On our 40th anniversary, we’ve been talking about the history of our charity from its beginnings at Syrena House in Plymstock, in 1982. Much has changed since the days when the specialism of hospice care was completely new to most of the UK, including Plymouth, and St Luke’s was limited to just seven beds for patients.
Now, four decades on from the cramped conditions of Syrena House – the suburban property that was bought and converted thanks to huge community support so that our hospice could begin giving its specialist care to terminally ill people nearing the end of their lives – St Luke’s looks after up to 300 patients at any one time, supporting their families and carers, too.
Central to this is our integrated approach to patient care, which involves working closely with other health and social care providers, from GPs and district nurses to hospitals and care homes. This is what ensures people living with progressive life-limiting conditions, such as cancer, motor neurone disease and multiple sclerosis, are looked after compassionately and as seamlessly as possible whether they are at home, in hospital or at Turnchapel.
Always pioneering, St Luke’s was the first hospice in the UK to adopt this more collaborative way of working, in 2005. Many other hospices up and down the country then learned from its example, following a similar approach for the benefit of people living and dying with terminal illness.
Innovative since its beginning, St Luke’s has evolved to meet the changing needs of our patients. This means our highly trusted service reaches far beyond the walls of the specialist inpatient unit, with our community team on the road 365 days a year across Plymouth and its surrounding areas so that, wherever possible, people who want to be looked after at home can realise their wish.
Chief Executive Steve Statham said: “For each and every one of our patients, we strive to give the very best personalised care in the place that is right for them. For many, this means staying in the familiar surroundings of home, as long as it is safe to do so. Wherever we look after them though, it is always with a focus on what matters most to them, helping them to be as at ease as possible.
“We are privileged and proud to do what we do, but it is only made possible thanks to the generous support our charity receives from the community around us. A huge thank you to everyone who embraces St Luke’s, from our volunteers, donors and fundraisers to the healthcare partners who collaborate with us to ensure our patients receive such well co-ordinated, compassionate care.”
When manager Matt Geoffrey needed St Luke’s care in his early 40s, our community team looked after him at home so that he could stay with his wife Sarah and their two young children.
Sarah said: “Matt was determined he did not want to die in hospital, and it was St Luke’s that helped make a plan so that he could be at home, including supplying a wheelchair and special bed.
“The team was with us the whole way through and made it possible for us to still be a family. Thanks to them, our kids were able to be kids, which was amazing, and Matt was able to live to the end in the way he wanted to.
“It’s really hard to sum up how I feel about everything they did for us, but they were like our family’s professional comfort blanket. I can’t thank them enough.”
His wife Jeanette said: “Being a nurse meant I was able to care for Jim at home, but when his condition deteriorated and he required specialist help, St Luke’s nurse Sonja was amazing. She was a reassuring presence for us all.”
Claire said: “My last journey with my beautiful daughter was in an ambulance from hospital to Turnchapel after we decided as a family it was where Chloe should be looked after when she became really poorly.
“Going there was absolutely the right decision. It doesn’t feel clinical at all and from the moment we arrived, everyone from the doctors to the porters treated us with the utmost respect.
“I’m forever grateful to St Luke’s for what they did for us. I remember Chloe telling me she felt like princess when she was able to use the bath with lights and music. To feel like a princess in a hospice really is special.”
Jess said: “St Luke’s came once a day and then more frequently as our needs changed. They did as much as they could to help, and it meant I got a little break from looking after Tom and could spend time one-on-one with Poppy. What they did for us gave us the most amazing three weeks together at home.”
When Tom’s condition worsened, it was St Luke’s End of Life Urgent Care team that stepped in, visiting four times a day.
Jess said: “They were so kind and so calm, and because of their training they were able to alert me when Tom was nearing his last hours.”
Today, one of the people at the forefront of the specialist end-of-life care St Luke’s provides, Medical Consultant Dr Jeff Stephenson, shares his reflections on two decades with our charity.
“It is said that at the age of about 40 life can become richer because one has the skills, wisdom and means to make it so. Plymouth’s own hospice charity reached middle age this week and has matured well. I have worked as Consultant at St Luke’s for about 20 of those years, and it has been a privilege to be a part of its journey.
“While much has changed, some things haven’t: the passion, patience and professionalism of staff and volunteers across the organisation, the bedrock on which our excellence is built; and the goodwill, generosity and support of the people of Plymouth and its surrounds. And so many of the patients and families whom we serve continue to inspire by their fortitude, resilience and grace in the face of terminal illness.
