Today I wrote my last update for the Teesside Hospice team.
Hi Everybody
It’s been a while since Ive written an update and with this being my final full week, I thought I’d better do one now before it’s too late!
It’s been a lively start to 2024 at Teesside Hospice. Across our services – inpatient unit, lymphoedema, counselling, wellbeing – demand has been pretty consistently high. There have been some dips in IPU occupancy but also some peaks with rates higher than we’d usually expect. Our lymphoedema team have continued to manage a huge increase in demand but like any service, has now pretty much reach the capacity it can manage without additional staff and resources. Whilst our counselling service remains focussed on complex grief and trauma, referrals for that specialist support have increased and with waiting lists being far from ideal, the team are looking at what more we can do to get people the help they need as quickly as possible. Our wellbeing team remain as innovative as ever with the work delivered in the hospice alongside trialling outreach activities in different parts of the area. We’ve just heard the in-reach work the team do into James Cook Hospital is being continued for the rest of the year which is great news as it helps us to quickly find and bring in people who are currently on the wards who would benefit from the specialist care our hospice provides.
Of course, none of this would be possible without the superb teams that we have – you! I know some have been battling recently with nasty bugs that have been going round so a huge thank to everybody for stepping up and keeping services, events and shops running when staff numbers have been down a little. On the hospice site there have been some more changes with the new barrier going in on the car park and a lovely refresh of the décor in the training room and upstairs meeting room. With the spring flowers starting to bloom it’s also a great reminder of the wonderful work our volunteer gardeners do keeping on top of what is a never endling task of maintenance, planting and weeding!
Over the years Ive been at the hospice, money (or the lack of it!) has been a big focus of my work. Our income generation teams have had another cracking year and by the end of this month we’re expecting our latest shop in Ingleby Barwick to be open. Fundraising and retail can be a hard slog at times with lots of work the rest of us don’t see so a huge thank you from me to that team because without their work we wouldn’t be able to deliver anything like the level of hospice care we do.
Whilst we’re not out of the woods yet on our NHS funding, we’ve made some real progress in recent months. Commissioners have now agreed that we should be paid a fair rate (we currently only get around 1/3rd of that level) for the specialist work we do on their behalf and they have also agreed that rate should be the same level NHS organisations get paid for doing similar activity. It sounds straightforward but getting to this point has taken a huge effort, locally, regionally and nationally and even though our contracts don’t yet reflect this ambition – the direction of travel is now in the right direction with much more optimism about how hospice funding will evolve over the next few years. I know that some of the changes we had to make in past years were hard to stomach but by reducing our overheads then, we’ve been able to better manage the deficit and are now in a much stronger position to weather the storm until the promised new NHS contracts finally appear.
Alongside my own departure, there are a few other changes taking place over the next couple of weeks. At the Board of Trustees meeting on Thursday our wonderful Chair, Elaine Criddle, will be stepping down after 6 years and her fellow trustee Cath Ellington will also be leaving us. Cath has done a sterling job chairing the income generation committee and will be much missed by the whole team. We have two potential new trustees joining at that meeting including one who has been specifically recruited to help us think about how digital, AI and technology might help the hospice develop in the future. Gary Whitehead, who has been a trustee for five years, will be taking over as the Chair of the Hospice. I know many of you will have already met Gary but for those who haven’t, I’m sure you’ll be seeing him around the hospice and popping in to shops and services to say hello.
Elaine and I have worked closely together over the last few years on refreshing the way our governance works at the hospice, taking our story out into the wider world and campaigning for fair and sustainable funding from the NHS. It seems fitting that we both bow out at the same time and handover to Gary and Mike Thornicroft who will be starting as the new Chief Executive on 4th March.
After the board meeting in the training room on Thursday, about midday, there will be a bit of cake and a chance to come and say goodbye to Elaine and Cath. It will also be a chance to meet Mike will be joining us too before he officially starts on Monday. If you’re around and have the time please do pop in and say hello….and goodbye!
These last five years or so have been amongst the best of my life, working with some of the best people and for such an important cause. It’s been far from plain sailing with plenty of curve balls (like a little global pandemic!) along the way but it’s been an absolute honour and privilege that I’ll never forget.
Thank you for all you have done for the hospice and for the support you’ve given me over the years. #TeamTeesside, you really are the best!
Christmas is one of those periods in the year that give many of us pause for thought, the opportunity to reflect on the last year, spend time with loved ones and feel the absence of those no longer with us. As a hospice, this has been the first year since 2019 that hasn’t been dominated by covid and although the acute phase is thankfully over, the long shadow of the pandemic has left a legacy that we will be confronting for many more years to come.
At the forefront of my thoughts is the seemingly permanent change in the demographic using our inpatient services with younger people now much greater in number than previously. In time we’ll have official data but there is little doubt in my mind that the delays in diagnosis and treatment during lockdown is a direct contributor to this change and is seems unlikely the challenges our partners in the NHS are facing will be resolved any time soon. As a hospice we are doing all that we can to make our services welcoming and accessible for younger people and thinking too about those with young families and what more we can do to support children and other loved ones experiencing the devastation of trauma, loss and bereavement.
This sits on top of what we know is increasing demand for palliative and end of life care. With its energy, community, history and iconic landscapes it can be easy to overlook the long-term health problems many Teessiders face. As a hospice we want to be there for everybody who can benefit from our care but a peculiarity of NHS funding has always meant that specialist palliative and end of life care, what many would consider the very foundation of a caring society, has always relied heavily on charitable funding and donations for its support. In the face of rapidly increasing costs, this year finally saw MPs uniting and the government amending the law to change this anomaly and as your local hospice we have been campaigning hard to make sure this brings much needed and lasting change to our area. Progress has been painfully slow but with clear law and statutory guidance I am confident that in years to come hospices like ours, that started the year with a large financial deficit, will be able to gradually expand the services they offer and help more people and family affected by terminal illness.
Of course, the NHS will never cover all of the costs associated with hospice care and for the next few years at least, we have to fundraise for around 70% of the costs of delivering the care many people assume is already paid for. Our remarkable community of fundraisers, donors and supporters have worked tirelessly again running events, charity shops, challenges, corporate sponsorships and more. As always, I’ve been bowled over by how just much our community values its hospice and the money raised has enabled us to care for many hundreds of people and families who need the specialist-level hospice care that isn’t available elsewhere. To each and every one of you please accept my thanks and gratitude. I know how difficult times are right now for many people and your support is something we truly value and never take for granted.
