My Memories of St Michael's Hospice

ST MICHAEL’S HOSPICE HEREFORD:

A PERSONAL ACCOUNT OF HOW IT ALL BEGAN

by Richard Miller

St Michael’s Hospice Hereford: A personal account of how it all began by Richard Miller

Dr Richard Miller & Dr Jeff Kramer (2015)

Foreword

This is a remarkable story portraying the very best of human endeavour, determination, resourcefulness and inspiration.

I first became involved in the plan to establish a hospice in Herefordshire when I met Richard at the County Hospital to discuss a mutual patient. When we finished he asked me if I might be interested in helping to plan such a project since I dealt with patients who might benefit. I jumped at the opportunity to help and found myself in Richard’s sitting room having tea with him, Freda Pearce, a lady who led a group of fund-raising enthusiasts. Also present were Councillor Olwyn Barnett, Sandra Griffiths, a district nurse and Reverend John Hall-Matthews, the vicar of Tupsley at the time. After much discussion we decided to proceed. Thanks to Richard’s quiet driving force and Freda’s great help fund-raising, together with help from the West Midlands Health Authority in the form of an interest free loan, we were able to start. The proverbial acorn grew into our first great oak and so St Michael’s hospice started. This went on to produce our second acorn which grew into our new twenty bedded development. Now, the provision has further developed a highly popular Hospice at Home service.

This is all due to the fantastic support of many donors, both large and small, including a committed and enthusiastic team of volunteers. St Michael’s wouldn’t be the place is it without the excellent team of caring staff we have been fortunate to employ. It is thanks to everyone it is such a special place and highly valued within the community. St Michael’s now stands as a great tribute to the late Freda Pearce and Dr Richard Miller, who are greatly missed.

Dr Jeff Kramer

St Michael’s Hospice Hereford: A personal account of how it all began by Richard Miller

St Michael’s Hospice, Hereford, Bartestree (1983)

St Michael’s Hospice, Hereford, Bartestree (2023)

Introduction

People often ask me how St Michael’s Hospice came into being and presentations I have given on the subject have appeared to provoke genuine interest. Although I have written on the topic before, I thought its publication as a booklet might appeal to a wider audience. My hope is that you find it an interesting and, even, inspiring read.

Seeing the need

My concern about the quality of care that people received at the end of their lives started as a medical student in the late 1950s when I was just 20. I helped care for several people of my own age who did not have long to live. The concept of holistic care was very limited then and care frequently did not prioritise symptom control, let alone the spiritual and emotional needs of patients and their families. These were some of the first patients I came into close contact with, and the experience had a profound effect upon me. It helped me want to always provide kind, compassionate, care which focused on the individual person and prioritised their needs.

This commitment was reinforced over the next decade. I became a GP in Hereford in 1964 and cared for many people reaching the end of their lives, including a good friend with cancer. I was very aware of the gaps in my knowledge of the management of distressing symptoms and felt inadequate when dealing with death and bereavement. This sparked an interest in the emerging speciality of Palliative Care.

Learning about hospices

In 1976 I met a friend from my student days, who informed me that he was leaving General Practice to become Medical Director of St Barnabas’ Hospice in Worthing, East Sussex. Coincidentally we spent our annual family holiday nearby and the next time we were in the area, I phoned the Hospice to see if I could visit. My friend was on annual leave, so I spoke to the founder of the Hospice, Dr Gusterson, known to all as Gus. He was a retired anaesthetist and Lay Minister, and he invited me to visit St Barnabas’. Gus proved to be a truly inspirational advocate for hospice care: his philosophy was to provide people with holistic, compassionate, individualised care which aimed to ensure that they lived in the best way possible for the time they had left. Meeting Gus transformed my interest into a passion and shortly afterwards, I spent a week at St Barnabus’ learning more about the hands-on care of patients. Over the next few years, I regularly sought Gus’s advice and he always provided me with great support. His wise counsel often helped in overcoming many of the obstacles faced as we planned and built St Michael’s. Above all he encouraged the conviction that nothing less than a fully equipped modern building would do and it must include an inpatient unit.

I visited several other hospices over the next few years and always received the warmest of welcomes. Each time, I was deeply impressed by the special atmosphere and the outstanding care given, not just to the patients, but also their families. I also met other pioneers of the hospice movement, including Dame Cicely Saunders. All were happy to share their extensive expertise, knowledge, and skill. I became increasingly convinced of the need for a hospice in Herefordshire. I visited a number of potential sites in and around Hereford but soon realised I was way out of my depth, and it was not something that I could achieve on my own.

