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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
More than a Leafy Suburb
The Story of St. Luke’s Hospital
As Told by
Patients, Staff and Stakeholders.
By
John A. Weafer
Anne Marie Weafer
Weafer and Associates Research & Consultancy Ltd.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
TABLE OF CONTENTS
Page
Acknowledgements…………………………………………………………… 6
Executive Summary …………………………………………………... 7
Chapter One: Introduction and Background ….………………………. 17
1.1
Int
roduction
1.2
Ba
ckground to the Study
1.3
Re
search Approach
1.4
Str
ucture of the Report.
Chapter Two: Literature Review: The Impact of Hospital Design on
Patient Treatment and Care …………………………... 24
2.1Introduction
2.2Hospital Design
2.3Healing Gardens
2.4Hospital Design in Practice
2.5Complementary Therapies
2.6Concluding Comment
Chapter Three: The Views of Patients ………………………………... 49
3.1
Pro
file of Patients
3.2
Pat
ients’ Reaction to Hearing they had Cancer
3.3
Pat
ients’ Preconceptions of St. Luke’s Hospital.
3.4
St.
Luke’s Response to Patients’ Initial Concerns
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
3.5
Ov
erall Satisfaction with the Care and Treatment in St. Luke’s
3.6
W
hat Patients Value about St. Luke’s Hospital
3.7
W
hat Patients will Miss about St. Luke’s Hospital
3.8
Co
mparisons with Other Hospitals.
3.9
Pat
ients’ Rating of Specific Aspects of St. Luke’s
3.10 Suggested Changes to St. Luke’s
3.11 What St. Luke’s Means to Patients
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
Chapter Four: The Views of Staff …………………………………….. 91
4.1
Int
roduction
4.2
4.3
4.4
4.5
4.6
4.7
4.8
Sta
ff Perceptions of how satisfied Patiens are with their Experience of
St. Luke’s Hospital
W
hat Staff Perceive to be of Benefit to Patients.
Sta
ff Satisfaction with Care Given to Patients in St. Luke’s
Sta
ff Rating of Specific Aspects of St. Luke’s Service
Sta
ff Perceptions of How St. Luke’s Compares with Other Hospitals that
Provide Cancer Care in Ireland
W
hat Staff Value About Their Work in St. Luke’s
Ar
eas Of Working Life Staff Would Like to Change
Chapter Five: The Views of Selected Stakeholders …………………103
5.1
Int
roduction
5.2
Th
e Majority View of Stakeholders
5.3
Th
e Views of Stakeholders who Personally Agree with the Transfer of
St. Luke’s Services
5.4
Th
e Views of Stakeholders who Question the Merits of Transferring St.
Luke’s Services
5.5
Co
ncluding Comment
Chapter Six: Support and Rehabilitation Services ……………………114
6.1 Introduction
6.2 Model A: Specialist Oncology Hospitals.
6.3 Model B: Acute Hospitals with Oncology Departments.
6.4 Model C: Specialist Cancer Care Centre Attached to Oncology
Hospital.
6.5 Model D: Palliative Care Facilities.
6.6 Model E: Independent Cancer Centres
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
6.7 Concluding Comment
Chapter Seven: A Possible Future for St. Luke’s Hospital …………... 135
7.1 Introduction
7.2 A Possible Future for St. Luke’s Hospital
7.3 Concluding Comment
Appendix 1 – Existing Resources and Facilities in St. Luke’s Hospital
References
Acknowledgements
This study would not have been possible without the co-operation of a large number
of individuals. We wish to express our sincerest thanks to all who participated in the
study: patients, staff, and stakeholders. We would like to extend our thanks to the
Board of the Friends of St. Luke’s Hospital and its chairman David O’Halloran
(succeeded by Peter Byers in October 2009); and to the Board of St. Luke’s Hospital,
and its chairman Padráig White. We would particularly like to thank a number of staff
members in St. Luke’s Hospital who assisted in various ways with the planning and
conduct of the study. Special thanks to Eileen Maher (Director of Nursing) who gave
considerable time, energy and wisdom to the project. Also, thanks to Ann
Broekhoven (Chief Executive Officer), Philippa Drinnan and Imelda Kelly
(Administrative assistants), and the various Department Heads and nursing staff who
facilitated the research.
