From oncology nurse to CEO
Introduction
Alison Moorey, CEO of St Wilfrid's Hospice, has been working at the hospice since 1997. St Wilfrid’s Hospice is an independent Hospice, based in Chichester, and since it opened in 1987 has provided care for over 10,000 local people. Their services are provided free of charge and as they are not part of the NHS they rely on public support for 85% of their £5.6m annual running costs. Alison joined St Wilfrid’s as Director of Nursing in October 1997 since which time she has played a significant part in the evolution of the Hospice. I met with Alison recently to hear how she and the hospice have evolved since she started there 14 years ago.
SFM: How did a young nurse find herself working in what may be perceived as one of the more depressing medical specialties - oncology?
Alison: I trained as a nurse about 30 years ago and the first nursing job after qualifying was night duty in an oncology unit in Bristol. At night fewer nurses are on duty so immediately you find yourself in a position of having to take more responsibility. Looking back it must have said something about where my career would take me as I wasn’t intimidated by responsibility. For a while I moved into orthopaedic nursing which was more fun for a young nurse because the patients tended to be a lot younger than those in oncology and their problems weren’t terminal, but deep down making a difference was what I got the most out of so I moved back into oncology.
SFM: After years of working within the NHS what prompted you to move
Alison: One thing that bothered me about working in oncology in those days was that the system was to continue treating cancer patients when it was evident that their cancer wasn’t responding. I felt there comes a point when the patient needs to get off the roller coaster of treatment and receive palliative care to make the remainder of their life as comfortable as possible. When I say stopping treatment I’m referring to interventions that are trying to arrest the inexorable progress of the disease. Sadly some cancers reach the point where no treatments work and at this point I feel that it’s kinder to the patient and their family and friends to recognise the battle is over and to make the remainder of their life as comfortable and as dignified as possible.
Working within an oncology unit within the NHS meant I wasn’t in a position to recommend stopping treatment and switch to palliative care so when I heard that the Countess Mountbatten Hospice in Southampton were recruiting for a Junior Ward Sister I applied and got the job.
After a few years there the Director of Nursing was going on maternity leave so maternity cover was needed. As the Senior Ward Sister was nearing retirement she didn’t want the additional responsibility but rather than recruiting cover the Director of Nursing asked me to cover as she felt I had the skills. Within NHS nursing there are clearly defined tiers, or grades, within the career structure and had I been looking to move it’s unlikely I’d have applied for Director of Nursing roles so finding myself in a position where my skills and abilities were recognised and I could ‘jump’ two rungs in the career ladder was a tremendous opportunity. Fortunately for me she didn’t return from maternity leave to the same job so I found myself as Senior Nurse Manager.
During my seven years at Countess Mountbatten my role evolved from a nursing with responsibilities for managing a ward in to a more senior management role with some nursing. As Senior Nurse Manager I had two jobs in one - running a ward and running a unit. When I started nursing all roles involved some degree of nursing and pure management roles didn’t exist, but nursing was evolving and management roles were moving away from hands-on nursing. Up until that point I hadn’t considered moving into management as people management is a really difficult skill and I knew I was a very good nurse.
SFM: What brought you to St Wilfrid’s?
Alison: In 1997 I was about to get married and although I wasn’t looking to move jobs a close friend, who had worked at St Wilfrid’s, told me their Matron was about to retire and they were recruiting a replacement. She urged me to apply. The Matron’s salary was more than I was earning so that was honestly part of the attraction! Whilst the Countess Mountbatten was part NHS funded St Wilfrid’s was part of the Independent Hospice Movement. I hadn’t considered moving into the independent sector as back then it was very different from how it is today and viewed by some as a career backwater. However, based on a recommendation, I thought I’d give it a go.
I was invited for interview and entering the reception my first impression was of a welcoming atmosphere. Everyone I met or saw was positive, friendly and perceptibly happy. (SFM: I had exactly the same impression when I arrived to interview Alison). The interview was unlike any other interview I’d attended. All six interviewees were there at the same time and we all had lunch with the Trustees then we were taken around the gardens. Fortunately I didn’t know any of the other candidates. We each had appointed times for our interview and had been asked to prepare a presentation. Mine went well - on reflection too well - so I didn’t think I’d be selected as I thought I’d come across as overly confident. However that evening Dr Brendan Amesbury, the Medical Director, called to offer me the role.
SFM: What was it like moving to an independent Hospice?
Alison: 1997 was a huge year for me as I’d moved house in May, offered the role at St Wilfrid’s in June, married in August then started at St Wilfrid’s on 1st October. The Matron retiring, Pat, had been at the Hospice since the start and we had a month working alongside each other before we left.
