Article by Rev. Dr. John Smith
Rev. Dr. John Smith response to recent events concerning the future funding of Cransley Hospice.
( previously printed in the Kettering Evening Telegraph.
A short history lesson. The modern hospice movement began in the 1960’s when St Christopher’s Hospice in London was founded. The word hospice means a resting place on a journey; that journey being from life to death. It recognised that a different approach was needed with a focus on symptom control rather than cure, of emotional and spiritual support to the patient and family, helping people to live until they die, never giving up but caring in a very different and skilled way.
Since then the movement has spread throughout our country and throughout the world too, and Cynthia Spencer and Cransley Hospices are part of that. Hospice is not just a building, the work it does spreads far beyond to our hospitals and to the community.
So far so good this is where it gets more difficult.
The first hospice was built and staffed using charitable money and that is how most hospices have been built, paid for and run. The NHS buys into the services of the hospice but does not run or control them. Each independent hospice needs to raise millions every year.
There are however a small but significant number of hospices, including the two in our county, that are run and funded by the NHS.
When Cransley opened its doors in that old ward at St Mary’s Hospital, NHS funding was virtually 100%. It soon became complicated because people expressed their gratitude by donating to the hospice. We did not ask for this but it enabled us to improve the service by employing more staff. Many of you if you have had contact with the hospice will realise that it is the staff who make the difference. Once you employ extra staff you begin to need to raise the money to pay for them each year. That is why we started our charity, under the leadership of Diana Patrick, and why it now raises over £600,000 each year for Cransley, a sum that is 30% of the total cost of running the service with the NHS contributing the other 70%.
Our local health commissioners want to alter the way in which hospices are funded in our county. Is this a threat or an opportunity……I think the latter,
I think that potentially it is a massive opportunity for our community, but that will depend on us all being prepared in what are still difficult times to donate more money and more time to the hospice charities. If we are not prepared to do that then the services to patients in the last few months of their lives will not deteriorate but they will not develop either.
Let me explain.
56% of the population of Northamptonshire die in places other than their home whereas 70% of people, given a choice, would like to die at home.
Less than 6% of people die in a hospice, many more would like to, it is the second most preferred place of death. Most die in our general hospitals which is the least popular preferred place.
And of course, it is not just about place. It is about quality, humanity, time, space, anticipation of problems. It is about being listened to and supported. We need to do all this and more.
It is clear that both hospices need more beds, although Cransley has a more urgent need. In those beds many complex problems can be sorted, allowing patients to go home and, if they wish, stay at home.
Patients in the last year of their lives need regular review, problems can be anticipated, plans of action drawn up, drugs ordered, equipment in place. This done there will be less crises, less emergency admissions.
The very sick do not get serious problems only between 9 and 5, there is a need for a 24 hour, 7 day a week service that can and will respond to crisis. That service needs to be staffed by skilled well trained staff with specialist back-up.
And all of this applies to not just cancer patients but end stage heart and lung disease, and neurological illness too. It needs to be able to manage this in patients with dementia too, and learning disabilities who find it difficult to express themselves.
If this is to happen the NHS is not going to come up with more money. That is the reality. We will need to raise at this end of the county upwards of £6 million to build a new Cransley and probably £2 million plus each year to run the sort of service I describe.
You must be crazy I hear you say. No I am not. It is possible. At the moment the hospice charities are raising £3 per head of population in Northamptonshire. In Warwickshire they raise £9, in Leicestershire £16 per head. Yes they are wealthier counties but Northamptonshire has a heart and given the opportunity will rise to it.