St Mary’s Hospice, Ulverston

Project summary

Helping a small, rural hospice keep their beds open and overcome gaps in provision by providing partnership, support and training for medical staff.

Background

St Mary’s is a small, rural hospice in Ulverston, on the Furness Peninsula, providing both specialist and generalist palliative and end of life care. The hospice employs over 100 staff, who support around 800 patients and their families each year.

The challenge

In 2019, St Mary’s hit a problem which forced them to temporarily close their beds. Their senior doctor was going on maternity leave, and despite negotiations with local partners, and an international recruitment campaign, they were unable to find a suitable replacement. They had heard about Supportive Care UK from colleagues, and approached us to explore the options for short-term support and longer-term consultant cover.

The remaining doctors on St Mary’s medical team were themselves new to the hospice, and were initially anxious about trying our remote model of consultant-led support. However, it was clear that using Supportive Care UK would be the only way they could reopen their beds and provide the same level of specialist care, and so the team decided it was worth pursuing.

Our solution

Our initial recommendation was to provide St Mary’s with our out of hours (OOH) cover between 6pm and 8am, five days each week, with 24-hour cover at the weekend. We then added two board rounds and one multi-disciplinary team meeting each week, which allowed our consultants to guide the St Mary’s medical and nursing teams in supporting their patients more confidently.

The team at St Mary’s soon concluded that having a little more support in the system could make a big difference, so we evolved our provision in response to their needs. We began by adding in a Friday catch-up, to help anticipate weekend difficulties. After a further six months, we started to provide clinical supervision, first for the St Mary’s doctors and subsequently for their assistant nurse practitioners. Finally, in early 2020, we agreed to run regular review sessions to analyse complex cases, providing training and debrief experience for the in-house team.

Impact and outcomes

In simple terms, our collaboration with St Mary’s has allowed the hospice to keep all its beds open, despite the staffing challenges which are endemic in the sector. And on a day-to-day level, it is supporting the delivery of high-quality care in a number of ways:

It has taken the precariousness away from staff management, with leaders no longer having to worry about covering absences due to sickness, holiday or study leave.
It has provided St Mary’s with more consultant cover than they could have obtained from their local system, or afforded independently.
It has allowed the medical team to develop their practice and strengthen their decision making and multi-disciplinary skills.
It has encouraged the leadership team to reflect on the best way to support their internal medical team.
And it has also left them with the confidence that challenges can be overcome with enough imagination.

Additionally, the St Mary’s team believe that the process has highlighted the value of innovation, and provided a model which could transform the future of palliative and supportive care in rural areas.

We started working with SCUK out of desperation, seeing it as the only way to save our bed-based service. However, the collaboration has grown to be so much more than a solution to a crisis.

Together, we have tested the boundaries of the possible and found a way to make a small rural hospice more resilient; I would now be reluctant to exchange this model for our previous one. We foresee this approach will grow over time and would encourage anyone struggling with palliative and supportive medical cover to contact them. You will not regret it.