I was used to the ways things worked in the NHS and it was very different at the Hospice. I was used to taking responsibility for expenditure and making decisions; I’d needed to spend money in the NHS so I was used to juggling my budget and making savings in some areas to fund expenditure in others. However when I started St Wilfrid’s the Trustees had more operational involvement than they do now so even when I wasn’t increasing overall expenditure I had to get their prior approval. Adjusting to this was very difficult but fortunately that’s all changed now.
However the big up side to all the differences in management style was that from a patient’s point of view more time and resource were dedicated to them, their families and friends - then and now. The other big difference was that we are masters of our own destiny and we decide how we raise funds and how that money is spent.
SFM: How have things changed since you started?
Alison: When I started there was a terrific team which we’ve since grown. Because my role was purely management and I had always regarded leading and managing people as the most challenging part of management I got a place to study an MA in Leadership and Management at Chichester University starting in September 1998. Having got married later in life we’d decided we should try to start a family. However I became pregnant more quickly than expected so was already pregnant when I started the MA. In fact the results of my second assignment came through whilst I was in hospital having just given birth to our daughter. I decided to devote my energies to being a mum and take a year off from the MA. After 6 months maternity leave I returned to work.
When I resumed my studies I found that combining work, being a mother and writing a dissertation was a struggle. I wasn’t struggling intellectually but simply because if I do something I aim to do it to the absolute best of my abilities and finding enough hours in the day to get everything done and aim for a distinction just wasn’t happening. My tutor asked me if I I wanted to give up to which I replied with an emphatic ‘no’. I have a great working relationship with Brendan Amesbury, our Medical Director, so told him of my struggle. He knew me well, and knew my capabilities and suggested a simple solution - to take 2 weeks off. It was exactly what I needed to focus my attention and energies and I attained the distinction I was aiming for.
SFM: How did you become CEO?
Alison: In 2002 our management team consisted of three people the Medical Director, Director of Nursing (me) and the General Manager. In 2002 regulations governing the independent healthcare sector had changed and the governing body, the National Care Standards Commission (now the Care Quality Commission), required all providers to register. Part of the registration process involved nominating a ‘registered person’ namely an individual who was ultimately accountable for every area of the operation and was involved in the day to day running. We realised that it wasn’t realistic for Brendan to be the registered person and logically I should take on the role. Although I was chairing the management team the reporting lines were confusing as the members of the team reported to me but they were accountable to the Trustees.
By 2005 the Board of Trustees was evolving and it was becoming more and more important to network externally, particularly with other Hospices. It was evident that what St Wilfrid’s needed was a clear structure with clear lines of accountability and as more and more Hospices were appointing CEOs I spoke to the Chair of Trustees about the issue. Status and networking were vital to the future of the Hospice and finally in December 2006 the Trustees approved what was an ‘appointed’ CEO position. I had learnt from studying for my MA the importance of leadership styles and adapting these as required and how vital networking and using contacts as support was in a senior role.
It was an interesting evolution and although most of what I did hadn’t changed, the new title did make a difference and the new reporting lines helped enormously. The Trustees needed to change to a new way of working. My appointment as CEO was followed soon after by Anthony Wickins taking over the role of Chairman of the Board of Trustees. Anthony was Vice Chairman and he stepped in when the Chair became unwell and was unable to continue. Anthony was very much a change agent and the changes he made to the Board of Trustees helped my role as CEO evolve.
SFM: Recently I noticed you were advertising for Trustees. Is that something you’ve done before?
Alison: No. Historically the role of a Trustee was to ensure the running of the Hospice was in ‘safe hands’ but we now recognise that it is essential that the Board of Trustees has the right skills mix. For the first time we were openly recruiting for Trustees and we were amazed at the response - 45 expressions of interest and 20 applications. Some of those who expressed interest have since become part of our team of volunteers. Previously we’d approached people we knew but now we are able to define what skills the Board of Trustees needs in order to advise and steer the Hospice. We have a clearly defined job description, run a proper recruitment process and, following appointment, all Trustees undertake a formal induction.
Looking back I realise how much has changed. When I arrived at St Wilfrid’s the Board of Trustees was very involved operationally. Now the Trustees look to me for guidance, and we are clear that they are here to support and guide, but also importantly to challenge and question the Management Team.
Last March Angela Wormald, a Trustee since 2010, took over as Chair of the Trustees. In 1995 she was appointed HR Director at the Chichester offices of the publishers John Wiley & Sons so has commercial expertise, a wealth of local knowledge and has also raised money for the Hospice.
There has also been a debate about the length of service before re-election. At the moment a Trustee can serve a maximum of 9 years. The environment in which we operate is very different from when I started. Whilst we are still providing care for the terminally ill the way we make it happen and recognise everyone’s contribution is different. Everyone is part of a big jigsaw and if any pieces are missing we can’t complete the picture. In this type of environment the danger is that the clinical staff could be regarded as the most important people in the organisation, however we’ve a culture that recognises everyone plays an important role because caring for our patients is very much a team effort.