On a personal note, this will be my last Christmas at Teesside Hospice. After five years in the role of Chief Executive its time for me to move on to pastures new in the spring. Working at Teesside Hospice has been an enormous privilege and given me the ability to see, every single day, families like my own who needed hospice care and got it because of the team here. In my book that’s priceless and something that will stay with me for the rest of my life.
I’ve lost count of the number of blogs I’ve written over the years about mental health, leadership, hospice care and charity in general. This one will be a bit different. The headline says it all but if you want to know why, read on. Perhaps with a cuppa and a biscuit though because it goes on a bit!
I came to Teesside Hospice coming up for five years ago now at the end of 2018. Still raw from my Mums death the previous year, I wanted to make sure that families like ours got the same level of care as we did in Mums final days. Mistakes in her care in hospital had been painful. Approaching death on a busy bayed hospital ward uncomfortable. Different people every day, no clear answers. Mum was in the wrong place, with the wrong people at the wrong time.
Her transfer to St Luke’s in Sheffield for what was to be her final week brought such a relief to us all. Dad could park the car without drama, there was peace and calm, the staff were approachable and kind. I can’t tell you the number of times Mum talked about the amazing food, even though by that point she was eating very little.
The clinical team took care of us all. They helped us plan as a family, listened to what was important to us. Made sure Dad had something to eat when he didn’t go home for food. When her grandkids came to say goodbye the team made the day a memorable one, taking Mum outside so we could enjoy the sunshine together and making a frightening and overwhelming experience just that little but easier for us all.
In that time something clicked in me and my passion of the previous decade or so, mental health turned to hospice care. True hospice care that genuinely puts people first, not a tick box strapline and logo on a website that too often falls by the wayside when pressure mounts elsewhere. In many ways, good mental health support and good support at end of life are entirely intertwined everywhere except in NHS organisational structures and service specifications.
Like many well laid plans, the reality of hospice finance soon curtailed my early ambitions. Having worked previously in a well-integrated, collaborative system the fractious nature of my new area became quickly apparent. Few co-terminus public bodies, historic competition between providers and districts, the legacy of unresolved grant and contract ‘anomalies’ and the usual churn of health service reorganisation in an area facing huge health inequalities, higher burden of illness and entrenched levels of poverty and exclusion. In addition to the external pressures, internal governance at the hospice needed a refresh so my first year was spent doing all those things that will be familiar to many incoming Chief Execs. Seeking out allies, unpicking historic arrangements, building new teams, structures and objectives, stopping some things, starting others. Oh, and of course that small challenge of Covid whilst working in a charity that relies on retail and fundraising events to support good deaths in the community. I’m sure there is a book to be written at some time about that final point alone!
Over the years we’ve invested in the teams and leadership at the hospice, refined our messaging, found cost efficiencies, strengthened alliances, increased our fundraising, refreshed the buildings and restructured most of our services. The challenge of financial sustainability remains but campaigning for fair funding, which since last year is now simply that required by law and guidance, is at least moving on from the previous one-way stuck record of “you need to prove the difference you make”. Finally specialist palliative and end of life care is recognised as the core, mandated health service it should always have been.
Of course, it’s not all been plain sailing. Campaigning and changing established power and practice can raise all sorts of emotions and fears and sometimes these have been played out in unhelpful ways. Recognising why people are reacting as they are rationalises the behaviour but still, it’s not a pleasant experience. Thankfully it’s not been my first gig and I’m just one person amongst an impressive team of leaders – both inside and outside the hospice. Looking out across the hospice teams today I’m so proud of how they have developed. From the governance though to the clinical services, income generation and support services. Our partnerships and collaborations with the NHS, local authorities, voluntary sector and others. Our corporate supporters and of course the many thousands of local people who donate money every year to keep Teesside Hospice there for them, a local charity they trust and rely on in some of the most difficult times imaginable.
So why on earth am I leaving!?!? The answer is both complicated and simple.
I’ve always believed that a charity Chief Exec role is a unique one that has a shelf life. I know some disagree but for me, five years give or take a year or two feels right. Its enough time to make a difference but without becoming part of the problem. Staying long term in the top job is a slippery slope and whilst a small number can manage it well, I’ve seen too many senior leaders who become entrenched, disconnected and struggle to stay fresh. I don’t want to be that person people associated as the charity, rather than working for the charity.
There are also two very practical reasons for choosing now as the right time to step down. Throughout our forties, that busy decade when everything seemed to be about long hours and work, my partner and I talked dreamily about being able to step back a little, travel, relax. I’ve spent years commuting and working away from home and whilst the A19 is much kinder than the M1 and podcasts help the time go by its slowly becoming a chore. With Paul taking early retirement from a stressful railway job at the end of last year he’s now loving his part time shop job and that’s certainly been another factor in my thinking.
With these three things, plus the hospice being in a good place operationally it seems like the perfect time to set a firm date in the diary and put succession planning into practice. I deliberately chose to give a long notice period so that the board will have time to reflect on what the charity needs from its next Chief Executive. Modesty aside, I was right for 2018 but this next phase may require a different skillset or experience. The next five years or so has the potential to see a significant and positive shift in how hospice care is funded and integrated into the wider NHS. How hospices collaborate, share or even merge will become increasingly important, especially in an area like ours with several operating on a relatively small geographic footprint. It will be an exciting time for a new leader to take over to build on a firm base and maybe even take that dream I had in 2018 of hospice quality care for everybody a little bit closer to reality than I managed in the time I’ve been here.
What next for me? Who knows? Whilst I can’t see myself hanging up my suit just yet a time to rest and reflect is appealing. I’ll certainly be volunteering in a charity or two and maybe even looking out for something part time or non-exec. Mental health, hospice care and the power charities have to speak truth to power to bring about social change is too far baked into my DNA to just read, watch Netflix of play Minecraft for the rest of my life!
