Heather Richardson, Joint Chief Executive at St Christopher’s, London, UK, explains how a conversation with two doctors from Rwanda and Bangladesh has led to radical changes at St Christopher’s to reflect contemporary opportunities and challenges.
In the last plenary of the recent World Congress of the European Association for Palliative Care in Berlin, Dr Christian Ntizimira spoke powerfully of the work that he and others have done to build palliative care in Rwanda in recent years. He spoke of his commitment to a sustainable model, driven by a strong vision and innovation. He described an ambition for compassionate care reflective of the sad history of his country and the related suffering of its population. He confirmed the value of strong partnerships locally, nationally and internationally in these efforts.
In the midst of his presentation he told a story of a visit to St Christopher’s some years ago, and of a conversation he and Professor Nezam Ahmed from Bangladesh had with me at the end of their time spent at the hospice. They both described difficulty replicating the care they had witnessed in London given the disparity in the levels of resources available to them, compared to those available at St Christopher’s. They spoke also of the differences in the nature of suffering that they saw in their work and its demand for context specific responses. Overall, they were not convinced of its value to their work in the future.
The profound discomfort and disappointment that this discussion gave rise to then, and again when Christian described the conversation in his talk in Berlin, are easily recalled on my part! I knew immediately as he spoke to me back in 2014 – one month after I had started work at the hospice – that we needed to radically change our approach to education and training at St Christopher’s so that it continued to be effective in supporting people to deliver high-quality palliative care elsewhere in the future.
Without doubt we had good foundations – learning informed by research and practice; teachers drawn from clinical contexts with first-hand experience of delivering care; an extraordinary history of pioneering leadership driven by a desire to get care right for individuals at the risk of being forgotten. But our approach needed to be quite different if we were to continue to be valuable beyond our direct care in south-east London, and to retain those aspects of our history essential to the success of people like Christian and his vision in the future.
Christian and Nezam’s feedback was timely as the team at St Christopher’s embarked on a new and iterative strategy for education and training. We proposed this to the board of trustees two months after the meeting and they agreed the initial plan in early 2015. It placed greater emphasis on negotiating and understanding what people wanted to learn prior to establishing new programmes; it sought opportunities for reciprocal learning between all involved; engagement of new partners in framing the problem and the answers, and greater shared exploration about issues on which there are no easy answers. We agreed that we must concentrate on solutions focused on community involvement, system wide change and global development, alongside care on offer to an individual and their family. We recognised public health opportunities alongside expert patient care and, as part of this, we committed to extending our education and training to the public as well as professionals.
Developing a 21st century learning hub
We decided also that we needed different facilities to enact this strategy. We could see the value of using technology to connect with colleagues, in addition, or as an alternative, to face to face education and training. We wanted new spaces to model new skills, and we needed facilities that enabled the involvement of new and more partners. Our current education centre was outdated and uncomfortable. If we were truly committed to education and training fit for the 21stcentury, then our facilities needed to reflect that. So, despite all the economic and other uncertainties that have shaped the UK in the last three years, we launched a capital campaign and commenced work on a new learning hub, in order to respond to the needs of a much wider audience.
That building is nearly complete now and our new approach is embedded already in our work today. We hope to open the new learning hub at the end of this year or the start of next. We are busy working on new programmes of learning: new relationships, information and roles through which these will be enacted.
Thank you Christian and Nezam for being part of that change; for being honest and critical in your perspective of St Christopher’s, and for holding me to account in relation to my promise for change some years later.
I have been watching and listening carefully since then to make sure we are relevant for the future. Our recent partnership with Dr Suresh Kumar, the Institute of Palliative Medicine, Kerala, and the Bangabandhu Sheikh Mujib Medical University in Bangladesh, to establish a new fellowship for leaders of palliative care in low- and middle-income countries delivered in India is evidence of our desire to be different. That ran for the first time in January this year with more than 40 participants. St Christopher’s was there, learning as well as teaching, keen to enable the efforts of new pioneers in the field in any way in which we could add value.
We believe we have a place in supporting the development of palliative and end-of-life care – as we had 50 years ago under the strong vision and leadership of Dame Cicely Saunders. Her tenacity, ambition and unrelenting commitment to changing the experience of people who are dying is something we want to continue. But its enactment and focus will need to be different to reflect contemporary opportunities and challenges. We realise that and look forward to its ongoing iteration with the help of others.
- St Christopher’s education programme.
- Follow Heather Richardson on Twitter @stchrisheather
- Read Dr Christian Ntizimira’s post on the EAPC blog: From Crisis to sustainability: Building palliative care with limited resources that gives the background to his plenary lecture. You can view several more posts relating to the 16th EAPC World Congress here.
- View and download the ePosters from the 16th EAPC World Congress (available for a limited period only).