SFM: You mentioned networking - tell me more about it.
Alison: Within the Hospice sector there are a number of formal and informal networking groups. There is a national charity - Help the Hospices - which has a formal membership structure for Hospices to join. Their aim is to provide a wide range of resources, news and information for those working in the sector, and to campaign on behalf of independent Hospices. I also find it tremendously valuable to network with other CEOs. The south coast region of the charity meet three times year and also there is a more informal group of eight Hospices within Sussex who meet four times a year. I’ve learned a great deal from networking and because I’ve benefitted from it so much I wanted my colleagues to benefit similarly so I’ve encouraged the setting up networking for Directors of Nursing, Lead Nurses - community and in-patient, Registered Managers and Finance Directors.
It does involve an investment in time but the benefits of letting go, talking about issues and making connections face to face far outweigh the costs. Any senior role has enormous pressure and added to that we are dealing with very sensitive situations day in day out and we don’t always get it right.
We also want to use networking to reach other local charities as there are local issues that affect us all.
SFM: How do patients come to be at St Wilfrid’s Hospice?
Alison: Patients are referred by medical professionals when a decision has been made that no further curative treatment can be administered. This doesn’t mean they are receiving no medical intervention, but what they are receiving is palliative - that is it keeps them as comfortable as possible but it will not cure their illness. Palliative care can include radiotherapy or chemotherapy as both can be used to slow tumour growth which may help to keep the patient comfortable.
Although the reasons patients come here are very sad our staff and volunteers can see that they make a difference. They all have a sense of empowerment to use their time and skills to benefit our patients so what the Hospice does is seen differently by different people.
SFM: You have 14 beds but you want to grow your service. How will you do that?
Alison: When patients are referred to us they can be with under our care for days, weeks or months and what we do is to make the end of their life as comfortable as possible. Those requiring full time care so will occupy one of our 14 beds but at any one time we will be providing care for around 210 people within the community as outpatients (Day Hospice) and in their homes (Hospice at Home).
We are looking at the configuration of our services with the aim of providing more support to people in their own homes – including Clinical Nurse Specialist support and Hospice at Home. We introduced the Hospice at Home in 2009 and whereas there are many services that provide assistance and care in the home they are usually in and out, whereas the Hospice at Home concept is hands on care and practical help during the last few days of someone’s life. It requires a mix of qualified and unqualified nursing staff to provide care 24/7 and its purpose may be to prevent admission to an inpatient unit, to offer respite for carers, to manage a crisis during an illness or to provide end of life care. It’s a big new development for us and we are looking how to develop it further to provide more people with better care during the end of their life as there aren’t enough services offering these skills and experience in the community.
We are working closely with our local hospital with the aim of reducing the number of patients who die in hospital. We have recently appointed a new Head of Education to further develop our education programmes to provide end of life care education to nursing homes and care homes amongst others. The needs of a patient during the end of their life are complex - whether they are personal, drugs, equipment, or a combination of these - and they extend beyond what the community or hospital team can reasonably provide. At St Wilfrid’s we have the skills and knowledge to work with other health and social care providers to deliver the best possible end of life care.
You may not associate laughter with terminal illness but because our staff and volunteers see the difference they make they love their work and get great pleasure from what they do. The positive side of what we do is making the end of life as good as it realistically can be and that brings relief to our patients, their families and friends so we do have a happy, positive feel in the Hospice and you will hear people laughing and singing.
The services hospices provide are extending beyond the traditional in and out patient model and for example one Hospice offers a fully operational advice line. A great deal needs to be done to improve public awareness by educating people about the services provided by hospices, the importance of planning for the terminally ill and the specialist needs related to end of life. We need to demystify death and encourage people to talk about end of life issues and plan for their future.
SFM: The fundraising staff of many charities are located in traditional offices yet yours are here at the Hospice. Is that a good idea?
Alison: One of the most valuable benefits of the way the Hospice is set up and run is that our fundraising is so close to the cause. Our fundraising staff are based here at the Hospice so they see the patients, their families and friends, as well as all the clinical staff and volunteers. They can talk to those that want to talk and it gives them a far better feel and understanding of our culture and what we are trying to achieve as well as seeing what the funds achieve. Next year, 2012, is our 25th anniversary year and we are planning all sorts of activities and having a special service in the Cathedral at which we will honour and remember all those that have been involved with the Hospice since it started. If you want to participate full details are on our website.
Links
St Wilfrid’s Hospice http://www.stwh.co.uk/
Countess Mountbatten Hospice http://www.cmhcharity.co.uk/
Help the Hospices http://www.helptheHospices.org.uk