We’re expecting the recruitment process to start in the next month or so and I’m delighted that our Chair, Elaine Criddle, who had planned to step down this year has agreed to stay on to lead the recruitment of the new Chief Exec. Elaine has been an instrumental part of the success Teesside Hospice has enjoyed in recent years and a great support to me in my role. Her continuity of leadership during the transition will bring assurance and confidence to the wider board, team and partners.
It’s too soon for me to be writing my goodbye speech but for those who have supported and encouraged me over the last few years. Thank you. What we’ve done at Teesside Hospice has been a real team effort from our paid staff, volunteers, trustees, supporters, customers, donors, partners and wider colleagues. The most special gift the hospice gave me was the ability to see, every single day, families like my own who needed hospice care and got it because of the team here. In my book that’s priceless and something that will stay with me for the rest of my life.
TLDR: I don’t know what AI will bring but I know it’s coming and we need to prepare.
For many years holidays were a time I would ‘try’ to relax, switch off and recharge. To be honest, it was rare that I ever really managed it but after a tricky first half of the year I took the plunge this time, turned off email, avoided tweeting and left work in the very capable hands of the hospice team.
With the usual stream of information interrupted I did indeed get the break I’d hoped for but rather than switch off, my brain jumped tracks. Instead of the here and now I started to think outside my usual and predictable topics and shifted into a much more deliberate and thoughtful consideration of something that been bouncing on the edge of my radar for some time but never really had the space to come into real focus.
Artificial intelligence and machine learning still seem like words from a sci-fi story when I see them written down. As a charity Chief Exec with much more mundane issues around workforce, finance and governance filling the day my pondering of what these things might mean doesn’t go much further than a few sessions with ChatGPT and the self assurance that my ‘O’ Level in Computer Studies means that of course I’ll be able to understand it all when the time is right. That last bit is obviously tongue in cheek but conflating IT and the ability to kick a printer into action with AI is probably one more than a few of us have made. AI isn’t something anybody in a leadership role can afford to “delegate to IT”.
Spending just a couple of weeks researching, delving into various sub-Reddit’s and Wikipedia articles has given me a sharp awakening on just how fast this new technology is developing and started me thinking more seriously about how it might affect my little bit of the world in a much shorter time scale that I might have previously imagined.
With the TV news channels talking about doomsday scenarios and debating the need to regulate AI development I find myself rather sceptical about the attempts our world governments might try in that sphere. Not known for putting global benefit first, I suspect we’ll be seeing lots of protectionism (sovereign, political, personal) with those who have the greatest power probably the ones least likely to understand the global repercussions of the actions they choose to take.
Likewise the debate on AI ethics. In our already deeply polarised society, who chooses what is ‘good’? With the likelihood of a global consensus infinitesimally small the possibility of competing ethical codes, including their outright absence in some cases seems inevitable. I sincerely hope I’m mistaken in this belief but history does not seem to say otherwise.
So with the big questions outside of my ability to influence, where doesn’t that leave AI in the short to medium term? What areas of my work might change and what should I be doing now to best prepare?
Working in a charitable hospice I can already see clear lines forming on where AI might or might not impact. In a hospice, like in many caring services supporting people in times of distress, I doubt AI will replace the human connection, compassion and love most of us need in times of turmoil. A shoulder to cry on, a hand to hold, a silence held between people sharing pain and loss. Likewise, with robotics seemingly falling behind AI development, the hands on nursing and care, cooking and cleaning, maintenance and transport, retail and much of our fundraising simply can’t be done without human beings trained and equipped to do job they have specific skills in.
In other areas though the future is much less clear. Governance, regulation, finance, human resources, contracting, strategy development, marketing, communications to name just a few are data driven activities with specific policies and predictable actions used to guide decision making. What too of medicine and other knowledge based roles? Whilst Doctors will inevitably remain an essential part of our system, could a large language model be trained on enough data to reliably diagnose and prescribe? Could it review clinical data and offer options? Would it be able to stay up to date without stopping working, follow NICE guidance and make sure records were 100% accurate all of the time? From what I’ve read, much of this is already being developed and at a pace unimaginable just a few years ago. With ChatGPT being able to write computer code, could this solve the interoperability problem that have plagued healthcare and other IT systems? Perhaps not this year but what about next?
Thinking more widely across our sector, what will it mean when next generation systems like GPT 5/6 can draw on the sum knowledge on the internet and give answers to problems we’ve been unable to comprehend so far? The causes and correlations that drive many of our charitable activities, shining a searing spotlight on the drivers of inequality, justice and truth.
How will we use this new data to mobilise and focus our resources? Of greater challenge though, how will we react if those answers surprise us or challenge long held assumptions? What if it offers workable solutions that conflict with our historic purpose or personal values? Whilst it won’t happen next week, those of us thinking through three or five year plans might need to be prepared for a paradigm shift in how we think and how we work.
All of that is easy to say but what will I actually be doing differently to prepare?
Firstly, I can’t do it alone. I need to make sure my team and my board feel safe and are having similar thoughts with a shared level of understanding. Secondly, ‘we’ can’t do it alone either. Working as part of a system we need to learn and develop together and make changes that avoid unintended consequences elsewhere.
Thirdly I think we need to beware the naysayers with power and influence. You know the ones – they avoided social media, have PA’s who type their emails and are desperate to hold onto the status quo through either fear of the unknown or the fear of losing control. They’ll probably be safely retired when the AI future arrives and that’s probably their driving goal anyway.
Fourth and fifth I think go hand in hand. The new work paradigm AI will bring will cause upheaval in the workplace. We need to look out for our teams, put resources into skills and training, be mindful in our language and cautious in adoption.
Of course all of this suggest we retain some choice over the timing and the scope of AI. My suspicion is that many of us in leadership roles will be caught out regardless of how much thought we put into it or how colourful our risk assessments and Gantt charts are. What will count is our ability to flex and adapt our work practices and organisation as the world around us changes.
So there we go. My deep and meaningful thoughts on the AI future. I wish I could offer any certainty on what it will look like and more clarity on when it will happen. The one thing I am sure of is that this juggernaut is in its way and we’ll feel it rumbling down the road much sooner than many of us expect.
I’m not sure whether this should be a blog, a diary, a book or a confession! The last few months have been a bit of a whirlwind and I somehow seem to have gone almost four months without writing a single blog. There’s a lot to catch up on!