“The place has certainly changed. The hospice building has undergone several renovations but it continues to provide an atmosphere of peace and calm that is often therapeutic in itself – the ‘hospice effect.’ And our community services recently returned to the hospice site after two relocations, with potential for more seamless working between inpatient and community teams. Things come full circle!
“St Luke’s has become more prominent both locally and nationally, with the integration of our clinical services across Plymouth, the expansion of our hospital team and our community services, and our innovative and pioneering projects, service developments and educational initiatives. We have changed perceptions about what we do, and are probably less thought of as simply the ‘hospice on the hill’. However, the association of our services with a hospice building can still be persistent despite our messaging about being a ‘hospice without walls’ influencing care in whatever setting patients find themselves.
“While the care we deliver hasn’t changed much, the processes around it have become more complex and time-consuming. The pioneering, seat-of-the-pants freedom of the early hospice movement was still evident to a degree at St Luke’s when I started. It has since been squeezed, though not completely suffocated, by the increasing regulatory and bureaucratic frameworks of mainstream healthcare – and quite rightly so in many respects, but we seem to expend much more effort on activities to prove and validate what we do. Sometimes, a casualty of that can be the luxury of time to spend with those whose time is running short, something that was our great strength with a focus on ‘being with’ rather than ‘doing to’ and a counter to the notion that dying is something to be fixed. But we willingly embrace such frustrations in pursuit of our vision for better end-of-life care for all.
“And here is where St Luke’s has most obviously matured, and arguably secured its future in our community – the adoption of a coherent vision. In my early years I can’t recall a clear vision. We provided exemplary care to those we looked after or were involved with, and we influenced care elsewhere through education and training, and it felt good and rewarding to do so. But it was an uncomfortable fact that while we provided a Rolls Royce service to a few who happened to be referred to us, many others weren’t getting an adequate level of support. And despite the great progress that had been made there were still people who were dying badly. Then about seven years ago, as we grappled with the challenges posed by changing demographics and predictions of future care needs, a vision crystallised.
“A community where no person has to die alone, in pain or in distress. I am proud to have had a part in developing this vision. It is an expansive one, extremely ambitious and yet eminently possible. It looks beyond St Luke’s, recognising that we can’t provide such care to everyone that needs it, shifting the emphasis somewhat from our direct care to our role in training, teaching, equipping and supporting others, including care home staff. It has made us more secure in our identity and given confidence about our future role in the changing healthcare environment.
“It was a driver for the decision to reduce our number of beds and focus more resource on the community. It has validated the time and resource we have devoted to training other professionals – in my time we have had about 60 trainee GPs working for us, and hosted over a thousand medical students on placements, in addition to students in nursing and other disciplines. And it has motivated us to seek opportunities to collaborate with external healthcare partners, such as Livewell Southwest and Marie Curie.
“We have come a long way. But there is still a long way to go. I had hoped that by now we would have better treatments for some of the symptoms we deal with, but most of the drugs and approaches we use haven’t really changed. I had hoped that we would have a fairer and more effective social care system, without which our vision simply cannot be achieved. I had hoped that we would have changed the narrative about death and dying to a much greater extent. It seems to me that there can still be a temptation to over-treat, trying to stave off death for a little longer in a society that has largely lost any sense of there being anything more important. Yet paradoxically, our society now appears closer than ever to opening the door to euthanasia and assisted suicide, with seismic repercussions for end-of-life care, and perhaps testament to our collective failure to capture the public imagination with what a better way can look like.
“All this presents huge challenges for St Luke’s. But we are ready to face them. And in many ways the pandemic has better equipped us to do so. We have demonstrated our resilience and adaptability, and there is a greater internal cohesiveness. We are collaborating more effectively with external services. And we have been given the opportunity and privilege of refining who we are and what we do going forward. Here’s to the next 40 years!”
On the 40th anniversary of St Luke’s Hospice Plymouth, we began our series focusing on the past of our charity that has touched the lives of so many local families over the past four decades. Today, we share the reflections of Dr Mary Nugent, who started as a young doctor at the hospice in our early years and soon became a central figure in the small yet dynamic team whose dedication, skills and compassion helped shape the specialist service for which St Luke’s is still renowned today.
