

This satellite unit is hopefully an example of how hospices can be innovative in recognising local need and putting a solution in place that suits its local communities. We really do need the strength and support from our NHS partners to be able to continue to do this as well as innovate. I think there are some things that we shouldn’t be doing that the NHS are far better placed to do than we are, but there are also things that we can do that maybe the NHS cannot do. It’s a strong partnership when it works well.

St David’s is celebrating its 20th anniversary this year. What have the hospice’s greatest achievements been over the years?

We’ve continuously been able to develop, the hospice has gone from strength to strength really. It’s really well loved in the community, and obviously we never lose sight of the fact that we wouldn’t be here without their support over 20 years. We’ve had a lot of celebrations for our anniversary recently and it’s nice to be able to say thank you to people who are still with us fortunately, who were around when the idea of building the place was first instigated.

Our reputation is our strongest feature – being able to continually set standards for ourselves in terms of levels of care, and to then meet those standards year after year. That’s a testimony to all the clinical people who’ve been involved in delivering services over the years. We’re nothing without our reputation, so we really want to protect that.

For more information visit St David’s Hospice

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