First up – I’m OK. My mental health has taken a bit of a battering of late but after getting some help, listening to sound advice from professionals, colleagues and friends I’m now feeling much better. It’s funny how after spending years working in mental health I thought I knew the signs, the coping mechanisms, the triggers and that all I needed to do was get them arranged in the right order in my head like a nice Excel formula and I would be unstoppable. If I’ve learned one big life lesson over the last few years, it’s that we all only have a finite capacity to deal with ‘stuff’ and as that pile of ‘stuff’ builds it will inevitably begin to wobble. For me, most of my stuff was a bizarre number of close family bereavements over a few short years and dealing with that alongside the drama of the pandemic, its practical impact on work and my own default of getting annoyed by what I see as injustice and always wanting to change the world, regardless of my actual ability to do that! In the end, something had to give and stepping back from the second Chief Exec job at St Teresa’s was the difficult choice I had to make. With the benefit of a couple of weeks hindsight, I’m confident that was the right decision for both hospices and for me and I’m delighted for Nicola Myers who has taken over as interim Chief Exec.
In other news, the campaigning work in Tees Valley to ensure everybody has access to good palliative and end of life care has continued at a brisk pace. Alongside fellow hospice leaders I went to Parliament in January to speak to the All-Party Parliamentary Group on Hospice and End of Life Care about the challenges we face and the urgent need for government to review how specialist PEOLC services delivered through hospices are funded. Despite a new law mandating the commissioning of those services and very clear statutory guidance showing they should be fully funded the reality on the ground is very different. At Teesside Hospice, only 25% of our specialist services are funded by the NHS…..a very long way from the 100% the statutory guidance suggests. Whilst this has been a long-term historic problem, the post pandemic impact on our ability to fundraise, alongside unprecedented rises in costs make it impossible for us to continue making up the difference indefinitely. Parts of Tees Valley are amongst the most deprived in the country with significant health inequalities, reduced life expectancy and increased need for PEOLC. We’re fortunate at Teesside Hospice to have reserves to fall back on – many others either don’t have them or have them at our level. With many hospices delivering the only specialist inpatient beds and services able to support people dying with more complex conditions, what happens when the reserves run out and hospice services close? More ambulance calls, visits to A&E, extra GP appointments, more medication, days spent on hospital wards are the easy metrics to count but what about those people who die in pain, those who suffer unnecessarily during their final months, miss opportunities to create good memories or share stories, the distress and trauma family members experience witnessing all of that? That might not be so easy to put into one of the NHS’s famed activity profiling spreadsheets but that’s absolutely what we should all be concerned about.
The sad truth is that unless change comes soon that is what will begin to happen across the country, with Tees Valley most probably at the forefront of the wave. That is why campaigning now is so important. We cannot wait until services have cut back or closed to start making a noise. Not just for Teesside Hospice but for our communities, our families and ourselves.
We cannot accept “there is no money” as a default excuse. Collectively we will invest £157 Billion into the NHS in 2023/24 (item-4.2-public-board-meeting-financial-position-and-the-future-financial-outlook-.pdf (england.nhs.uk)). I’m under no illusions about the pressures the NHS faces but when others are mobilising and campaigning for their share of the pot – we cannot quietly sit back waiting for crumbs or platitudes to be thrown at us. These are political decisions, commissioning decisions, personal decisions. We need to shine the light of public accountability onto each of those domains and if that becomes uncomfortable then those who make the decisions need to clearly explain why properly caring for the terminally ill and dying is a priority they cannot support.
Despite the slow progress I remain optimistic that change will come. We are hearing some encouraging words from local commissioners that rapidly need to turn into meaningful change. I suspect the reality of hospice finances is only just beginning to dawn on some who have not really understood its precarious nature or the impact its collapse would have on them, their work and the wider system. With a General Election on the horizon and a surge in campaigning capability across the whole hospice network the next couple of years will interesting ones for sure!
One of the drivers for me coming back to Teesside full time was missing the connection and relationships I had with the teams in the hospice, income generation and retail. Over the last couple of weeks I’ve been able to sit in on handovers, visit the fundraising team and pop into a few of our shops again. In many ways, this is one of the best parts of my job – being able to see the teams in action, hear the stories in their own words and being able to chat with people and families we are supporting, donors and customers. Sitting in on the handovers I get to witness the truly holistic approach to healthcare we take in the hospice, looking not just at clinical needs but social, practical, spiritual and emotional too. One of the things that sets hospice care apart from hospital-based care is our support for the wider family and networks. It’s a joy to listen to these needs being given time and attention by the full team and not just handed off or outsourced to ‘carers support’. Some might call this ‘gold plated care’ but for me, it’s good, sensible healthcare that does what’s needed to keep support networks functioning, reducing anxiety, distress and suffering.
I called into one of our shops yesterday to say hello and thank you to the team. Much of our retail workforce is made up of volunteers without whom we would really struggle to operate. One I chatted to was a retired nurse who had only recently started to volunteer to give something back to the community she lives in. Another was a young guy who wanted to learn more about working in retail to help with his future career plan. Yet another a student who wanted to gain some experience of working and was interested in the social justice aspect of charity work. Checking today, we have 320 volunteers across the different hospice services – more than double our paid workforce and collectively they help us not only generate the funds we need to pay for hospice care but actually deliver that care too.
Last month I was asked to speak at the ACEVO (Association of Chief Executives in Voluntary Organisations) conference about what its like to be a charity Chief Exec during tricky times. Whilst I thoroughly enjoyed the event and presenting, one of the highlights of my day was sharing a stage with Polly Neate, the Chief Exec of the homelessness charity, Shelter. I rather cheekily went off script when it was my turn to talk and shared my own volunteering story from way back in the mid 1990’s when I wasn’t working, wasn’t sure what to do, needed some help and ended up volunteering at Shelter. I ended up volunteering for three years and the experience changed my whole life. I finally got to say a very public thank you to Polly and Shelter and to all of our volunteers at the hospice – my heartfelt thanks go to you for all that you do. Thank you.