Having been recruited by St Luke’s first Medical Director, Dr Sheila Cassidy, who spotted her potential and went on to become her mentor, Dr Mary – as she became known to everyone – joined the hospice in 1985. This was at Syrena House in Plymstock, the forerunner of the specialist inpatient unit at Turnchapel that was bought and converted, thanks to huge support from local people who believed in St Luke’s mission to relieve the pain and distress of terminally ill people nearing the end of their lives.
Dr Mary quickly found her vocation looking after patients holistically, recognising that in listening and focussing on what matters to them, alleviating their pain and putting them at ease, people with conditions such as cancer, multiple sclerosis and motor neurone disease can live well to the end of their lives and die with dignity.
Together, Sheila and Mary – plus the small team of nurses alongside them – developed this as their way of working, ensuring patients felt understood and uplifted and their families supported and reassured.
Dr Mary said: “When I joined St Luke’s, I could see how innovative the team was, giving bespoke care to terminally ill people as inpatients instead of them having to stay in hospital or being looked after at home. As a young doctor though, I could barely even spell palliative care so I was in at the deep end, and that’s how my journey with the hospice began.
“Space was incredibly tight at Syrena House, but we used every inch for the care and comfort our patients. We all crammed in together and just made it work. The bathroom even became the doctor’s office and we had a makeshift desk across the bath! There were just seven patient beds initially, with three more added later because patient referrals kept on coming.
“I found my niche at the hospice because we had the luxury of time to love and look after our patients. What we were doing was desperately needed by people in Plymouth and surrounding areas, and it was exciting to be part of developing something that was so pioneering.
“The camaraderie was tremendous, too. We were friends working together, all to help people who were in the last stages of life. I was quickly building on my basic medical knowledge, learning about the anatomy of being very sick and the effects and benefits of new drugs, then taking to the road to teach young doctors around the country about what we were doing and why it was so important.
“You have to remember that palliative care wasn’t recognised as a medical specialism until early 1994 – since which time is has grown and grown – so we were all just seen as ‘hospice doctors’. Recognition of the highly skilled work we were doing in hospice care only grew thanks to Dr Sheila Cassidy – and others like her – who had the insight and tenacity to make changes that were needed so that talking about death and dying became a bit less taboo and patients received more personalised care, maintaining their dignity.”
With a pressing need for larger premises, we embarked on a high-profile fundraising campaign for what became our purpose-built inpatient unit at Turnchapel, which opened in 1988. The 20-bed facility with beautiful views was built on land given to us by Plymouth City Council.
Dr Mary said: “When the move to Turnchapel came, it was a joy. Double the number of beds, plenty of bathrooms and wonderful new gadgets. We created the very best hospice environment we could, enabling people with terminal illness to be themselves and be looked after as themselves.
“There was great excitement when Prince Charles performed the official opening, in 1988, with crowds lining the driveway all waving their flags. He was well informed about the hospice movement and generous in his attitude, spending time talking to patients, volunteers and staff
Dr Mary, who became Medical Director of St Luke’s in 1993, has fond memories of the many patients she met as well as the family atmosphere Turnchapel provides for them, thanks to the kindness of staff and volunteers.
She said: “I remember patients’ weddings, which though they had to be arranged quickly by our team, were so beautiful and poignant. I also recall a lady who recognised me from the hospital and greeted me like a long-lost friend. She was determined to have at least three weeks of being looked after by me, and she did. I can still see her smiling face.”
During her time with the hospice Dr Mary witnessed – and was part of – a big expansion in the provision of palliative care, which included closer working between St Luke’s and the Primary Care Trusts to pioneer an integrated palliative care service. Whereas previously, Derriford Hospital had been separate to the hospice, in 2005 the new St Luke’s Hospital Service was established, with Dr Mary appointed its lead. In her dual roles of Palliative Care Consultant at Derriford and Medical Director at St Luke’s she was the link between the two organisations.
Dr Mary said: “I was made very welcome by the consultants. No barriers were put up and the integrated service at the hospital got into gear. This meant a joined-up service for patients, with hospice staff providing education and leadership for many hospital doctors and nurses.
“St Luke’s is a leader in palliative care, and the triple service it provides at home, in hospital and at the specialist unit has been replicated by many other hospices because they, too, have recognised how much patients benefit when they experience a seamless service. The needs of patients must always be at the centre of that service, and St Luke’s has never forgotten this.”