Freda Pearce and launching the appeal

In July 1979 I first heard of a lady named Freda Pearce. I attended a meeting where I discovered that she was planning to raise money for a hospice in Herefordshire! She had just completed an appeal for a body scanner for the oncology unit at Cheltenham General Hospital where she had been treated for cancer. That appeal was very successful, raising the £90,000 needed to buy the scanner outright. Arriving on Freda’s doorstep the following morning, I introduced myself and announced that we shared a common ambition. In no time at all Freda was planning a fundraising campaign.

Shortly after I met Freda, I happened to see Jeff Kramer in the entrance of the old Hereford County Hospital. Jeff was Hereford’s first Consultant Haematologist. During our conversation, I mentioned the idea of building a hospice in the County and he immediately expressed an interest. So began a close and warm relationship that continues to this day, over forty years later.

A small group of us met in my front room: Freda, Jeff Kramer, the then Vicar of Tupsley, Reverend John Hall-Matthews and Brian Adams. Brian was a quantity surveyor I knew well; he recommended Nigel Dees as the ideal architect. Despite being daunted by the enormity of the task, we decided to go ahead, encouraged by John Hall-Matthews’ assurance that with enough faith and determination anything was possible.

Using Freda’s existing group of ladies, several other potentially interested people were approached to form a fundraising and planning committee. The committee was named the Freda Pearce Foundation for Continuing Cancer Care, and the appeal was launched. Needing to raise a huge amount of money, fund-raising groups were established all over Herefordshire and adjoining areas.

We were greatly encouraged by the overwhelmingly positive interest and enthusiasm. The local press and radio were very supportive, providing vital publicity. The support of the public was amazing from the outset and remains the Hospice’s main source of income. However, small fundraising events, although extremely helpful, were never going to raise sufficient funds on their own. Freda personally wrote hundreds of letters to various organisations and individuals, both locally and nationally, with some very positive results. There was a very generous response from local businesses and grants were received from a few charitable trusts. Freda’s biggest personal scoop was a cheque for £50,000 from the King of Saudi Arabia! That is over half a million in today’s money!

Jeff Kramer, Chairman of the committee at that time, approached the then West Midlands Health Authority. They took the unprecedented step of agreeing to an interest-free loan of £400,000. It was this loan that finally made the project financially viable, and, without it, St Michael’s may never have been built. The Hospice’s finances were so strained in the early years of operation that it was allowed to defer repayments of that loan several times.

Choosing a name and logo

We had launched the appeal before choosing a name or logo for the Hospice but almost immediately realised both were necessary to focus public interest. It was agreed that a name was needed that reflected the vital spiritual aspect of hospice care, so it seemed appropriate to name the Hospice after a saint. After some discussion St Michael was chosen as he is said to accompany the dying on their final journey. I am convinced that I can sometimes detect his protective presence in and around the Hospice. We also recognised that we needed an eye-catching and distinctive logo and wanted this to be designed by a local artist. An approach was made to the Hereford College of

St Michael’s Hospice Hereford: A personal account of how it all began by Richard Miller

Art and, we selected the wonderful design by student Jane Cross. The logo remains unchanged to this day and depicts the now very familiar image of the Dove of Peace flying into the light.

Launch of the Macmillan service

Shortly after the appeal launch, I visited the headquarters of the National Society for Cancer Relief, (now Macmillan Cancer Support) with Ann Frost the Head of Nursing Services in Herefordshire. We were informed that the Society did not usually provide grants for capital projects such as ours, but we were advised to ask for help in establishing a Macmillan Nursing Service. As a result, the first Macmillan Nurse was appointed in 1981, the second a year later. They gained enormous respect for their very skilled and compassionate care for, and support of, patients dying at home as well as their families. The concept of hospice care was quite new at that time and there is no doubt that their excellent work greatly facilitated the acceptance of St Michael’s when it finally opened.

Freda Pearce & Hereford College of Arts Student Jane Cross (1982)

The building

The Committee understood that the location and design of the Hospice were crucial to the success of the project. Ideally, we wanted a modern attractive building which incorporated the most up to date health care facilities combined with a calm, peaceful, home-from-home atmosphere on a site that benefited from natural surroundings. Nigel Dees and Brian Adams were appointed to plan and cost the project.