The views expressed in this report are those of the authors and do not necessarily
reflect the views or policies of the Friends of St. Luke’s Hospital or the Board of St.
Luke’s Hospital.
John and Anne Marie Weafer
Weafer and Associates Research & Consultancy Ltd.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
Weafer and Associates Research & Consultancy Ltd.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
Executive Summary
1. Background
This report presents the main findings from a research project carried out by
Weafer and Associates Research on behalf of The Friends of St. Luke’s
Hospital and the Board of St. Luke’s Hospital. The primary aim of the
research was to capture the essence of St. Luke’s Hospital from a patients’
and staff perspective by exploring the impact of St. Luke’s Hospital
immediate environment on patient well-being, care and cure.
The study also sought to place the research findings from St. Luke’s Hospital
into a broader context by reviewing the academic literature to establish what
evidence, if any, exists of a link between the environment within which
patients experience treatment and care, and the outcome of that treatment and
care. Finally, the review explored different models of support for cancer
patients that might be applicable in the context of the long-term use of the St.
Luke’s Hospital campus, within the parameters set by the National Cancer
Control plan and the HSE model of primary and acute care services.
The information detailed in the report was gathered from a variety of sources
using different research methods, including in-depth personal interviews,
focus groups, telephone interviews, and self-completion questionnaires. A
total of 370 participants took part in the research.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
1. Key Findings
The Views and Experiences of Patients
Overall, the 200 patients that participated in the study were unequivocal in
their praise and support for St. Luke’s Hospital. The majority of patients were
more than satisfied with virtually every aspect of the hospital, including the
relaxing, safe and peaceful hospital grounds, the standard of the food, the
comfort of the rooms, the privacy afforded patients, the speed with which
patients received appointments, the amount of information provided by the
hospital that enables patients to make informed decisions, and the expertise
and friendliness of staff. When asked what they valued most about St. Luke’s,
the patients highlighted the following:
 The contribution of staff who were perceived to be caring,
understanding, friendly, knew you by name, took time to explain
and answer any question, and who acted in a professional
manner.
 The hospital environment generally and specifically the grounds
that were perceived to be spacious, well laid out, calming, and
therapeutic; the atmosphere of the hospital; the cleanliness; the
feeling that everyone ‘was in the same boat’; and the Lodge.
 The medical treatment which many rated as excellent, combining
an effective and personal service. More than nine in ten patients
indicated they were completely satisfied with their medical
treatment and overall care.
Almost two thirds of patients said they would miss something about St.
Luke’s Hospital when their treatment is finished. For most, it is the
camaraderie of other patients, followed by the care and attention of staff, the
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
reassurance and routine of the treatment and check-ups, knowing everyone
has cancer, the grounds of the hospital, the Lodge, being able to leave
responsibilities outside the gate, and always having enough to do. Their
views are perhaps best illustrated by a few verbatim comments that patients
gave when asked what they valued about St. Luke’s:
The sense of calmness you don’t feel in yourself. The setting and the
grounds to walk around. Private places to be on your own or with
people. The staff are extremely supportive and nurturing. They can
have fun too. Everyone is in the same boat – you are not a pariah. We
bolster each other up. You have good days and bad days. When you
have cancer, you need to be supported and Luke’s is a specialist
hospital that can do that. There is more awareness amongst Luke’s
staff. I had a bad experience in the past but here, the nurses give you
their number to phone at anytime.
I don’t think I would have managed so well outside Luke’s. It has such
a lovely atmosphere; it really saved me. Such a healthy environment. It
is all around you. You can see it from wherever you are. It has a nice
canteen and it is not too big or impersonal. It is an atmosphere for
recuperating.
