St Luke's Hospice

A Message from Lord Pickles and Lord Blunkett, followed by St Luke's Hospice's best practice article

The ability to listen and learn from one another has always been vital in parliament, in business and in most aspects of daily life. But at this particular moment in time, as national and global events continue to reiterate, it is uncommonly crucial that we forge new channels of communication and reinforce existing ones. The following article from St Luke's Hospice is an attempt to do just that. We would welcome your thoughts on this or any other Parliamentary Review article.

Blunkett signature Rt Hon The Lord David Blunkett
Pickles signature Rt Hon The Lord Eric Pickles

www.stlukes-hospice.org

BEST PRACTICE SPONSOR 2020
THE PARLIAMENTARY REVIEW
Highlighting best practice
38 | THE NEW HALL LANE PRACTICE
in their countries of origin, and some
actively resist having any vaccinations
for themselves or their children as they
regard them as dangerous.
Throughout it all, however, we are
trying our hardest to face these
challenges with compassion and good
humour. We have for many years been
involved in training all levels of learners,
including medical and nursing students,
as well as trainee general practitioners.
We try to recruit from among the
learners who have trained with us as
we find they are used to the problems
faced by team members andpatients.
Success against a difficult
backdrop for general practice
We have successfully retained many of
our key staff because they know that
their emotional needs as well as their
intellectual and training needs will be
addressed at work. Many of our staff
have spent their entire general practice
careers with us. We are lucky to share
the joys, heartaches and irritations of
working life with each other, which
makes us better able to deliver a quality
service in less-than-ideal surroundings.
At present, however, we are concerned
that the wellbeing of general practice
is hanging in the balance. Many
practices have closed, and many
others have merged to remain viable.
It is clear that there is a driving force
towards merger in order to find
economies of scale in primary care.
The plans seem to be to provide
as many services as possible in the
community to reduce costs. This is a
good idea, but it cannot be successfully
implemented without the resources
to follow. It is impossible to provide
quality services on a shoestring budget.
In spite of an arguably challenging
medical backdrop, we will continue to
provide services at scale and innovate
to deliver evidence-based quality
general care to our patient base. Our
developments up to this point have
allowed us to thrive through difficult
circumstances, and I am confident this
will carry on being the case.
The wellbeing
of general
practice is
hanging in the
balance
»OUR WISHLIST
If it were possible to influence policy for the future of general practice, there is a wish list we would produce.
»General practice works efficiently because self-employed GPs give their time freely to do unpaid and unacknowledged
work. This would disappear if all practices merged and we became employees of a larger organisation.
»Allowing private companies to take over the core work of the NHS leads to poorer services in many cases. They
cherry-pick the easiest work and leave the challenging cases to NHS staff. In both general practice and secondary
care, this leads to the loss of vital income streams that have traditionally subsidised the less lucrative services.
»Resources cannot be allocated simply on the basis of population numbers. The characteristics of the population
must be taken into account. It seems obvious that the sickest patients will need the greatest numbers of
doctors, nurses, drugs – but this is, unfortunately, not always what happens. Services should be concentrated in
the areas of greatest need.
»Many recent contract changes have been decided by our negotiators on the basis of ideals held by a white,
middle-class and educated population. They do not fit with the needs or demands of our patients. Many seem
to be devised entirely for London or other cities of similar size. Once again, the outcome of this is reduced
income streams that compromise our ability to provide services to our patients.
Our multicultural team
39ST LUKE’S HOSPICE |
HEALTH & SOCIAL WORK
CEO Alpana Malde
St Luke’s tranquil garden
Working across the boroughs of Harrow and Brent,
St Luke’s Hospice provides palliative care to local
residents. Two-thirds of the hospice’s care is provided
in the comfort of peoples’ homes, and the 12-bed inpatient unit
is on hand for individuals who require specialist care. Hospice
UK statistics show that as many as 80 per cent of hospices are in
financial deficit; CEO Alpana Malde explores how hospices like
hers are preparing for the future given these monetary concerns
and the UK’s ageing population.
St Luke’s Hospice is based in northwest London. We provide specialist palliative
care to people with illnesses that are no longer curable, in Harrow and Brent.
