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Resilience and Adaptability: A hospice perspective

St Giles Hospice

This article is part of the Greater Birmingham Chambers of Commerce’s Raise the BAR (Business Adaptability & Resilience) Campaign, sponsored by Western Union Business Solutions. For more campaign content click here. This campaign provides Chamber members with a platform to share learning and inspiration on this agenda. All views and opinions expressed below are those of the author only. 

By Emma Hodges, Group CEO, St Giles Hospice 

The hospice business model is an unusual one.   We develop specialist clinical services, provide them at no charge to the service user but at a cost of £10m, and with no guarantee, that a combination of the NHS (c. 32%) and charitable donations will pay for them.  Our charitable income relies on the generosity and goodwill of local people and businesses in supporting our fundraising, shops or lottery operations.  We benefit from over 6,000 volunteering hours per week, which based on the minimum wage would cost us c. £2.3 million pounds.  We have a workforce of just over 400 across the group, most of whom are healthcare staff, for whom we compete with in NHS labour market.

The modern hospice movement which is just over fifty years old was founded out of a response to deficits in care for people with terminal cancer.  However, hospices have responded to other demands reacting to the challenge; why should it by only people with cancer who have access to such high quality care? 

The challenge however, is that demographics have been changing rapidly.  Baby boomers are moving into older age and there are more people dying each year.  People are living longer, often with multiple conditions and demands for hospice care is far outstripping available capacity and resources.

It’s been the case for many years that hospices have been well funded by the communities they serve. In turn, the hospices have grown and provide a range of high quality services. In addition, in accordance with Charity Commission requirements, they have built up sufficient reserves to ensure the future sustainability of the organisation is protected. But, things have changed. The hospice funding model has matured. With fixed geography catchment areas, austerity and increased competition from other good causes, there is more limited opportunity to raise more and more from the same fundraising pool – whilst every year costs continue to rise.

Over recent years at St Giles, we have adapted our services to support more people.  Not everyone needs the specialist palliative care that our medical and nursing teams provide, so alternative models can help people live better with a terminal condition.  Not everyone needs formal counselling for bereavement, our help points, in thirteen locations across our community, are accessible to anyone struggling with grief.  We have positioned our hospice as a community resource and hope that the extra people we are seeing and supporting start to support us in raising funds or volunteering.  Many of the new services cost less and require a different workforce than our specialist palliative care services.  However, it is our specialist palliative care services that generate most of our income and meet the complex physical and emotional needs of local people living with a terminal illness. 

We have some really innovative ideas on how to adapt our care services to the growing challenges we face, however balancing demand and resources is an ongoing and very real and immediate challenge.  Many people working in hospices are driven by a moral compulsion to ease suffering and to ensure equal access to high quality care; however, there are significant barriers in being able to achieve this such as workforce capacity, financial resources and demand for existing services.  The reality is that our business model is under pressure and resilience is an increasing concern.  We must be honest about this and really understand what is driving these challenges and what can be done to overcome them. 

There is a tension.  We must ensure financial robustness, strong governance and provide Trustee oversight.  We must also continually ask for money – appeal to the good nature of local people and negotiate with an NHS that has its own financial challenges.  We have limited forward visibility of our income – legacy income is unpredictable which means we never really know what our income will be in any one year.  The challenges on the high street affect us too.  Our costs are increasing as most of our expenditure is on pay.    We can be criticised for spending money on ‘back office support’ or marketing.  However, we are a £13m turnover business as well as a community based charity.  We have to spend money to generate money and we have to employ expertise to ensure financial adaptability and resilience in addition to that required for care services.

For businesses or investors looking to support a charity, they want it to be well run and efficient. They want to know their energy, time and investment is making a sustainable difference and not being wasted.  For some they want to leave a tangible personal legacy, sometimes in their name and in that case, business sustainability and resilience, must be a consideration.

Some of our challenges are similar to those of any business; however, there are others unique to all charities and some specifically to hospices.  We have more work to do in order to continue to adapt to the difficult market conditions we face.  We hope that by talking about the challenges we face more publically and balancing messages of resilience and a need for more income helps us to engage in new debates and discussions. It’s a simple aim - to help us ensure hospice care remains a sustainable service for local people for years to come.