The Lodge is fantastic. I wouldn’t have lasted anywhere else for 8
weeks. You have privacy and patients around you are the same as
yourself and they are a support group from day 1. It is unbelievably
friendly – all the staff.
The majority of people here are of the impression that they will leave
here cured and that is a great psychological boost to everyone even if
you are not feeling that well yourself. I dreaded going into hospital. I
had never been in hospital before but the Lodge was unbelievable. You
would think you were on holidays, just no sunshine. The facilities are
great and the food lovely, and you make good friends. I couldn’t say
enough about it.
The nurses give you all you need. Their whole approach is so good.
They know you are apprehensive when you come in and they know how
to handle it.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
The Views and Experiences of Staff
The majority of St. Luke’s staff believe that patients are satisfied with their
experience in St. Luke’s, mainly because it is a small personal hospital, but
also because of the quality of the medical care, the beautiful grounds, the
facilities, the relaxed atmosphere, the holistic treatment, the comfort of the
hospital, the patient focus and camaraderie amongst patients.
When asked what they identified as being of particular benefit to the
wellbeing of patients in the current service provided by St. Luke’s, the top
three factors identified by staff were: the grounds/surroundings, the patient
focus that is made possible by the relatively small size of the hospital, and
staff expertise.
Staff also rated most aspects of the service in St. Luke’s very highly,
especially the relaxing hospital grounds, the helpfulness of the staff, the
expertise of staff, the overall care given to patients, the standard of food, the
safety of the hospital environment, the information given to patients, and the
support provided to patients’ families.
2. Alternative Models of Support and Rehabilitation
One of the objectives of the study was to explore different models of support
for cancer patients that might be applicable in the context of the long-term use
of St. Luke’s Hospital campus, within the parameters set by the National
Cancer Control plan and the HSE model of primary and acute care services.
The review is not intended to be complete, given the considerable number of
health facilities offering services to cancer patients throughout the world.
Rather, its aim was to stimulate discussion and debate on possible future
scenarios for St. Luke’s Hospital in order to facilitate the Friends of St. Luke’s
and the Board of St. Luke’s make an informed decision regarding their longterm goals.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
A review of six different models of support and rehabilitation considered in
the report concluded that the Independent Care Centre model was most
appropriate to St. Luke’s immediate future. The establishment of a palliative
care1 facility also had merit in terms of its scale and caring ethos.
Furthermore, there is an increasing demand for palliative care services in
Ireland. However, such a move would appear to represent a significant shift in
the underlying ethos of, and care provided in, St. Luke’s. In the opinion of one
member of staff, although palliative care is ‘part of what of what we do, it is
not what St. Luke’s is about’.
Two types of Independent Cancer Care centres were considered in the report:
Maggie Centres that are typically located close to oncology hospitals and the
Penny Brohn Cancer Care Centre in Bristol. Characteristically, these centres
provide a caring and supportive environment that is not always possible in
larger, acute hospitals. Their role is quite specific – to provide support
services for patients with cancer and their families.
St. Luke’s is effectively an independent cancer care facility, which, following
the implementation of the national cancer strategy, will retain services and
facilities that are at least on par with the level of services in centres such as
the Maggie Centres and the Penny Brohn Cancer Care Centre. Given the very
high regard with which St. Luke’s Hospital is held by patients and their
families and friends, and the comprehensive range of support services already
in place in St. Luke’s, it would appear logical and cost-effective to develop St.
Luke’s as a step-down rehabilitative centre for patients with cancer rather than
seeking to build up these services in another institution some time in the
future. One possible scenario for St. Luke’s is presented below.
1
The meaning of palliative care needs to be clarified from the outset. As used here, it refers broadly to
hospice or immediate end-of-life care. However, it is also possible to view palliative care as the
extended time leading up to end-of-life, which could take years. In the opinion of some staff in St.