Our health and social care professionals work together in a holistic, multidisciplinary
capacity, putting the person and their wellness at the centre of all we do, adding
life to days when days cannot be added to life.
Our care
The care we give is free of charge, available to all and respectful of the cultures,
religions and beliefs of our richly diverse community.
Two thirds of our care is provided in the home so that individuals are supported to
be as independent as possible. Demand for this type of care is rapidly rising, and
as a society, we need to consider how we care for people at the end of their life
keeping them in surroundings they are familiar with, whether that is a residential
home or their own home.
FACTS ABOUT
ST LUKE’S HOSPICE
»CEO: Alpana Malde
»Established in 1984
»Operates in the London
Boroughs of Harrow and Brent
»Services: Inpatient, wellbeing
and community
»No. of employees: 185, as well
as 850 volunteers
»St Luke’s Hospice relies on the
support of the community for
more than 60 per cent of its
funding
St Luke’s Hospice
THE PARLIAMENTARY REVIEW
Highlighting best practice
THE PARLIAMENTARY REVIEW
Highlighting best practice
40 | ST LUKE’S HOSPICE
»THE IMPACT OF OUR WORK
“I was initially referred to come to
StLuke’s Hospice by my occupational
therapist. My first reaction was –
hospices mean end of life. People
are not aware of what happens in a
hospice. I have lived locally for 25 years
and I passed the hospice every day but
never knew what happened there. I
never expected that I would come to
the hospice. People generally think
hospices are just for cancer patients
butSt Luke’s also cares for those with
other terminal illnesses. When I first came here it opened my eyes.
The staff, dedication and care from top to bottom is amazing.”
Our multidisciplinary team
includes specialist doctors, nurses,
physiotherapists, complementary
therapists, social workers and
bereavement counsellors. This umbrella
covers medical, physical, emotional,
spiritual and practical needs and
ensures that the people we care for
and their loved ones are able to live
each day as fully as possible. We work
in collaboration with colleagues in the
NHS, taking an integrated approach
and working with them to improve
care for people at the end of their life.
In the hospice itself, our care is
delivered in our day centre, where
patients attend for a day or two a
week, benefiting from social activities
such as exercise, gardening, music
therapy and art and craft activities.
We are also able to care for people
in our 12-bed inpatient unit if they
need more specialist care to manage
complex symptoms, terminal care or
even if their carers require respite.
Contrary to common belief, over a
quarter of the patients who stay with
us are discharged home, their needs
having been addressed.
In the community, our team of
specialist palliative care nurses work
with patients and families to ensure
that these patients are able to access
the services and care they need and
that they are able to stay in the
comfort of their own homes for as
long as possible. In addition, we
have a team that delivers “hospice
at home” support for day-to-day
domiciliaryneeds.
Our single point of access is a helpline
and referral service set up and partly
funded by NHS Harrow CCG. This is a
telephone line manned on a 24-hour
basis by expert nurses with capacity
for a rapid response visit if necessary.
In addition to patients and families
who call when there is a crisis, this
service has supported ambulance
staff who are called out to keep dying
people at home rather than enduring a
distressing admission to hospital.
In 2017, 82 per cent of calls from
ambulance staff to this service resulted
in inpatients staying at home, relieving
pressure on stretched hospital facilities.
We are looking to extend this service
into Brent as well.
Values and mission
Our core values are care, respect,
excellence, inclusivity and
empowerment. These values are the
bedrock on which we base all that we
do and how we do it.
Our physiotherapists
provide assessments and
exercise programmes to
ease symptoms
Adding life to
days when
days cannot
be added
tolife
BEST PRACTICE SPONSOR 2020
THE PARLIAMENTARY REVIEW
Highlighting best practice
40 | ST LUKE’S HOSPICE
»THE IMPACT OF OUR WORK
“I was initially referred to come to
StLuke’s Hospice by my occupational
therapist. My first reaction was –
hospices mean end of life. People
are not aware of what happens in a
hospice. I have lived locally for 25 years
and I passed the hospice every day but
never knew what happened there. I
never expected that I would come to
the hospice. People generally think
hospices are just for cancer patients
butSt Luke’s also cares for those with
other terminal illnesses. When I first came here it opened my eyes.
The staff, dedication and care from top to bottom is amazing.”
Our multidisciplinary team
includes specialist doctors, nurses,
physiotherapists, complementary
therapists, social workers and
bereavement counsellors. This umbrella
covers medical, physical, emotional,
spiritual and practical needs and
ensures that the people we care for
