Apresentação feita por Rob George no seminário internacional Conass Debate – Cuidados Continuados e Integrados: um desafio para o presente, realizado em Brasília nos dias 26 e 27 de dezembro.

1. Lessons from St. Christopher’s:
what we are learning
Professor Rob George MA MD FRCP FRCGP Hon
Medical Director
Cicely Saunders Institute King’s College London
“You matterbecauseyou areyou, and you
matteruntil the last momentof your life.
We will do all we can not only to help you
die peacefully,but also to live until you
die.”
DameCicelySaunders
Completing my life
well, not meeting
my death badly

2. CULTURE & PREJUDICE
HIV, & the disadvantaged dying
Beginnings of a Movement
COMPASSIONATE COMMUNITIES
Service development at scale
The UK’s Journey: from the best for one
to something for everyone?
Total Pain
The team approach
Completing lives well
Avoiding harms on the way
Capturing complexity
1967
1987
2000
2010
1891

3. 500 voluntary hospitals
were established in
England during the 12th
and 13th centuries.
Where things all began: buildings!
“for the man who is neither
curable nor incurable but
simply dying”.
(Colonel William Hoare 1891)
‘I want to give to the poor for love
what the rich can buy with money’
(Venerable Mary Aikenhead 1900)
The Mildmay Mission Hospital
1866-1970 ‘The fever Hospital’
1988 ‘The HIV Hospice’
Amidst a lot of suspicionCicely Saunders
1950’s 1967 St Christopher’s
Built

4. Focus on the individual The unloved,
the unlovable
and the
unlovely
You matter
because you are
you; you matter
to the very last
moment
We are not here
to help you die,
but to help you
live until you die
There is never
nothing
more that you
can do
http://endoflifestudies.academicblogs.co.uk/
early-origins-of-st-christophers-hospice/

5. 2030
Life expectancy:
85 years
Top causes of death:
Dementia /organ failure
multiple morbidity
Typical social context:
More lone-living – friends
& neighbours as carers
Disability before death:
Long-term frailty and
chronic impairment
A changing picture of dying
1900
Life expectancy:
47 years
Top cause of death:
childbirth
infection
accidents
Typical social context:
extended families
Disability before
death:
Not much
2018
Life expectancy:
80 years
Top cause of death:
Dementia
Heart disease
cancer
Typical social context:
Dispersed, smaller
families
Disability before death:
Months to many years

6. Rob George 2019
Clinical, financial and ethical imperatives:
frailty and multi-morbidity is our problem now
People die from
lives
Population-based
• No size will fit all
• What is the best
that you can do?
• Build capacity
• Collaborate
• Co-produce
• 83% of health
spending is in the
last year of life.
• Palliative care in
our communities
must double by
2040
• Most of our
dying popln are
old & frail
• The rest have
multi-morbidity
• People with
different diseases
have different
needs

7. Rob George 2019
“No problem can be solved from the same level
of consciousness that created it.
We must learn to see the world anew.”
Albert Einstein
Horizon Scanning

8. Challenges in the UK
the origins of the movement with
very strong local interests driven
often by particular deaths
The heavily medicalised model of
illness leads to people being seen as
pathologies and not people.
The expectations of the NHS &
social care is unsustainable
 death is removed to institutions
 a ‘service’ culture vs care culture -
done to rather than done with
Solutions in the UK
Death and dying is not special, but
universal
 The Hospice Movement has been special
It is a ‘back to the future’ that is
needed
 Community in terms of location or
common values eg faith
 Social networks and individualism as
proxy for extended family
 Local partnerships and co-production
(Confused) complexity, Consumerism,
Capacity, Change resistance

9. “I can make the last
stage of my life as good as
possible because everyone
works together confidently,
honestly and consistently
to help me and the people
who are important to me,
including my carer(s).”
Each person is seen as an individual01
Maximising comfort and wellbeing03
Each community is prepared to help06
All staff are prepared to care05
Each person gets fair access to care02
Care is coordinated04
National Approach

10. 8 cross-cutting domains.
Specialist level Hospices are involved in all domains

11. Implications for Hospices -an interdependent blend:
direct and indirect care support, skills development, education and engagement
IMPACTdirect &
Individual
indirect &
communal
RESOURCE
highest, most focused,
& least flexible
Lowest, most
adaptable & responsive
A resource to other
professionals/ services
Public support and education
Societal change
Innovation & influence
Service offerings
Direct
Care and
support

12. IT & Learning Hub, community partners
risk zone
Building is always risky
PERFORMANCE
TIME
One near collapse
 Frailty
One success story
 Heart Failure
Four developments
 IT (ECHO)
 Learning Hub
 Compassionate
neighbours
 Coach for care
 Wellbeing project
 New partnerships
FRAILTY
We did it our way …
HEART FAILURE
We learned our lesson

13. Rob George 2019
 Frail elders, family and friends
 GPs, palliative care, mental health and
allied health professionals, geriatricians
 Social care, social workers, personal care
providers
 Third sector: Age UK, Ageing Better,
Hospice UK
 Academic collaborators
 St Christopher’s
Age-attuned Hospice Care:
https://www.stchristophers.org.uk/wp-content/uploads/2018/10/Age-attuned-Hospice-care-document.pdf
National Institute of Health Programme Grant:
Defining needs, seeing what is available, developing
training programmes

14.  60 Care Homes
 GP Communities of Practice
 One Hospice
 International partners (Premier)
Age attuned
palliative care:
Light touch
Re-enablement
Rapid response
Judy 75, good
neighbour to
Anna 43
 >125,000 volunteers in the UK
contribute to hospice care.
 25% of additional expenditure saved

15. Integrated community action,
education and
professional support

16. The patient as part of a community
guides priorities…

17. A society in which citizens help each other through
the difficulties that arise as a result of death, dying
and loss
where death is seen as part of life
where planning for end of life is the norm
in which citizens feel confident to support their families,
friends and neighbours in times of serious illness or
bereavement
where medicine and healthcare can focus on doing what it
does best
o redressing challenging clinical problems

18. Sydenham site
51-59 Lawrie Park Road, Sydenham, London SE26 6DZ
Bromley site
Caritas House, Tregony Road, Orpington BR6 9XA
Telephone 020 8768 4500
Email info@stchristophers.org.uk
www.stchristophers.org.uk
#stchrishospice
St Christopher’s is a registered charity (210667) registered with the Fundraising Regulator