Supporting people where they want to be: Strathcarron Hospice

We had to understand that the way people lived would be different. It wasn't going be as nice from the staff’s point of view as being in the hospice, but for the patients that was where they wanted to be and how they lived.

Irene McKie, CEO of Strathcarron Hospice

The hospice is located in Denny, a small town in Falkirk in the central lowlands of Scotland. It covers a very large geographical area, from Cumbernauld on the north edge of Glasgow, north through to Kinross and up to the east side of Loch Lomond.

It includes villages like Tyndrum with 200 inhabitants, to bigger towns like Stirling which have a population of 50,000, as well as large rural areas which can be an hour, even two hours away from the nearest hospital. It’s an area that can clearly benefit from the service.

Since it launched in 2014, it’s had numerous benefits, including reducing the hospice’s waiting list by caring for people in their place of choice.

“The service supports people to be where they want to be when they die” says Chief Executive Irene McKie. “People die more peacefully because they are where they want to be. Quite often they die with their dog on the bed, or the cat around them, with someone playing music.  For a lot of people that actual home environment is really important to them. We don't insist on having a hospital bed so if they want to be in their own bed, they are.”

The recent report carried out by independent health consultants Phrisk shows the tangible successes of the service.  “The evaluation report shows that we're saving the NHS six beds. The NHS consistently has more patients than they have beds, they usually start the day on about minus 20 to 30 beds and they’re juggling this every day to see who they can get home and who they can move to accommodate, and which people they feel they need to admit.”

“There’s also a key performance indicator for NHS Scotland about the percentage of your time that you spend in hospital in the last six months of life. In that sense we are really contributing quite significantly to that performance indicator.”

Hospice care at home has existed across England and Wales for a number of years. Before rolling out their own service Strathcarron did their homework, speaking to many hospices in England to find out what they did and how.

The main challenge, Irene says, was to persuade GPs to make referrals. “However within about three months, we had a referral from every practice in the area. Our challenge was at the beginning, to get the first referral and to make sure we didn't turn it down because we were short of resources. We had to flex up quickly to meet demand because if we said no, they probably wouldn't have come back again.”

Another challenge was getting used to a new way of working, particularly for the staff. “They had previously worked in the hospice so they had to get their heads around the way people lived at home” she explains. “It wasn't necessarily neat and tidy. One of our first patients had turned the kitchen into a library, using the kitchen cabinets and shelves for his books and putting his cooker in the hall. He cooked and heated things up, eating to live, but he lived to read.”

“We had to understand that the way people lived would be different. It wasn't going be as nice from the staff’s point of view as being in the hospice, but for the patients that was where they wanted to be and how they lived.”  

All the team have a debrief at the end of each day, talking about what has happened before going home. “We consistently get scores of ‘excellent’ from Scotland’s Caring Inspectorate. ‘Excellent’ is as high as you can get in Scotland and one of the things they do every time is interview staff. And the staff, they think it’s the best job they could possibly have.”

“We had been worried because in an inpatient unit certain patients are going home. Whereas we were just looking at the very end of life so all of the patients were dying within a few days of the staff meeting them, so we thought that’s a tougher ask. And yet they're saying it’s very rewarding. We've now got more than double the staff we started with, but the original four are still with us five and a half years on.”

The service currently looks after people in the last two weeks of life, but they would like to expand this to be able to see patients a bit earlier, from the time at which their health starts to deteriorate.

Their second goal is to support people living alone to die alone if they want to. “We haven’t achieved that and we reckon it’s because people aren’t being referred. I think that may be because at GP level someone is deciding you can’t possibly die alone at home or be at home at the point when you’re dying if you live on your own.”

Irene believes they can help a lot more patients out of hospital, and also get them out sooner. “There is a culture that the hospital is a very safe place to be, and that it must be very scary to be at home.”

“I also think people in acute hospitals struggle with the idea that although Hospice@Home will look after you at home that does not mean they are physically there 24/7. We will leave, the district nurse will leave, and we will be at the end of the phone if they need us.”

“Most people don’t want us be there all the time. We spend quite a lot of our time describing to people what will happen during the process of dying, because they haven’t a clue, and we’re just reassuring them so that they’re not scared.”

For more information visit Strathcarron Hospice