and their loved ones are able to live
each day as fully as possible. We work
in collaboration with colleagues in the
NHS, taking an integrated approach
and working with them to improve
care for people at the end of their life.
In the hospice itself, our care is
delivered in our day centre, where
patients attend for a day or two a
week, benefiting from social activities
such as exercise, gardening, music
therapy and art and craft activities.
We are also able to care for people
in our 12-bed inpatient unit if they
need more specialist care to manage
complex symptoms, terminal care or
even if their carers require respite.
Contrary to common belief, over a
quarter of the patients who stay with
us are discharged home, their needs
having been addressed.
In the community, our team of
specialist palliative care nurses work
with patients and families to ensure
that these patients are able to access
the services and care they need and
that they are able to stay in the
comfort of their own homes for as
long as possible. In addition, we
have a team that delivers “hospice
at home” support for day-to-day
domiciliaryneeds.
Our single point of access is a helpline
and referral service set up and partly
funded by NHS Harrow CCG. This is a
telephone line manned on a 24-hour
basis by expert nurses with capacity
for a rapid response visit if necessary.
In addition to patients and families
who call when there is a crisis, this
service has supported ambulance
staff who are called out to keep dying
people at home rather than enduring a
distressing admission to hospital.
In 2017, 82 per cent of calls from
ambulance staff to this service resulted
in inpatients staying at home, relieving
pressure on stretched hospital facilities.
We are looking to extend this service
into Brent as well.
Values and mission
Our core values are care, respect,
excellence, inclusivity and
empowerment. These values are the
bedrock on which we base all that we
do and how we do it.
Our physiotherapists
provide assessments and
exercise programmes to
ease symptoms
Adding life to
days when
days cannot
be added
tolife
41ST LUKE’S HOSPICE |
HEALTH & SOCIAL WORK
For the future, we have a four-point
mission to:
»Reach more people
»Constantly improve all we do
»Extend our influence by collaboration,
innovation and education
»Be an accountable and sustainable
organisation
Our challenges
Traditionally, hospice patients have
predominantly been those with cancer
and neurological conditions. With
advances in technology, people are
living longer with a greater number of
conditions and increasing frailty at the
end of their lives. If we are to support
more people, we will have to adapt
and add to what we already do so that
we can support this frail population
earlier in their end-of-life phase with a
greater focus on their wellbeing.
In common with all healthcare
organisations, recruiting nurses
is especially difficult. As a small
organisation, we cannot afford to
recruit from overseas. Currently, we are
able to match NHS salaries; however,
if these keep increasing, we may fail to
attract staff, putting our care at risk.
Hospices across the country are setting
deficit budgets because of increasing
demand for services, increasing
staff costs to stay competitive and
constraints on statutory finding. At
the last Hospice UK Conference, it
was stated that over 80 per cent of
hospices are in deficit. St Luke’s has
recorded deficits of £1 million in each
of the last two years. This has depleted
our financial reserves and is simply
notsustainable.
We have had to make some tough
decisions over the last year and have
reviewed everything that we do to find
savings of £300,000. We have had
to cease some services. Notably, we
have had to stop providing education
and clinical support to care homes.
This may mean that the quality of
care for residents in those homes is
adverselyaffected.
Finally, we do not know how wider
political and economic factors will
impact us. We receive approximately
40 per cent of the costs of our care
from government sources, and if there
are cuts to funding for the public
sector, this may mean we receive less.
If we cannot recruit workers from the
EU, then hiring skilled staff may be
even more challenging. Donors who
fund most of the costs of our care may
have less money to give us.
In short, we see the makings of a
perfect storm for hospices.
An ideal future
The government needs to act and
review funding for hospices so that we
are able to continue to survive, thrive
and grow.
We bring significant charitable leverage
to the table, and for a relatively small
investment in macro-economic terms,
we could support a much greater
proportion of people who are frail
and at the end of their lives with our
exceptional person-centred care. The
UK leads the world in offering the best
end-of-life care because of a strong,
dedicated hospice movement. Let’s
keep it that way.
The UK leads
the world in
offering the
best end-of-life
care because of
a strong,
dedicated
hospice
movement.
Let’s keep it
that way
Supporting local people
is at the heart of what
we do

