The Voices that Shaped Us:
Modern Hospice in the Making

Reflections

Reflections


 Over-reach and over-spend 

Living up to our international reputation while staying afloat has sometimes been difficult.

Despite inspiring the modern hospice movement, St Christopher’s did not always have the management and fundraising strategies to sustain all our activities.

Applying our holistic approach widely, including to people needing long-term care, meant we sometimes ended up delivering ‘gold-plated care for the privileged few’.

While we continued our international teaching programme, by the 1990s new palliative care research was increasingly taking place elsewhere.

A financial crisis in 2000 proved that St Christopher’s was spreading itself too thinly. Difficult decisions were made to close services such as Draper’s Wing for elderly residents and to stop admitting long-stay patients.

We embraced up-to-date IT systems and, importantly, shifted our focus from the in-patient unit to the community.

We also forged formal links with the NHS, securing some guaranteed funding and improving our efficiency.

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 We had a projected deficit of £1.8 million and banks would not give us an overdraft.

 Dame Barbara Monroe, Former Chief Executive, St Christopher’s Hospice

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The downside is we were part of everybody’s myth and Cicely, in a way, was part of everybody’s myth. As she got older, that must have been, not exactly a strait jacket because she probably sank into it with some comfort, but it made it very hard for us to change. We had a crisis and we had to change and that gave us the kind of external push.

 Dame Barbara Monroe, Former Chief Executive, St Christopher’s Hospice 

If you don’t move with the times and if you’re not changing your service delivery to match what the community needs, then you find yourself having problems. And I guess St Christopher’s, being the remarkable organisation it was in the 1960s and 70s, it probably got a bit stuck in terms of service delivery.

 Nigel Hartley, Former Director of Supportive Care, St Christopher’s Hospice

 Change in the 21st century 

External events and changes in society continue to challenge St Christopher’s, encouraging us to develop how we work. Increasingly, people choose to be helped to live at home, and we have moved away from open wards towards single occupancy rooms.

In 2010 the chapel was replaced with the Pilgrim Room, a quiet space open to all, to reflect the diversity of belief amongst people who come to St Christopher’s and provide a space where all feel welcome. Then in 2012, a serious legionella outbreak required us to modernise our plumbing system and buildings.

During the HIV/AIDS crisis in the 1980s we wrongly discouraged patients dying from AIDS-related causes from accessing our services. We recognise and apologise for the harm this caused to people and for many years we have been committed to ensuring that nobody is excluded from St Christopher’s. Please read our full statement here.

Recently, during the COVID-19 pandemic, we brought together community members, organisations and volunteers through a Community Aid initiative, helping to tackle isolation and loneliness. We moved our support services online and, where possible, remained open for visits on the wards.

During a review of our history, we were sad to note moments when we have failed to provide care where it may have been valuable. In particular, we regret our response to people with HIV/AIDS early in its epidemic. Like many healthcare providers at the time, we failed to encourage patients dying from AIDS-related causes from accessing our services, and we recognise that this led to a lack of trust in our organisation amongst many individuals and communities at the time.


In retrospect, we wish that we had been more open with professionals who wished to refer patients to us; and had better listened to people’s needs and sought to understand where our expertise and support at the end of life would have been beneficial. We apologise for failing them in this regard.

For many years, we have been committed to ensuring that nobody feels excluded from St Christopher’s, but we know that inequalities in end of life care continue to exist. Despite our strong aspiration to be inclusive and highly responsive to emerging needs for palliative care, we recognise that there are still barriers preventing some groups of people from accessing our services. Whilst some of these barriers reflect our own limitations, many others are a consequence of much broader structural and societal inequalities. 

We want to help redress this inequity of access to care, and have made doing so a key priority at St Christopher’s. With our new Centre for Awareness and Response to End of Life, we have developed a programme of learning focused on understanding and reducing structural inequalities which impact end of life care. Our Quality Governance programme identifies groups and communities with palliative care needs who are at risk of marginalisation, and galvanises action to ensure they are not forgotten. In addition, our Board of Trustees have invested in research specifically targeting exclusion from end of life care.

We are keen to ensure that history does not repeat itself, and will make every effort to continue improving our services to reflect past, current and future needs.

Voices reflections rb Marie Curie and St Christophers Rapid Response Unit

 When we tried to close the chapel, you’d think we were blowing the place up. The hospice was built round the chapel, Dame Cicely was a Christian, that was her foundation, but it’s not an idol. So, for example closing the chapel caused an awful lot of problems but the reality was it was not a good use of that space. 

 Deborah Holman, Former Clinical Nurse Specialist, St Christopher’s Hospice 

 Covid has made us work and think about supporting, not only the community of our patients, but also supporting ourselves more and looking at a bigger picture of how we can work together. So, what a pandemic does is amazing in how you work closer together. I feel really proud of what we’ve done. 

 Anne Nash, Consultant Nurse, St Christopher’s Hospice 

 Hospice: Today and the Future

Death and dying affect us all. Since 1967, St Christopher’s has developed into an organisation addressing these universal issues alongside the communities we serve, locally and internationally.

From our pioneering Community Action Team, established in 2018, to engaging with new research projects, we want to use our reputation as the home of the modern hospice movement to continue to improve people’s experience of death.

The COVID-19 pandemic, the Black Lives Matter movement, and the climate emergency have all made it clear that more needs to be done to challenge inequalities in healthcare, including end of life care, by ourselves and the organisations that we work alongside.

An ageing population will require additional support and dementia is now the leading cause of death in the UK. As more countries legalise assisted dying, we must decide how to respond to potential changes to the law and in society.

St Christopher’s CARE, the Centre for Awareness and Response to End of Life, is our new education space for everyone – public or professional – to consider how we live with dying and loss in the future.

 The best will mobilise the community 

 Shaun O’Leary, Former Chief Executive, St Christopher’s Hospice

voices reflections rb Compassionate Neighbours

 Hospice care is so human. Everybody dies, everybody needs care: it’s so obvious that we shouldn’t waste our time on horrible, pointless interventions when we could actually make people comfortable and Namaste Care [a programme for people with dementia] is an echo of that for people with dementia, which is now the foremost cause of death in this country.

 Min Stacpoole, Former Nurse Lecturer in Palliative Care, St Christopher’s Hospice

 Until we do normalise what death and dying looks like, we’re going to continue to put it behind closed doors in a hospice or in a hospital.

 Vincent Docherty, Safeguarding Lead & Social Worker, St Christopher’s Hospice 

Where we are today

 Much of St Christopher’s today would be easily recognisable to the pioneers of hospice 55 years ago. The difference lies in the scale of the services we offer and the range of people we reach. 

In 2022:

  • the hospice continues to offer 28 inpatient beds. 
  • community-based services (including support in care homes) are used by around 1200 people at any one time. 
  • bereavement services support around 1500 adults and 250 children and their families each year. 
  • community action, focused on end of life and facilitated by the hospice, reaches around 450 people a month. 
  • less than 50% of our users have a primary diagnosis of cancer. 
  • we anticipate helping 10,000 people learn through St Christopher’s CARE in the course of the year. 
  • we raise in the region of £14m a year from our community and enjoy the input of over 1000 volunteers, alongside a paid workforce of around 500 people. 

Also in this section

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The voices that shaped us: Early years

Explore the story behind the creation of St Christopher's Hospice

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The voices that shaped us: The work

Hear about on the wards and the work of the hospice as it developed

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The voices that shaped us: Your say

Share your thoughts on death and dying, on the role of hospices and on your memories of St Christopher’s

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