One of the happiest surprises of my year so far was to hear how successful the Midnight Walk was at Teesside Hospice last month. It’s no surprise to anybody that community fundraising is difficult right now with the multiple pressures on finances most people are facing. I still like to think of myself as a fundraiser at heart and know all too well how difficult it can be shaking tins, asking for sponsorship, selling raffle tickets even at the best of times. Expectations on this event were low and but thanks to our incredible team they smashed the target and all in raised about £100K to support the clinical work the hospice is doing this year. It was a phenomenal team effort, with amazing support from our community and showed that even in times of real challenge, if we get the message right, are trusted in what we say and share it in the right way, we really can aim for the stars!
Looking back over this increasingly long blog I’m reminded that the things that bind us together as colleagues, families, networks and communities are the things we have in common. Our shared values and behaviours attract us during the good times and comfort us in the bad.
Compassion, trust, integrity alongside skills, ethics and accountability are all nice to write on a strapline but when they are lived and nourished become something altogether more effective and powerful. If we hold true to our values, recognise and act when things don’t feel right, we can’t go far wrong.
There’s so much more to talk about and share – our new wellbeing outreach services, expanded lymphoedema care, increased capacity in our counselling service, introduction of electronic prescribing, success of our coffee shop. From further afield, how the new laws on assisted dying in Jersey and proposed changes in Scotland might affect us here, the new approach to regional engagement from Hospice UK, our hospice collaboration across North East and North Cumbria and how we’re working strategically with the ICS to influence policy. I think I’d better leave that for a second volume though otherwise this long blog will need breaking down by chapters!
A much longer update than I expected. I started writing and couldn’t stop. I was going to edit it down but thought some of you might welcome a longer read with a bit more detail.
I’m writing this on a cold Sunday afternoon. My other half has gone to bed in readiness for working a nightshift later and I’ve found a nice warm coffee shop that I suspect I might be staying in until closing time! I’ve been sat thinking about all that’s happened this year, what might happen next year and thought I’d share some of my thoughts with you whilst also taking the opportunity to wish you all a very Merry Christmas!
It’s a cliché I know but 2022 has been a year like no other. Certainly in my own experience and many of the people I talk to. We started the year optimistically with the hope the worst of the horrendous covid years were behind us, we watched in horror as the war in Ukraine reminded us of the cruelty and inhumanity on our own doorsteps. We saw the knock-on impact of that war hitting energy prices with inflation racing out of control fuelled also by the inevitable post pandemic economic problems coming home to roost. Politically we witnessed infighting, dishonesty, opportunism and power grabs – to the seeming delight of the media with 24/7 headlines and social feeds proclaiming one crisis after another. In our hospices we watched almost helplessly as our long standing fundraising channels were very seriously challenged by the growing cost of living crisis and at the same time – the need for our specialist, truly personalised hospice care felt ever more real and urgent.
Yet despite all the challenge, the gloom, the fear and negativity we have witnessed some remarkable acts of kindness, progress, insight and compassion. As some people and communities struggle with the cost-of-living crisis, others have come forward, stepped up and reached out to help. Charity was born through altruism and never has the power of charitable endeavour been more apparent. Not just individuals and groups but also funders and whole sectors. Seeing a problem, coming together, looking for solutions and helping those in need. This is what drew me to this sector, keeps me in this sector and makes me so proud of the collective part we play as one charity amongst thousands.
Parliament is something that rarely receives praise but this year politicians of all parties joined together to support a change in the law that made access to palliative and end of life care a statutory right for the very first time in history. NHS England, who in my experience have been far too blasé about hospice care delivered in a way that I never expected. Robust and clear funding and commissioning guidance to back up these new statutory rights. Explicit statements that make funding of core and specialist level palliative care the responsibility of the state, with charitable funds being used to enhance those services to bring added value to the system. This has been the long sought-after dream for many of us and finally – the foundations for the transformation of hospice care have been solidly laid in a way I wouldn’t have dreamed possible pre-covid.
Turning policy into practice will of course take time. I was disappointed but unsurprised that some of the local barriers in Tees Valley remain in place but am more confident that ever that those hurdles can and will be overcome. The blockers wont be allowed to hold on to the status quo and change in how hospice care is commissioned, delivered, integrated and funded is now inevitable.
The job of our trustees, leaders and teams over the coming year is to make sure our hospices are in the strongest possible position to take advantage of these new opportunities. Nobody will turn up on our doorstep with a pot of gold and the responsibility is on us to demonstrate our work is an essential part of the wider health and social care system. To make this happen, our boards and leadership teams have been looking outwards at what the wider world will expect from us and aligned those with our own charitable purpose and objectives. Next year will be the one where we step up our readiness for change, draw on the strength of our collaboration and partners, take a focussed look at how we use our resources and polish our model of hospice care to make it not just attractive but irresistible to our funders and supporters. This will take some visionary risk taking, ambitious leadership and the wholehearted support of our remarkable team but I’m confident we can make it happen. The alternative doesn’t bear thinking about and we will not let that happen.
As part of the collaboration between our two hospices, our Boards of Trustees have agreed an overarching set of objectives that both hospices will work towards. I’ve copied them at the end of this update for those who are interested. In the New Year, the SMT will be working with our teams and departments to flesh them out into tangible actions for us all work on. The approach and focus might be different between our two hospices but the overall goal – as indeed for most hospices – will remain the same. I know some of you may have felt disconnected for the corporate objectives in the past but be assured – our Boards will have a keen eye on them and I will be using them to frame my expectations and discussions with our senior teams and departments over the coming year.
Financially both our hospices are forecasting significant losses at the end of this financial year. As things stand, its about -£700,000 at St Teresa’s and -£350,000 at Teesside. These are structural deficits that can only be reduced by saving money or increasing income. We already know that inflation will increase costs next year and the teams are looking now at how we can meet the almost 10% statutory increase in National Minimum Wage whilst maintaining effective pay scales, goodwill and effectiveness of our teams. The good news is that both hospices have reserves to take us through the coming year and both Boards of Trustees are braced for another significant deficit budget. Having shared the urgency for the additional NHS funds with the Chief Executives of our ICS and Tees Valley ICP I’ve received considerable assurance this will happen in time for the 2024/25 budgeting cycle. This is why we need to use this coming year to make sure we’re in the very best position possible to benefit when those additional funds start to flow.
