Strategy into practice – a blueprint or a provocation?

Categories: Featured, Must Read, and Opinion.

Tracey Bleakley, Chief Executive of Hospice UK, looks at the practical ways in which the hospice sector can evolve.

The question I’m most often asked as CEO of Hospice UK is for a blueprint of the hospice of the future.  We talk a lot about the future in the hospice sector, and a trawl of presentations and plenaries at the Hospice UK conference for the past few years supports this.  But they have one thing in common – they are theoretical, inspiring, visionary and lacking in practical detail.  What we need to know is what a hospice might look like in five, ten years and beyond, and how to get there.

What does evolution and revolution really look like and how do we do it?

In the coming weeks and months we’ll be focusing more on this. My first suggestion is for all hospices to focus on evolution.  Plan a board or SMT away day to look at current need, changing demand and demographics in your area and plan what you would design today if the hospice didn’t exist.  It’s an exercise that we ran at the Hospice UK roadshows this summer and it’s incredibly useful in taking a completely fresh look at your area and the people you are trying to reach.

All the information you will need to run the session is in the Hospice UK PopNat tool, and in our clinical benchmarking report. You can also download this .zip file which contains everything you need to know about how to use PopNAT, and run the exercise.

PopNat is incredibly intuitive, you don’t need a password to use it, and the results, graphs, tables and data are all easily copied and pasted into board reports and materials.  Simply enter the website, register your name and enter the name of your hospice, it couldn’t be simpler.  The tool is designed to help hospices plan for the future, identify unmet need and to innovate services based on intelligence about the end of life and palliative care needs of the local population.

Straight away, you can see the number of people in your area over 65 and 85 and how these numbers are projected to change over time.  The number of people living alone over 65 is important in planning hospice at home and services that rely on partnerships with carers and close family.  The cause of death and dementia register statistics will help you plan services around the conditions your population is living with and dying from.  The index of multiple deprivation data will identify barriers around housing, crime, education, skills, training, employment, health deprivation and disability, living environments and income.  You can assess how much free care is given in your area by family carers and their needs.  You can look at religion, ethnicity and cultural groups.  And you can look at all of this data on a map, showing where your patients and families are and their specific needs, and also where your potential donors and fundraisers are.

At the end of the exercise you’ll have designed a set of services and locations that look very different from your current hospice and provision.  Getting there can seem impossible, the barriers are huge.  But what about the opportunities?

So here’s a scenario that focuses on services traditionally delivered in the hospice building.  You’ve looked at PopNat and discovered that you have huge areas of unmet need in disadvantaged communities and most services are provided from a single hospice building in an affluent area that was donated to the charity many decades ago by a wealthy philanthropist.  The hospice does run community services and hospice at home, but referrals from more deprived areas are few and far between and transportation out to the leafy hospice suburb is limited.  Also, you’d love to engage with patients and families earlier but the word hospice and the idea of going to a building where people are dying is a barrier.

The charity Chest, Heart & Stroke Scotland had similar issues.  They decided to look at empty Blockbuster Video and PoundStretcher stores on the high-street as a means of providing accessible services for communities. You can find out more at the Hospice UK 2019 Retail Conference on 11 April here.

Imagine a hospice hub on the high-street.  It has a high quality coffee-shop like The Mill at St Catherine’s Hospice in Preston, book store and tempting retail offer to pull in the public.  The goods and price point is appropriate to the local area, but the look and feel and quality is superb.  It also offers scheduled well-being, day-respite, out-patient appointments, lymphedema services, palliative chemotherapy, art therapy and a host of social prescribing for hospice patients.  The café hosts carer support sessions, mother and baby groups, legal support and death cafés.  The local community use the hub through the day and into the evening and local MPs and community leaders run their surgeries there.  Students hold art exhibitions, aspiring artists, jewelry and clothing designers get their big break selling their goods there.  Other local complimentary charities rent space there and provide services (Citizen’s Advice, MIND, Relate, Alzheimer’s Society, Age UK), as do new social enterprises (hair-dressers, Osteopath’s, Beauty Therapists).  They all offer discounts to patients and families.

The hospice negotiates a good deal from the landlord for filling a problematic empty shop and bringing footfall back to the high-street, and the rent from sub-letting helps alongside the retail income.  Fundraising and volunteering increases as more people are aware of the hospice as do referrals.  People are less scared of accessing hospice services because they aren’t going to a building where people are dying, so they come to the hospice earlier.  It becomes the heart of the community.

The hospice consults more widely.  They find support for opening more community hubs and pulling all patient services (with the exception of inpatient care) out of the hospice building and onto local high streets.  The space at the hospice is sub-let to other charities for back-office and to host community nursing teams.  More car-parking is available to support the education centre, and more training is run through online portals and Project ECHO.  The former hospice wellbeing centre is turned into a nursery similar to the one at Dove House Hospice in Hull.  This brings in additional income and importantly attracts more community nursing staff to work at the hospice.

Because more services are available closer to patients, there is a possibility of merging in-patient units so economies of scale can be realised.  Bringing back-office and nursing teams together means that organisational collaboration and mergers become more accessible.  Bigger teams with larger reserves can support wider services and have bigger ambitions to help more people.

More community nursing staff means more patients can be helped.  Patients are engaging earlier.  Fundraised and commercial income is up to support increased patient numbers.

Of course it wouldn’t work everywhere.  Rural areas might consider mobile hospice services (buses and mini-vans) and using community halls.  Children’s hospices might look at the day-care model used by Ellenor Hospice as a means to expand services outside of much needed, but costly overnight respite care and might take services into special-schools and existing respite centres.

In a similar way, the hospice boards should also be considering evolution in community services, local partnerships, joint provision with care homes and hospitals, education, training and research.

Hospices respond to local community need and so every locality will be different.  There isn’t a one-size fits all blueprint, but there are similar issues, conversations and ideas that we can explore.  I sometimes hear that health and social care is designed around the needs of the staff and not the patients.  With our workforce challenges, we need to have a long, hard look at whether our services meet the needs of either group in the new and emerging world.  If they don’t, then the opportunity for practical change and growth is even more exciting and real.

There will be more to come on this topic, but in the meantime, if you have ideas, comments and questions to share, please email Hospice UK or share via Twitter and comment in ehospice.  It’s vital we get the conversation started.