www.stlukes-hospice.org

This article was sponsored by St Luke's Hospice. The Parliamentary Review is wholly funded by the representatives who write for it. The publication in which this article originally appeared contained the following foreword from Rt Hon Elizabeth Truss.

Rt Hon Elizabeth Truss's Foreword For The Parliamentary Review

By Rt Hon Elizabeth Truss

Even by the standards of the day –this has been one of the most exciting and unpredictable years in British politics.

The leadership election we’ve just seen marks a huge moment in our country’s history. This government is taking a decisive new direction, embracing the opportunities of Brexit and preparing our country to flourish outside the EU.

As international trade secretary, I’ll be driving forward work on the free trade agreements that are going to be a priority for the government. Free trade isn’t just an abstract concept bandied around by technocrats. It is crucial for a strong economy and for the ability of families to make ends meet. Free trade benefits people in every part of our country, as British firms export to new markets and people doing the weekly shop have access to a wider choice of goods at lower prices.

The essence of free trade is in the title: freedom. It’s about giving people the power to exchange their goods without heavy government taxation or interference. Commerce and free exchange are the engine room of prosperity and social mobility. I’m determined to tackle the forces who want to hold that back.

One of my priorities is agreeing an exciting new free trade deal with the US, building on the great relationship between our two countries and the Prime Minister and US President. But I’ll also be talking to other partners including New Zealand, Australia and fast-growing Asian markets.

And with the EU too, we want a friendly and constructive relationship, as constitutional equals, and as friends and partners in facing the challenges that lie ahead – a relationship based on a deep free trade agreement. Our country produces some of the world’s most successful exports, and the opportunity to bring these to the rest of the world should make us all excited about the future. It is this excitement, optimism and ambition which I believe will come to define this government.

For too long now, we have been told Britain isn’t big or important enough to survive outside the EU – that we have to accept a deal that reflects our reduced circumstances. I say that’s rubbish. With the right policies in place, we can be the most competitive, free-thinking, prosperous nation on Earth exporting to the world and leading in new developments like AI. To do that, we’ll give the brilliant next generation of entrepreneurs the tools they need to succeed. Since 2015, there has been a staggering 85 per cent rise in the number of businesses set up by 18 to 24 year olds – twice the level set up by the same age group in France and Germany. We’ll help them flourish by championing enterprise, cutting taxes and making regulation flexible and responsive to their needs.

As we do that, we’ll level up and unite all parts of the UK with great transport links, fibre broadband in every home and proper school funding, so everyone shares in our country’s success.

2019 has been the year of brewing economic and political revolution. 2020 will be the year when a revitalised Conservative government turbo charges the economy, boosts prospects for people across the country, and catapults Britain back to the forefront of the world stage.



Rt Hon Elizabeth Truss
Secretary of State for International Development