I know financial problems can raise all sorts of anxieties but please be assured. We have a plan, we know where the extra money will come from, we have commitments it will happen and we have reserves that will tide us over until we get there. Despite everything that’s happened this year, I’m actually more optimistic than ever that the current uncertainty around hospice funding will come to an end and we’ll all be able to get back to focussing on what really matters – making the greatest possible different to people dying from a terminal illness who need our help and care.
One of the greatest privileges in my role is the freedom I have to leave my desk and go and see for myself what our charities deliver. I do this deliberately every week and whether it be inpatient care, counselling, family support, lymphoedema, wellbeing, complementary therapies or community services I hear the stories from those who benefit and see the skill, care and compassion in our remarkable teams. None of those services would exist though without the support structures around them – finance, HR, admin, retail, income generation, housekeeping, catering, fundraising, marketing, estates and none of these functions would work without the staff, volunteers and trustees who dedicate themselves to their work and our shared cause.
I hope you’ve found this update informative and reassuring. As always, if there is anything you want to chat, share or find out more about you know where I am.
Thank you for all you have done and continue to do. Have a very Merry Christmas and a great New Year.
David
Corporate Objectives
These corporate objectives are the most strategic of our organisational and service level goals. Operationally, each of our business functions and clinical services have their own objective which will contribute to towards these strategic goals whilst also incorporating actions that will improve quality, compliance, reach, efficiency and alignment with partner objectives such as the NHS Long Term Plan, NHS PEOLC Delivery Plan, TV ICB Strategy etc.
For this reason, these eight draft objectives focus on stability and sustainability that will protect our essential services. Growth, radical innovation, significant transformation are not precluded within these objectives but will be embraced with much greater ambition once our foundations and core sustainability and more secure. They are based on the nine principles we explored at the away day with language adapted to follow our discussion and local priorities.
Partnerships and Integration
We will actively seek to strengthen and develop our clinical operations with our NHS partners, ensuring our assets and resources increase and strengthen the outcomes delivered to the people our charities are here for.
We will work with our partners to identify and reduce barriers to integration from both sides to create a more seamless and integrated services for the people we are jointly here for.
We will actively seek out new partners whose work our resources can strengthen and whose expertise and support and strengthen our own capabilities.
Collaboration
We will solidify and strength the collaboration between St Teresa’s and Teesside Hospice by:
Adopting the best practice in each hospice, including services, business functions, income generation, policies and processes.
Mirroring our governance structures where appropriate and encouraging cross hospice participation in committees and operational groups.
Creating opportunities for frontline leaders to collaborate, connect, learn and share across each hospice.
We will remain open to and actively explore opportunities to expand our collaboration to include like-minded partners in the hospice and non-hospice sector.
Transition to Digital
We will take a collaborative approach between Teesside and St Teresa’s Hospice to adopt the same digital tools and solutions where possible with shared investigation, procurement, training and learning.
We will develop digital roadmaps for each of our business functions that align where possible with the plans of our primary partners and where appropriate support integration outside of our internal networks.
We will invest resources in improving our knowledge of available solutions, where digital might help and the core capability and confidence of our paid and unpaid teams.
Influence and Campaigning
We will develop a set of shared campaigning messages for St Teresa’s and Teesside Hospices that challenges misconceptions, promotes inclusion and resonates with audiences locally, regionally and nationally. We will enhance these with local, place specific messages for the localities in which we operate.
We will use our marketing and communications resources, including social and traditional media to share our campaigning objectives in a way that gains the greatest traction with our communities and those we seek to influence.
We will empower our leaders and others across the charity to feel confident and safe in their ability to share our campaigning messages and influence when opportunities arise.
Increasing Cost Effectiveness
We will ensure our clinical services are operating consistently at maximum efficiency. (occupancy, length of stay, uptake, referral pipeline, waiting lists, outcomes and impact).
We will develop a shared approach to benchmarking costs and costs per unit across Teesside and St Teresa’s Hospice and use this data as a tool to investigate significant variances. We will seek other benchmarks to assess against where possible.
We will use the benefit of our collaboration to jointly procure goods and services where it achieves a lower cost than doing so individually. When opportunities arise, we will explore buying-in services from St Teresa’s/Teesside/other partners in order to retain funds within our own eco-system.
We will be open and transparent about our financial position and ask our frontline leaders to seek out and realise cost savings in collaboration with their teams.
Increase Self-Generated Revenue
We will continue to strategically invest our reserves in pump priming new revenue streams in our fundraising and retail teams. We will increase our number of profitable retail outlets, fundraising methods and scale of fundraising campaigns.
We will significantly develop our ability to raise funds online with investment into digital skills, platforms, external support, branding and marketing.
We will explore increasing our use of partners and sub-contractors who can undertake fundraising on our behalf; to our ethical and quality standards.
We will seek out, respond positively to and invest in new commercial income opportunities.
Workforce Development
We will review all of our front line services to ensure our clinical teams are deployed in the most effective manner and avoid unnecessarily medicalising the non-clinical parts of our care.
We will develop longer term workforce plans for each of our services and business functions that consider current workforce pressures, our Environmental Social and Governance (ESG) responsibilities, the changing nature of volunteering and the impact of an aging workforce.
We will develop a compelling case for choosing to work in a charitable hospice, with appropriate remuneration, terms and conditions, wellbeing, other benefits and career progression.
Securing a Fair Funding Deal with the NHS
We will ensure our clinical services and the language we use to describe our work closely aligns with the NHSE Guidance describing how P/EOLC services should be commissioned, contracted and funded.
We will constructively lobby local commissioners to implement the national funding guidance, with our hospices being uniquely placed to deliver the care they are statutorily required to commission.
We will use the media, partners, politicians and others to support our campaign for fair funding with clear and direct messages about what will happen should St Teresa’s or Teesside Hospice close.
Next Steps
We work towards having a complete set of Corporate Objectives with more detailed delivery indicators agreed and in place for the start of the 23/24 financial year.
Trustees of each hospice read and consider these draft objectives
Trustees share thoughts (St Teresa’s by email as 24/11 being used for AGM, Teesside at board meeting on 1/12) on the direction of travel, support, concerns, omissions etc.
Each trustee board confirms/rejects/amends a complete set of corporate objectives and asks their Chair to agree any final amendments.
