A 30-year career spanning both clinical and non-clinical roles with St Luke’s Hospice Plymouth has given Paula Hine a unique perspective on the organisation and how it has evolved in order to survive in an increasingly tough climate.

Reflecting on her long career with the charity, Paula, who has recently been appointed Interim Head of Education at St Luke’s, said: “When I first walked through the doors of the specialist unit Turnchapel all those years ago, little did I imagine where my experience of looking after terminally ill patients on the ward would lead me.

“I grew up in nearby Tavistock and my early nursing career started locally at South Hams Hospital, where I did a bit of everything, but over time my interest in caring for people at end of life grew and this was the area I was keen to focus on. It appealed to me because of the ethos of holistic care, which led to me keeping an eye out for a job at St Luke’s.

“When I joined in 1991, the organisation was much smaller than it is today. The focus was on Turnchapel, where as well as inpatient care we also had a day hospice.

“At that time, nursing was still very traditional and even Florence Nightingale-ish in its hierarchy. The Doctor and Matron were in charge and we wore frilly hats which served no purpose! Thankfully, the hats wouldn’t be allowed now because of greater focus on infection control, but I still smile at the memory.

“St Luke’s did not have the wider support services we have today, except for admin for the clinical team, some educational provision and a small facilities team. In those days, we had no fundraising team as such but lots of eager volunteers. On the community care side, we worked with Macmillan and Marie Curie nurses – this being the roots of the service we have now, looking after patients at home – but we were yet to have a team at the hospital, something which did not develop until around 15 years later.

“I could always see that St Luke’s was keen to innovate and fluid enough to respond to the changing needs of patients, and when I developed an interest in increasing our provision for our patients with lymphoedema (a chronic condition that causes swelling in the body’s tissues), I was pleased to be encouraged to investigate the best way of doing this.

“Looking outside, and even travelling overseas, to learn about best practice enabled me to build a case for us to go from the massage therapy and bandaging that I already did for our patients, pushing a trolley around the ward, to extending the treatment – which can make such a positive difference to someone’s quality of life – so that it benefitted people at an earlier stage of their illness as well as those who were already inpatients. The funding we secured also helped us provide lymphoedema treatment for people with a non-cancer diagnosis, such as vascular- related oedema. It felt really rewarding to build the Lymphoedema Service from the ground up and develop it into the very busy clinic it became with a team of three.

“One of the best parts of the job was the rapport I developed with the people who came regularly for treatment, but this meant it was also very hard when they died because it does take an emotional toll. After ten years, I felt the time was right for me to step back from giving hands-on care, and this happened to coincide with an opening at St Luke’s for someone with the right experience to lead and grow the education we were already providing to our own staff and district nurses to help them fulfil their clinical competencies.

“The service started with me helping nurses with their clinical skills, such as infection control, tracheostomies and ‘drips and drains’, and grew into a team under the banner of HR. Gradually, links grew with the University, and the first module I developed was a bespoke assessment skills module for our Clinical Nurse Specialist (CNS) team, which along with other external courses helped to generate income for St Luke’s. When Gail Wilson arrived as Head of Education, she used her expertise and strategic approach to take this to the next level, developing a really innovative service involving a wide range of funded education projects, including education for care homes. About the same time, Liz Lawley joined the Education team, bringing experience of a Six Steps Care Home programme from Cumbria, which we introduced here, adapting it to include education end of life care for people with dementia and learning disabilities.

“Of course, as well as all the changes there have been in the Education team and the service we provide, so many years with St Luke’s means I have witnessed the evolution of the organisation as a whole, observing the way it has flexed to survive in a way that, sadly, some hospices have not been able to.

“I’ve seen connections, collaborations and partnerships grow, and huge expansion in retail and fundraising. What really continues to hearten me though, is our charity’s continued focus on meeting the needs of our patients. I remember the years when we first started looking after patients with non-cancer conditions, such as AIDS, and I have seen younger people needing our care, including those with brain tumours or motor neurone disease.

“While of course there is sadness because of the nature of our service, there is definitely more laughter than tears and, when I look back on my career so far – and the colleagues who have been there along the way – it is definitely with a smile.”