Finding the right location was a challenge and a number of sites, in and around Hereford, were considered. Quite early in our search Brian, Nigel and I visited Bartestree Convent where we received a wonderful welcome from the lovely nuns who gave us a fascinating tour. We were greatly moved by the serenity of the place and its stunning view across the Frome Valley to the Woolhope Hills. As we were about to leave, we stood by a small orchard to the south of the building and knew intuitively that this was where the Hospice should be built.

Having spent the next two days measuring the site, Nigel informed us that he could design a building that would fit the rather tight space. He subsequently produced a plan for an attractive and innovative building that made excellent use of the site and gave patients the benefit of magnificent views. None of the other venues could match the one at Bartestree, although it was some time before a final decision could be made. This was largely because there was some concern regarding access from Hereford, but it was decided that this was more than offset by the location’s many assets and its unique situation. From that first meeting we enjoyed a very warm relationship with the nuns until they sadly left the convent in 1992.

St Michael’s Hospice Hereford: A personal account of how it all began by Richard Miller

They very generously offered to lease the land to us for a peppercorn rent of 5p a year for 99 years. The Hospice was later donated the freehold of the original plot of land.

Local builder H. Vaughan & Sons was engaged. To mark the start of building in the Spring of 1982 there was a ceremony during which Freda cut the first sod while I released a ‘dove’. I recall it was actually a homing pigeon! The building was completed just over a year later with a total cost of £750,000 including equipment. The builders’ site office was a battered old caravan, in contrast to the large two storey structure used during the construction of new inpatient unit 30 years later!

Staffing and equipping the Hospice

Regardless of how excellent the building and location, the heart of any organisation is the quality of its members of staff. It was vital they all shared the core caring philosophy of St Michael’s. Our first

Freda Pearce & Richard Miller (1982)

St Michael’s Hospice Hereford: A personal account of how it all began by Richard Miller

appointment was the Matron, Joan Boyles, who was in post several months before the Hospice was completed. She led the recruitment process and appointed a team of wonderful people who set a standard and quality of care that has been maintained to this day. She was also heavily involved in choosing equipment and furnishings, some of which were highly innovative for the time, such as state-of-the-art baths. The first medical director was Richard Lamerton who brought a wealth of experience of Palliative Care. His assistant was Tricia Hall-Matthews, a wonderful hospice doctor. On more than one occasion she acted up when we were between Medical Directors.

The Hospice opens

St Michael’s opened with six beds and admitted its first patient in October 1984. The official opening by Princess Alexandra, in May 1985, was a truly celebratory occasion. When she was introduced to Jeff Kramer the Princess asked him ‘Are you well endowed?’ Needless to say, all of us struggled to remain composed. The Princess and her lady in waiting made a hasty retreat to the nearby toilet from which shrieks of laughter were heard.

Although the building had the capacity for sixteen beds, in three four-bedded rooms and four single rooms, there were insufficient funds for all these beds to be used. It opened with just four beds and the remainder were not fully open for at least five years. We relied on the patients’ meals being supplemented by Marks and Spencer (can we say that) who supplied us with delicious food which would otherwise have been thrown out! During those early years it proved much more difficult to raise funds for running costs than it had been to finance the building. In 1989 the Hospice was down to three months funding and facing possible closure. The decision was made to take the risk of going public with this predicament and launch

St Michael’s Hospice Hereford: A personal account of how it all began by Richard Miller

a massive fundraising effort. Thankfully the risk paid off and the Hospice has never faced such a dire situation again.

Thoughts and reflections

Although only five years elapsed between our first planning meeting and the Hospice opening, it had been far from plain sailing. Apart from the daunting task of raising the money to build and run the Hospice, we initially encountered reservations from several influential people. A nationally known, and highly respected, member of the hospice movement tried to persuade us to start with just a Hospice at Home service. I am convinced that, had we done this, Herefordshire would have had a very long wait for its own Hospice, as happened in a neighbouring county. Our determination that nothing less than an inpatient unit would do, never wavered. The overwhelming support of the Herefordshire community and wonderful people like Dr Gusterson were vital in maintaining that resolve.

