Abstract

Hospices across the UK are having to re-examine the way their services are run as pressure on funding is becoming increasingly problematic in a nation that has fiscal uncertainty. In Wales statutory funding for hospices is arrived at by a formula and St Kentigern Hospice receives 18% of its funding from the Welsh Office.

The hospice hit financial crisis in 2010 and took drastic measures with swingeing cuts to services, including the decision to make the medical director and sole doctor redundant. A decision was made that St Kentigern Hospice would become a nurse- led unit in the faint hope that this would save the hospice. This was entirely a reactive decision and could only be made because the hospice had a prescribing Advanced Clinical Practitioner, who had been practising for 18 months in that role.

One year later in 2011, the hospice was fully operational in both its inpatient and day therapies services and £1,000,000 credit in the bank. This is the story of innovation in practice where the advanced nurse practitioner role in palliative care has been extended to an autonomous level not practised anywhere else in the UK. From adversity this eight- bedded IPU and day therapies hospice now has a service that is economically robust and has been approved and recognised by the Welsh peer review process. Such is the success of the model that the hospice is undergoing a major new build, and expansion of services, funded entirely from its own resources, responding further to our communities’ palliative care needs.

The model and its sustainability along with challenges will be discussed. Change in practice, innovation and leadership for nursing within a hospice setting will be explored.