The Chief Executive of Les Bourgs Hospice says it is “morally responsible” to highlight the urgent need for new funding solutions to ensure Guernsey maintains sustainable hospice care into the future – ones which may require States support.
The island’s only hospice which is a 24/7, 365-day operation costs £2.8m per year to run with almost all of the budget spent on care and relying solely on charitable donations, fundraisers, retail and volunteering.
But in 2024 it was forced to draw around £1m from its reserves, with subsequent donations and improved fundraising bringing its operating shortfall to around £250,000 last year.
CEO Rob Jones spoke of using these reserves as a “moral way” to bankroll its services since they come from donations that were handed over to support the care of islanders, but has warned these funds will be exhausted within three years.
“The worst thing for us would be to say, oh I’m really sorry but we want to retain our reserves and our investment. So what we’ll do, we’ll just open one or two bedrooms. That’s not the right thing to do and we haven’t done it, we wouldn’t do that because we’re a charity,” he said.
“We’re an independent charity, It’s in our DNA to do that, but it just feels morally responsible to give everyone in the island this heads up, and I’m giving three years notice.
“We do a really good job fundraising on a small island, but that only goes so far – there’s only so much you can raise from selling second hand goods through a shop, and we’re getting better at it. We work really hard here to try and do our best.”
Work is underway to review palliative care in Guernsey between Les Bourgs and the States, with partnerships between government, GPs, care homes and the third sector being discussed.
Mr Jones expects the studies to conclude this September, and hinted that government support may be necessary as it is in other jurisdictions: “I think we’re getting to the point where we need to say it’s actually quite normal for a government to support hospices”.
Rising demand, increasing complexity
Les Bourgs has seen an uptick in the number of patients and the complexity of their care needs in the past two years.
“People in the past may come to us with, say one cancer, but in addition to that there might be other underlying health problems as well, or they become very dependent on others because they might have dementia, Alzheimer’s, MND, or there might be a disability, or there might be a renal failure, heart problems, and all the rest of it,” Mr Jones said.
But the surge in demand – which will only continue to grow due to the ageing of the island’s population – is not led solely by what most would consider the likely candidates and age groups to require hospice care.
“I think the thing that we’ve seen over the past two years which has really startled us is how the average age of people referred to us dropped so much. We’re now where the average age is in the 50s, but it also means we are getting people in their 30s, 40s and we’ve even had people in their 20s with aggressive cancers. We’ve not seen that before,” Mr Jones added.
“Not only are we needing to give more time and have more expertise on ward to help look after people and maintain our high standards, and that’s what we’re about here – It’s about caring for people – but also, at the same time, what we’ve seen is the costs creep up quite a lot.
“As people coming in are getting younger, you’re supporting people’s parents as well as their young children. So when someone comes into the hospice they don’t come in as an individual, they come in as a whole family because that’s what that’s what people need.
“But what families need is the care responsibilities taken off of them, so that they can spend time as a family and actually get a bit of normality, which they may not have experienced for some time. We’ve made some changes within the hospice for school children so that we can accommodate their needs when they’re staying because they want to be near mum or dad.”
Tightening purse strings
Mr Jones acknowledges that recent economic woes have hit not just Les Bourgs but those that they have relied on for 35-years.
“RPI has been running high. We know the cost of living everyone experiences. On top of that, you’ve got the secondary pensions which are being picked up by employers now, and this all has a cumulative effect,” he said,
“[Businessess] don’t have as much money as they used to to be able to donate. Margins much tighter, people have got less money in their pockets. Remarkably, people still find the money to give to charity. In Guernsey, it really has got a very, very supportive community, and people are giving their money. Sometimes you’ve got children who give their pocket money to support charities in Guernsey. We see that.
“Or they give their time, so they’ll come and volunteer in the shop or help the admin team out. Quite remarkable – But that gets to a point where it’s like, okay we really, really have done so well without support. But then when you see the cost go up, and then you see some of the main sources of income which we have had, like legacies, just really drop off a cliff, then you start getting a mismatch between the money coming in and the money going out.
“Quite easily in the space of two or two or three years, you can see the cost go up by a fifth, and that’s what we’ve seen just from those things happening. And then when you add on the need to be able to provide and train up more care teams that adds to it.
Funding into the future
Mr Jones said the States was informed over a year ago of the pressures facing Les Bourgs and the need to adopt a more sustainable funding model.
“They need to know, they’re our biggest partner. 97% of our referrals come from HSC so they need to know. Because what happens if we can’t take their referrals? It has a big impact on them so we made them aware, and we’re actively talking to them about what a really sustainable system of palliative care could look like for Guernsey for the next 25-years.”
“We’ve got active sub groups working on it, and I can’t tell you how good it is for the island to do that. England doesn’t have it and they should. Jersey’s got it, and it’s really benefited the island, and we’ve got a really good standard of palliative care on this island already by international standards.
“By having a strategy for the island it prioritises it from a government perspective, but also from a funding perspective. That’s what normally happens, so I think it’s very good news for the island. At the moment, I don’t know what that will mean for Les Bourgs other than we’ve got the opportunity to co create and try and find a design palliative care services in the island which fit for the future.
“Then the States, that’s their job to work out how they’re going to fund it and who gets what. But I’m also very mindful of the fact that we do raise money ourselves independently, so it’s not about them funding everything we do. But I can’t think of another [hospice] that doesn’t get that support. I think the fact that we’ve gone 35 years before mentioning that we might need it – It’s absolutely unbelievable.”