Luke’s Hospital and elsewhere, this is a need which is not being met in Ireland. This latter form of
palliative care could be incorporated within the service model proposed by the independent cancer care
facility, provided the primary focus of the facility was on care and cure rather than death.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
3. A Possible Future for St. Luke’s Hospital
Existing Services and Facilities in St. Luke’s Hospital
In addition to the relatively large outdoor area, comprising of landscaped
gardens and walkways, St. Luke’s Hospital has a comprehensive range of care
and support services, together with other facilities and specialist areas that
benefit cancer patients and their families (see Appendix 1 attached entitled
Existing Services and Facilities in St. Luke’s Hospital).
It is proposed that St. Luke’s Hospital should be retained as a cancer care
centre by continuing and expanding its current range of services along the
following lines.
Future Services and Facilities
1. Target Groups
It is proposed that St. Luke’s would serve the following target groups in a
way that is in keeping with the integrated focus of the national health
strategy (Department of Health and Children, 2001b).
(a) Local Community: At present, St. Luke’s Hospital provides facilities
for a GP emergency service. This could be expanded to include
additional care facilities for the local community, including a Primary
Care Team as envisaged in the Department of Health and Children’s
national health strategy (Department of Health and Children, 2001a).
Further to the national health strategy, members of the primary care
team will include GPs, nurses/midwives, health care assistants, home
helps, physiotherapists, occupational therapists, social workers and
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
administrative personnel. The strategy also allows for a wider primary
care network of other primary care professionals such as speech and
language therapists, community pharmacists, dieticians, community
welfare officers, dentists, chiropodists and psychologists (Department
of Health and Children, 2001a).
(b) Wider Dublin Community: It is proposed that St. Luke’s Hospital
would be an integral part of the Dublin Cancer Care Network through
the provision of research and education services e.g., seminars for
health care professionals and a research facility focusing on cancer
research. The available conference space will need to be augmented in
line with the services provided.
2. General Support and Care Services
The report of the national cancer strategy lists a variety of cancer support
services which it notes are regarded as important in many countries. These
services can include self-care, caregiver support, psychological support,
physiotherapy, occupational therapy, dietetics, speech therapy, patient
education and health promotion, appliance fitting, nursing services, and
community liaison (National Cancer Forum, 2006). The author and
management of St. Luke’s believe that St. Luke’s has the capacity,
experience and expertise to provide a wide range of support services to
patients and their families, either directly using its own resources or in
partnership with other agencies. Some facilities and services that could be
considered for St. Luke’s include the following:
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
Proposed New and Expanded Facilities and Services
(a) The Lodge facility on site should be retained for accommodating
patients who are actively receiving treatment and who have to travel
long distances for treatment. Transport connections could be scheduled
with radiotherapy centres in the Greater Dublin Area, with St. Luke’s
functioning as part of the Dublin cancer network.
(b) Some of the existing beds could be retained in a step-down facility for
patients with cancer requiring care after radiotherapy e.g., patients with
toxicities post radiotherapy or patients who are unable to go home but
who are not palliative/end-of-life. A small number of beds could be set
aside for symptom control/ palliative care.
(c) A shop(s) and service specialising in cancer care products e.g., wigs,
prosthesis. St. Luke’s currently provides a well-being programme. This
could be expanded in partnership with private sector companies which
specialise in cancer care products.
(d) A range of outdoor and indoor amenities that is appropriate for cancer
patients and their families, and which can take advantage of the
considerable space in St. Luke’s e.g., hydro-therapy pool. At present,
St. Luke’s has pitch and putt and bowling facilities which are popular
amongst patients.
(e) An educational research centre which could host public lectures,
seminars for patients and their families, seminars for Health Care
professionals, and support groups. Specialist events could also be held
to promote understanding and interest in cancer research. For example,
the Memorial Sloan-Kettering Cancer Center hosted a symposium,
Major Trends in Modern Cancer Research for young people to
stimulate interest and excitement in medical discoveries.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
(f) A telephone helpline specialising in education and support services for
patients. This helpline would need to be co-ordinated with the current
helpline operated by the Irish Cancer Society to avoid duplication.