I could not have managed without the support of my beloved late wife, Jane. She had to endure many evenings alone while I attended meetings, and to deal with other people’s opinions about the project. She frequently spent an hour or more on the phone patiently listening to the caller’s own ideas regarding the venture. All this was in addition to Jane’s vital role as a full-time GP’s wife. When I was on duty overnight and at weekends, she took calls from patients and provided advice and reassurance or had to find me to arrange a visit. This was when most households did not have their own phone and long before the now ubiquitous mobile phone!

Most sadly of course, the seemingly indomitable Freda did not live to see the Hospice completed. She died in the summer of 1983, yet

St Michael’s Hospice Hereford: A personal account of how it all began by Richard Miller

was still enlisting the support of her fellow patients in hospital just a few days before. Special permission was given for her to be buried near the Hospice, in the grounds of the Convent. Only a handful of the original committee survive and all Freda’s ladies have died, including the youngest, Elaine Ferber, who left us far too soon.

It was anticipated the Hospice would remain a quite modest facility with little impact beyond the local area. None of us anticipated what a vital and influential centre of excellence St Michael’s would become, its enviable reputation for outstanding and compassionate palliative care spreading far and wide. Freda would have been astonished by how many thousands of families would benefit from its services. She would have been particularly delighted to know that the community has adopted St Michael’s as ‘Our Hospice’.

Sadly, the lack of space here makes it impossible to mention individually the large number of people, from all walks of life, who freely gave of their time and expertise. Without their contribution the project would not have been possible. Indeed, throughout its life the Hospice has been utterly dependent on the multitude of amazing people who give up their spare time to perform a whole host of tasks that help ensure the smooth running and financial viability of St Michael’s.

Looking back there are many instances that I am convinced could not have happened just by chance. For example, my opportune and vital meetings with Gus and with Freda. And the extraordinary experience of completing our convent tour on exactly the spot where we knew the Hospice should be built. Many of us believe in Divine Coincidence and surely these are just supreme examples of this phenomenon.

St Michael’s Hospice, Hereford, Bartestree (2023)

St Michael’s Hospice Hereford: A personal account of how it all began by Richard Miller

It has been an enormous privilege to have been part of the team that was inspired to establish the wonderful facility that is St Michael’s Hospice. Little did we realise in the early days that we were going to create something far greater than our wildest dreams.

My longstanding association with the Hospice has been a source of great joy and pride. I believe I have gained so much more than I have contributed. In a world where there is so much suffering, being alongside so many really wonderful people, both staff and patients, is a constant boost to my faith in human nature.

Richard Miller with HRH Princess Alexandra (2009)

Postscript

Recently, I found myself on the receiving end of the amazing care provided by St Michael’s, initially at home and then in the inpatient unit. The standard of the care I received exceeded even my wildest expectations, with each member of the team showing infinite empathy and kindness, often in the most difficult of circumstances. Without exception, they are a very special group of carers. I find it particularly heartwarming to be frequently told how much people love working at St Michael’s. Although, inevitably, there is sadness, I am often reminded how much joy there is in the Hospice. Alongside the tears there is a lot of laughter.

My stay in St Michael’s galvanised me into completing this story, a task which had awaited my attention for too long. The fact that I was enabled to make it back home again provided the extra prod.

A Day So Happy

Richard attended a writing group in the Day Hospice in his last year. Here is a poem that he wrote about finding the site for St Michael’s.

A September Day that dawned so bright and clear, The sun shone on our faces

With white clouds scudding across the sky, While we took in the perfect view. We knew at once that this was where We would build our Hospice. It was one of the happiest days of my life.

A few words by Richard’s daughter

I grew up with St Michael’s Hospice. It was almost a fifth member of the family. Dad was for ever going to meetings about the Hospice, talking about the Hospice or taking me to look at a muddy field that would one day be the Hospice! It is hard to be excited about that when you are 10. His passion and commitment to the concept of the Hospice was second only to his love and commitment to my Mum, Jane, sister, Louise and me.

I am awed by what his idea has become. St Michael’s Hospice is not just a place, but it is the lynchpin at the centre of a care system which draws together services across the community. It holds the person at the heart of everything that it does and avoids dehumanising that person into just another patient. Dad died at home and the care, which was coordinated by the Hospice, was outstanding: he had the perfect death.

I spent many hours working on this memoir with Dad in his last year. He faced many challenges during this time, but he was determined to complete this and it had to be just right. In this final edit, I hope his voice still rings true and that he would be happy with it.

Sophie Hastie 2nd May 2024