Each Chair takes on board feedback from the other and with advice from the Chief Executive jointly agree a set of shared corporate objectives before the end of 2022.
With an agreed set of objectives, the Chief Executive is then asked to work collectively with our joint SMT’s to produce Success Indicators, Timelines and assign Executive Responsibility for each of the objectives. Whilst overall objectives will be the same across both hospices, the priorities, resources, KPI’s etc that are necessary for success may differ. (Risk and Resourcing plans will come at a later stage)
This completed set of Corporate Objectives will then return to each board of trustees for final approval.
Over the years the care we have delivered has changed. Whilst keeping the traditional quiet and calm environment to be nursed during final days, palliative care has become a medical speciality and with that our levels of skill, care and complexity have grown. Nowadays people have much more choice and control over where they die and hospice care has adapted to meet the needs of people who often have multiple conditions, difficulties controlling pain, problematic disease symptoms or a host of other things that can cause pain and distress for people and families facing the difficult reality of a loved one dying from a terminal illness.
As hospices we employ Doctors, Nurses, Consultants, Social Workers, Counsellors, Dieticians, Physios, Occupational Therapists, Complementary Therapists and many others whose expertise combines to offer a truly holistic service when time is often short and people can’t wait months for a referral elsewhere. We do this because we care but we also do this because this is what the evidence base and our regulator expects. Core and Specialist-Level Palliative Care have strict guidelines and as charitable hospices, we are inspected at the same level and by the same regulator as a local hospital or other NHS facility.
Whilst the NHS has always contributed some money towards our services that support hasn’t been properly reviewed for a long time. When Covid hit and our fundraising stopped overnight our hospices, like others up and down the country, faced a bleak future. We are fortunate that the Government stepped in and the Treasury released significant support funds. Without those funds many of us wouldn’t be here today. That crisis also brought realisation to the top of Government that hospice care needed proper sustainable funding. In May this year, MP’s voted through the Health and Social Care Act with specific statutory guidance that local commissioners make sure everybody in their area has access to specialist palliative and end of life care. This is the lifeline we’ve been waiting for but will change come in time? We are fortunate that our hospices are in fixed term energy deals but with each of them running at a large budget deficit and a predicted increase in each hospice of £120,000 when it comes to renew we can see real trouble ahead. The tiny 1.7% increase we had on our funding from Tees Valley NHS this year is a real terms cut whilst we strive to pay our staff fairly and continue delivering the essential services people with a terminal illness need. We’re lucky to have some savings but when those eventually run out, like others across the country our hospice will close and access to specialist hospice care in Teesside and Darlington will stop.
We know the health service is facing multiple crises right now but urgently need our local NHS partners to help us plan for the future and work with us on a transition to the fairer funding Parliament has guided them to consider. We can’t do this alone.
As we come towards the end of what has been quite a momentous week I wanted to take a moment to check in with you all and share a few updates on where we are in both of our hospices.
Some of you may have seen the acronym “VUCA” before. I don’t know the truth of it but I’m told it lies in military theory and is used by the CIA to describe challenging times. Standing for Volatile, Uncertain, Complex and Ambiguous it certainly seems to fit some of our operational, financial, and system challenges at work and events in the wider world that are directly impacting our personal lives, hopes and fears.
Add to that, the death of the Queen with 24/7 news coverage, the funeral, unplanned bank holiday (which will have helped some and caused stress for others), and today the mini-budget followed by the inevitable attention grabbing media coverage I know from my own experience just how overwhelming it can all feel.
In times of uncertainty I try to look for what I can control, what is a constant, what I know works. Over the last couple of weeks I’ve deliberately taken time out to talk to most of our teams, visit some of our shops across Darlington, North Yorkshire, Teesside and Cleveland, our clincial services and probably most importantly spoken with and listened to people and families who we have cared for.
As always, cutting right through to the ‘why’ we are here brings the clarity and focus I need to keep working through everything else – regardless of how slow, frustrating or plain annoying it might be. Seeing how we are reducing pain and distress for individuals and families facing terminal illness – and that if we weren’t here there would be nobody else to step in to do it – gives me assurance, makes me proud of our charities, our donors, our supporters and most of all, our people.
I see the care and compassion, the determination and grit. I also see the many frustrations that our limited income and financial deficit brings and the snail pace at which reform to hospice funding is happening. Where I am fortunate though is that I get to see other parts of the country who are ahead of us, the genuine desire of national NHS commissioners to drive real change, the cross party commitment of our MP’s and local politicians to support our hospices because they know how important they are to the people they represent.
Uncertain times need us to have hope that things will change and that things will get better and these last few weeks and months have brought real, tangible improvements in both hospices. New step down beds in Darlington, outreach services in Teesside, positive CQC reviews and inspections in both hospices. Increasingly high occupancy rates in our inpatient units with closer and more integrated sharing of our resources with NHS colleagues. Focussed work on opening up our services to all sections of the community, new approaches and projects promoting wellbeing, new and refreshed cafes, funding for additional education and training for our own workforce and wider partner organisations. Supporting all of this we continue to grow our fundraising teams in each hospice, opened a new shop in Yarm and close to agreeing another in Darlington. Although we are still looking at large deficits in each hospice (£426K Teesside, £734K Darlington) our extra income generation and cost savings mean these have improved slightly in the last month and we have reserves in place to carry us through this time of change. The deficit numbers can be scary but we need to remember that the NHS itself has now said that essential core and specialist-level P/EOLC services should be fully funded. This one change should fundamentally alter the outlook for hospices and those who need our care up and down the country and mean that rather than plugging gaps in NHS spending decisions, our charitable funds can go into additional services, enhancing the care we deliver and meeting the clincial, emotional, practical and spiritual needs of even more people and families in the future. Whilst this will take time to happen, perhaps especially so in Tees Valley, I remain optimistic that if we continue to deliver essential services, adjusting how we work to meet changing needs and do that in a way that avoids duplication and integrates with the wider system our future will be secure.
Whilst many still view hospice care through an outdated image of ‘just’ comfortable end of life care I have the huge privilege of seeing not just the breadth of services we provide for thousands of people but also what goes into making those services work. Between Teesside and St Teresa’s we are about 600 volunteers and 275 paid staff who collectively bring the clinical, wellbeing, support, administrative, governance and income generating together into this wonderful thing we simply call hospice care.
