How Rowcroft transformed end-of-life care in Torbay
- Credit: Rowcroft Hospice
I’m delighted to see that 20p from each copy of Torbay Weekly is going to Rowcroft Hospice.
The lockdown has created problems for many businesses but Rowcroft has been especially badly hit.
Their charity shops are shut and many fund-raising events could not go ahead but their vital work must continue. They cannot shut and furlough staff.
Looking at the success of Rowcroft, it is easy to forget its early difficulties.
When I arrived in Torbay in 1981 as a fresh-faced new GP, the retiring partner had been campaigning for a local hospice.
Rowcroft House had been earmarked and Dr Margaret McKerrow had been appointed medical director but success was not guaranteed.
First of all, as now, there were financial concerns. Raising money for a new hospice was one thing but could we keep raising money indefinitely for running costs?
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If fundraising failed to reach the target it would be possible to postpone the opening but, once opened, there would be on-going commitments.
Could we raise enough money day in, day out for staff salaries, electricity, gas and all the other running costs?
There was also some resistance among local GPs. The idea of a hospice was new and many older GPs had seen the loss of their maternity care and now might lose care of their patients at the other end of their lives.
Where, they asked, was cradle to grave care? Also, these GPs had cared for their dying patients throughout their career. “You can’t tell us what to do”.
Dr McKerrow had also been a GP and understood these concerns.
She personally visited most of the practices and explained how the hospice would be there to help them look after their patients and not take over. She quietly won their support.
In my hospital days terminally ill patients were put in a side ward. The doctor’s role was to save lives, death was a failure where 'nothing can be done'.
Pain killing meant increasing the morphine. And symptom control meant waiting until the patient was in pain or vomiting. No-one discussed their wider concerns.
When Rowcroft finally opened I worked there for one afternoon a week.
Margaret McKerrow was my mentor and she opened my eyes. She was quiet and calm. She told me that when working in a hospital her consultant had commented: “I cannot hear what you are saying, and I cannot read your writing which makes communication difficult.”
Typically, she was being unfair to herself.
I could always understand her although she may have had a point about her writing. We got on well, partially because we had been to the same medical school.
By anticipating symptoms and giving small regular doses of medication, she ensured that patients were kept alert and remarkably well.
But management went beyond controlling physical symptoms. We also looked at emotional, social and spiritual aspects.
Open discussion was encouraged but only at the patient’s speed. Some patients were scared, and we needed to find out why. Sometimes this was due to a misunderstanding or even guilt.
Simply talking it through often meant that we could reduce the painkillers. Knowing someone is there was often enough.
As now, most of our patients were not in the hospice but at home. Families were more relaxed knowing that the Rowcroft team were available on the end of the phone if care became difficult.
It was not only the Rowcroft patients who benefited. GPs and hospital colleagues could see the positive care offered at the hospice and changed their attitudes.
Even people who had never been near the hospice benefitted as the local medical community learnt more about end-of-life care.
When Dr McKerrow organised a national conference in Exeter she asked whether I could give a short talk. “It’s all getting a bit intense. Could you give a light-hearted amusing talk on death, dying and bereavement?”
It was a challenge but summed up her attitude. Rowcroft has never been a depressing place where you go to die.