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Creating a sustainable high quality hospicecare service
  1. Alison Ryan
  1. Weldmar Hospicecare Trust, Dorchester, UK


Introduction Demographics, increased patient aspirations for choice of type of care and our potential funding base, mean our current monolithic service structure and business model, which we share with many other hospices, is not sustainable. The project is to create a coherent service and financial system which will deliver high quality care to all who need it and be affordable in an uncertain future.


  • To understand what patient determined high quality outcomes are

  • To reconfigure services to be able to deliver these outcomes

  • To improve integrated working internally and with external agencies

  • To be able to measure cost effectiveness in service delivery

  • To increase our financial autonomy

  • To develop new income streams.


  • Researching patient determined quality outcomes

  • Challenging assumptions about existing, and exploring alternative, service delivery systems

  • Consultation with staff about the requirements of different systems

  • Developing sharper costing mechanisms to allow measurement of effectiveness in service delivery

  • Development of financial modelling and sensitivity analysis to allow differential decision- making about investment.

Results A reconfigured integrated service delivery structure based on delivering the right person in the right place at the right time with the right skills to meet patients needs.

A business turnaround programme to create sustainable flows of income and expenditure into the future.

Discussion The planned change involves structure, training development and financial remodelling but above all the cultural change required to put patient care and patient choice genuinely at the heart of service provision. The implementation has a 5 year timeline.

Conclusion Many other hospices face the challenge of maintaining quality while facing rising demand and uncertain income streams. This presentation shows a possible way ahead and the issues which may arise.

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