Thank you to each and every one of you – for what you do, the difference you make and this week….for being the collective rock I needed to hold onto in what has been a genuinely momentous rollercoaster of a week!
In many way, I can scarcely believe I’m writing these words….. Its 21 years this week since I started in my first charity Chief Exec job. How did the years go by so fast, and how did I so quickly become middle aged!?!?
Despite the passage of time, I can quite vividly remember the application process, interview and first few weeks of that first job. Having spent a few years as a volunteer housing advice worker at Shelter, moving into a paid job and eventually a Deputy Manager role I saw the Chief Officer of an advice centre (back before we were all called Chief Executives) role as a natural next step. My success at raising funds, alongside recent experience of compliance audits are the things that caught the panels interest with my ability to lead, inspire, motivate and sell not really figuring into the conversation. Just as well for me really as I think I would have struggled to articulate any half meaningful answers back in those days!
With the benefit of hindsight and the passage of time I can look back on those first few months and years with a critical eye. My understanding of leadership as distinct from management was only just starting to evolve. My ability to separate strategy from operations embryonic. My perception of effective governance was based on past experience rather than learning and aspiration. I remember the worry about not knowing all the answers, the regular feeling of being an imposter, the fear of challenging more difficult members of the team and the awe with which I looked at the ‘real’ Chief Execs who did their job with such easy confidence.
Over time I learned. Sometimes planned learning, sometimes from my mistakes but most of all from peers who I valued and trusted. Developing a network of people I trusted was instrumental in my development – not just people who would tell me nice things either – some of my hardest but most valuable growth came with kindness from critical friends and slow realisation that recognising what I was not so good at was just a valuable as knowing my strengths.
Over the next decade or so I changed jobs a few times, using each change as an opportunity to start again with the learning Id brought with me. Some of those job changes also included location changes, giving me the opportunity to start afresh not only internally but with partners and the wider sector. As my knowledge and perceptions of the environment changed so did my understanding of strategy, influencing, relationship building and campaigning. These areas shifted to being the primary focus of my work and with that single shift, my whole view of myself, the role and how I work changed. Of course the operational management, compliance and internal leadership were important but reaching out, learning, sharing, influencing and collaborating because much more powerful tools for change. And if I’ve learned anything about charities over the years it’s that whilst we’re superb responding to local need there is a danger this overwhelms us and stops us from seeking fundamental change that either reduces the need for our services or gives power to the voices of lived experience we hear every single day.
So, what have I learned after all of these years? I was tempted to write a top ten list, but the reality is actually much simpler. Choose a cause you care about, build and nurture a team you trust and who trust you, focus on outcomes rather than process, speak truth to power, know when it’s time to move on.
One of the odd things about my job is being asked to write updates for newsletters that are some months away from being published. Having just written an intro for a winter newsletter it’s got me thinking….not just how is it that time of the year already….but how absolutely brilliantly the our teams have got us through the last couple of years.
We’ve become so used to the daily grind of covid now that ‘just’ wearing masks in clinical spaces and testing seems almost normal. Changed access to the hospice for those who need our care, PPE, remote and video consultations and groups. Online fundraising, home working, Microsoft Team and Zoom. These are all things that we tinkered with pre covid but are now with us and here to stay. Some of these changes have been easy but some have needed us to learn new skills and new ways of doing things. Some have needed us to just grit our teeth and do it. It’s not just been in the hospice either – our fundraising and retail teams have been equally impacted in their own way. When we talk about how teams come together we often talk about bonds forged in adversity and with that in mind – we must have one of the strongest team we can all be proud of!
One of the biggest changes for me recently has been my new role as Chief Exec at both Teesside and St Teresa’s. It’s been a real privilege being able to gain a good overview of both hospices and use this to link up people across both charity’s to learn and share the best each has to offer. If you’re curious about what the teams are doing in the other hospice please do feel free to just arrange a chat/visit or let me know and I’ll sort it out for you.
This coming year will inevitably bring its own challenges. Financially we’re up against it but I’m optimistic a long term solution will come through closer integration with the NHS. Operationally, we’re seeing recruitment difficulties in some of our areas. You only have to glance at the news to see this isn’t hospice specific but the result is that its taking us longer to fill vacancies and if the people we need are not there we’ll need to find different ways of doing our work in the future. I know this has caused extra work for some of you and want to say a huge thank you for the way you have stepped up and helped out.
We’re all being hit with increasing costs and energy prices and I look with some envy at those private sector companies who are able to offer double digit pay rises and one off payments. Starting the year in a charity with a large deficit budget makes that impossible for us without closing services but it doesn’t mean we don’t see what’s happening or care about the impact its having. If you find yourself worrying please do talk to us or use the employee assistance programme. I don’t know how long this cost of living crisis is going to last but we’re in it for a good few months and I want to do what we can, with the resources we have to help anybody in our team who is struggling.
In terms of the hospice finance, our fundraising teams are on the frontline of the financial problems and facing some real difficulties with events, lottery and individual donor fundraising. It’s entirely predictable in times like these but as a fundraiser myself, I know how soul destroying it can be to see low uptake, events and donations cancelled. We’re not defeatist about this though and are doubling down on our fundraising efforts, investing in the teams and leveraging all of the community capital and support as have. Hospices have a special place in the hearts of many and if we can tell that story in the right way, it’s an advantage we have over many others who are competing for the same donations.
In the longer term, the answer to hospice funding lies with the NHS and the new statutory guidance they have issued on how local commissioners should fund hospice care is exactly what we needed to see. The NHS FULLY funding core and specialist services, charitable funds directed into enhanced care. It’s a common sense approach that recognises palliative and end of life care as a core service and sees the fundraising we do as an extra that sits on top. Now we just need our local commissioning teams to acknowledge their own guidance and tell us how they intend to respond. It might take a while but if we can show how well our services are already integrated into the wider NHS, I’m optimistic we will get there in the end.
Finally – as always – a huge thank you from me for all that you have done and continue to do. Clinical, retail, trustees, fundraising, admin, HR, reception, finance, housekeeping, catering, estates, volunteers, paid staff – our strength lies in our team and our team is pretty amazing!
David Smith 