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Care at all cost

Reflecting on Paul Brinsley’s fifteen years at the helm of Cornwall Hospice Care.

Cornwall Hospice Care is the only adult hospice care provider in the county. Its 20 beds across St Julia’s Hospice and Mount Edgcumbe Hospice offer vital end of life care to patients throughout Cornwall, as well as support for their families. As a charity, fundraising income is imperative to keep the hospices open and running. Continuing to operate and provide an essential service in a pandemic has brought with it many challenges, not least having to postpone 40th anniversary celebrations that were due to take place in 2020. Chief Executive, Paul Brinsley, has been steering Cornwall Hospice Care through these stormy waters and took time out to talk to me about the tribulations and triumphs that the last year has held.

How did your association with Cornwall Hospice Care begin?

After leaving university my main career really was at the Automobile Association where I was Head of Legal Services and then Manager of Consumer Legal Services at head office in Hampshire. After a few years, I decided I would like to do something different and took up a second career in the voluntary sector. I became Chief Executive of Age Concern Cornwall and then first Director of a hospice in Preston, Lancashire which is where I learned about hospices and palliative care and the unique value that they provide to patients and their families. A job in Cornwall came up and as I happened to be from Cornwall and count it as my home I applied for it and was fortunate enough to be appointed. That was in 2005, so 15 years ago now.

I understand that the two hospices were originally separate entities?

When I arrived, they were two completely separate charities but they had been working together for a while as there was a plan in place for them to merge and create a single entity for hospice care for Cornwall. Part of my taking up the job was being asked to undertake the amalgamation, which was quite a substantial task to take on. It was interesting, because at the time there was some resistance in the local community that perhaps their beloved hospice and its identity could be in some way diminished by creating a new single charity. I had to spend some time in public meetings reassuring people that it was absolutely in the best interest of patients and families across Cornwall to have the benefit of one organisation looking out for them. So, we went from seven separate corporations into three which was an excellent achievement in itself and gave savings just from doing that. The route to success in creating Cornwall Hospice Care was absolutely in keeping the two different identities of St Julia’s and Mount Edgcumbe and I’ve always been keen that this is preserved in perpetuity.

I think that helped reassure the public: knowing that they wouldn’t be losing any sense of their local association. For me, it wasn’t just about having hospices that served the communities of St Austell and Hayle, it was about the whole of Cornwall being able to access palliative care. Both hospices offer the same care and service and the fact that they remain very much part of the local community while offering care to the wider county, is a strength; it’s important that people feel close to their local hospice. Sadly, it’s financially impossible to provide any additional locations across Cornwall and so St Julia’s and Mount Edgcumbe remain the only two hospices for adult care in Cornwall.

It’s so important that people get the right support for end of life care. Our hospices provide complex pain management and psychological support for so many patients. Not everyone at end of life needs a hospice, but my mission is to ensure this level of care is there for those who do.

2020 was planned as a year of anniversary celebrations, how has the pandemic affected this?

It was sad that we were not able to celebrate the charity’s 40th anniversary as planned. Interestingly, in terms of the clinical care it is very much business as usual and we’ve kept all of our 20 beds open. We have been able to work closely with our colleagues in the NHS and the local health care communities to support them. We’ve continued to take patients from the hospital and the community which has been very helpful to our partners when they’ve been under pressure. That has absolutely carried on. Our staff have been fantastic and really stepped up to ensure that this has happened.

For non-clinical staff, it’s been a different story. At times we have had over 100 staff on furlough. I really feel for those staff who have had to do that. It’s absolutely not want they want to be doing – they want to be running their shops or out fundraising and not being able to do so has been frustrating and soul destroying.

Our 40th anniversary year was going to be a huge year of big events and we have had to cancel every one. It just wasn’t practical or safe to do so and as a responsible health care charity we want to be at the forefront of ensuring that we are doing everything we can do to support and adhere to restrictions.

Have you been able to do any fundraising?

We did have some virtual events, which have gone very well – Your Marathon, Your Pace was really successful; I took part in it myself and it made sure I got out of the house every day as well as reminding people we’re here. And of course we’ve also had Terry’s Bed Appeal which has proved to be very successful. The quarter of a million-pound appeal has only £20,000 left to raise.I have to be honest and say what has saved us is the work we’ve done with Government and local MPs to secure support funding. It was a national initiative and Hospice UK, which is our membership body, helped to negotiate on our behalf.

Last year we were generating £125,000 a week from all self-generated income, which means while we’ve not been able to raise money we’ve lost close to £1.6 million – that’s a lot, and not all has been covered. But, we’re a well-structured charity with reserves so we’ve been able to draw on those to support the work and keep going. It’s vital that we get back to fundraising for the future and the new financial year. Although we had to postpone the anniversary, we look forward to marking it when we can.

Ironically, 2019/2020 saw our shops have their best ever year, raising over a £1million net for the charity. I was all set on congratulating them with a suitable celebration but that has all had to be put on hold as well. However, we mustn’t lose sight of this as it was an incredible achievement.

Have you had to offer care in a different way during the pandemic?

The hardest thing has been having to restrict visitors; normally we would welcome families in to spend time with their loved ones and that’s a very important part of the provision – often at the weekends the hospices would be really full with families visiting but we’ve had to restrict that right down. It’s very sad not being able to offer the same kind of environment for families. A bit of reassurance and human contact is what is needed and that’s been a sad loss for both staff and patients.

Our clinical senior management team have been outstanding in ensuring that they have had all the PPE they needed and everything on that side has gone very smoothly. The staff have worked really hard not only on the wards but also in their private lives to keep themselves safe. That has been a big message from myself and the management team and it’s been to their credit. Self-imposed restrictions have been pretty relentless. We are currently part of the vaccination programme and that gives us hope.

Are there learnings you will take forward from this difficult time?

I believe the future of our fundraising will be a blended programme to include virtual events but combined with those large, mass-participation events that people really miss. We will take the experience we have had from operating under Covid restrictions to achieve a balance between the two.

There have also been learnings when it comes to our governance. We have a very active Board of Trustees who are very caring and passionate about their roles. We normally meet face to face but we’ve embraced technology and now we meet actually more regularly via video link. What’s been interesting is that trustees, who live both in and out of county, would normally have their individual roles – perhaps on an income generation committee or a clinical committee – and would only go to certain meetings. As we now meet remotely, we can all easily come together and we’ve had full attendance in meetings; you could say that the governance has improved because of this. Trustees, executives and management have become more aware of what’s going on across the board and are able to feel the pulse of the organisation as we go through this crisis. This is something we are interested in capturing and keeping.

It’s not just our trustees that have been affected. Working from home has raised the profile of the culture of presenteeism. Our front line staff – doctors, nurses, health care assistants, caterers, housekeepers etc – they absolutely have to be in the hospices. But we have other roles that can be done from home and I’ve been talking to a lot to our staff about presenteeism; the presumption that if you’re not visible, you’re not working. That is certainly not the case and we need to move away from that. Our aim is to support those who can and want to work from home in the future. It might be a blend, and I’m very open-minded about that. Quality of life is important and that’s a part of the hospice ethos as well as living in Cornwall and it’s important not to lose sight of that.

How would you sum up?

What’s been most important for me, has been to work towards the hospices being sustainable for another 40 years and that’s the key goal for me. I’m not at retirement yet, but when I am I want to leave the charity in a successful and a financially stable condition so that we can carry on caring for patients for as long as we’re needed.


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