Wayne de Leeuw
At Hospice UK’s national conference last month, Wayne de Leeuw, Interim CEO and Donna Peake, Head of Community Development at Dorothy House Hospice Care near Bath, gave a talk about meeting demand for end of life care by forming strategic alliances with partner organisations. Here they tell us more about this initiative.
The UK is experiencing demographic changes, increasing costs and a national shortage of skilled end of life care staff. As a result hospices are having to think differently about their models of care.
Dorothy House Hospice Care covers a predominantly rural area in East Mendip near Bath, with a population of around 64,000, of whom roughly 440 people need palliative care.
According to the Office of National Statistics, one in ten people in the area live in one of the most deprived neighbourhoods by geographical access to care services. It also has a dramatically rising, ageing population with over 65-year-olds set to increase by 61 per cent by 2030. The area is also expecting to have to care for twice the number of over 85-year-olds by 2030, with more complex care needs such as frailty, dementia or co-morbidities.
There are clearly many challenges to meeting future needs, but an eco-system of care can help. The definition of an eco-system is a network of service providers in a predefined community (including statutory, community, voluntary and private providers), enabling people to live well and die well. To successfully deliver the hospice’s strategic aims of providing palliative and end of life care to more people, the eco-system’s work will be defined by:
- Leadership to support the eco-system alliance(s)
- Partnership development (both informal and formal) to enhance learning, income generation and delivery (including education/research)
- Potential new service models (and funding) around delivery
- The role of the hospice as a coordinator of End of Life Care (EoLC)
- Technology platforms and support to help people take back control
Dorothy House’s vision is to help build a society where death is a part of life. Part of this ambition will be delivered by establishing three local eco-systems to ensure a shared local understanding of palliative and EoLC need, a future where the community receives equitable EoLC, and facilitative partnerships to develop sustainable and collaborative solutions.
The hospice’s first eco-system is called the East Mendip Alliance and consists of partnership working between Macmillan Cancer Support, Royal United Hospitals Bath, St Margaret’s Hospice and South Western Ambulance Service among others.
It’s vital when going into partnerships in an eco-system to be mindful not to bring our own egos or hospice agendas into the alliance. While we must continue to be proud of our role as specialists in end of life care we must also allow other partners to lead in areas where they have more skills, expertise or resources. It’s important to listen to others’ needs both in the community but also among alliance partners.
Our biggest driver in forming an eco-system was our community and what they felt was important in terms of bereavement, grief, end of life and what a good death would look like. We commissioned Community First to carry out interviews and to gather feedback from local groups across East Mendip.
We also looked at the wider systems and community assets that supported East Mendip, to understand the clinical and commissioning landscape from the NHS Long Term Plan and from a local GP perspective. Primary Care Networks were just emerging and it was vital we canvassed for local GP representation. We knew that our solutions needed to be sustainable, and that a quick fix was not the answer.
The mission of the East Mendip Alliance is to ensure individuals and those supporting them have access to the right end of life care, and to understand what is important to everyone on the journey towards the end of life.
The work streams the partners are working on include reducing inappropriate hospital admissions, improving health and social care sector training, better transport options for people to attend services in their local community, equitable care for non-cancer patients, and wider provision of bereavement support groups.