Some degree of partnership may be possible.
(g) Facilities for patient and family support groups. Groups are currently
facilitated in St. Luke’s.
(h) Outpatient facilities led by doctors, nurses and AHPs to be provided
for rehabilitation and support including, information centre, cognitive
behavioural
therapy,
counselling,
social
services
entitlements,
physiotherapy providing rehabilitation pelvic exercise programmes for
patients post pelvic radiotherapy, occupational therapy, speech
therapy. St. Luke’s could act as a one-stop shop for cancer support in
the Greater Dublin Area.
(i) A range of complementary therapies e.g., aromatherapy, reflexology.
(j) Dietetics and nutritional care.
(k) Counselling and support.
(l) Pastoral and Spiritual Care.
While other support services may emerge following further consideration by
interested parties, the key point is that St. Luke’s could quite easily and
effectively act as a step-down facility, providing hope and support for patients
with cancer and their families. This rehabilitative step-down facility would be
a centre for patients not ill enough to require hospice care and not well enough
to be discharged to their homes. In the main, it would be for people who have
finished their treatment but provision would also be made for patients in the
Lodge who would be actively receiving treatment in St. James’s and
Beaumont Hospitals.
Another way of presenting the support services that would be provided
through St. Luke’s is by the specific needs of tumour groups. Thus, for
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
example, patients with brain tumours would require the following type of
support: specialist nursing, occupational therapy, physiotherapy, speech
therapy, rehabilitation facilities, counselling and support, and leisure facilities.
Patients with head and neck tumours would require access to dental health
services and an oral hygienist, dietician and nutritional advice, counselling
and support, and information. Most patients would also benefit from health
promotion advice, particularly those with lung cancer.
Concluding Comment
Place matters, especially when the place is perceived to be a healing
environment which is universally praised by patients and staff. The review of
literature in chapter two reported an increasing amount of credible evidence to
support the tangible impact of ‘non-medical’ factors on patient well-being and
satisfaction. Some of these factors are ingrained into the very fabric of St.
Luke’s Hospital, including garden landscapes, a peaceful and safe hospital
environment, psychological and spiritual support services, staff that are not
unduly stressed, and the provision of a range of complementary medicine,
such as art. The views of patients and staff, together with the evidence
explored in the literature review, suggest that there is a tangible link between
aspects of the environment within which patients experience treatment and
care, and the outcome of that care. Therefore, it is strongly recommended that
any change to the location or fabric of St. Luke’s Hospital should retain those
services and features that have been proven to be most outstanding and
beneficial to patients, their families and staff.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
CHAPTER ONE
INTRODUCTION AND BACKGROUND
‘Cancer is a major cause of morbidity and mortality in Ireland.
Each year about 20,000 Irish people develop cancer and 7,500
die of the disease. One in four people overall will die from
cancer and 60% of cancer patients die within five years of the
diagnosis. Although cancer incidence appears to be falling, the
actual number of people developing cancer is expected to
increase because our population is ageing. The number of new
cases the system can expect to deal with by 2020 will represent
an increase of 107% on the number dealt with in 2000. We now
have approximately 120,000 cancer survivors’.
(National Cancer Forum, 2006, p.8)
1.1 Introduction
This report presents the main findings from a research project carried out by
Weafer and Associates Research on behalf of The Friends of St. Luke’s and
the Board of St. Luke’s Hospital. The primary aim of the research was to
capture the essence of St. Luke’s Hospital from a patients’ perspective by
exploring the impact of St. Luke’s immediate environment on patient wellbeing, care and cure. More specifically, the research sought to:
(i)
Establish what the patients value about the current environment,
facilities and service in St. Luke’s Hospital.
(ii)
Explore what the staff identify as being of particular benefit to
patients in the current service.
(iii)
Identify what selected stakeholders see as the value of the current
hospital environment.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
The study also sought to place the research findings from St. Luke’s Hospital
into a broader context by reviewing the academic literature to establish what
evidence, if any, exists of a link between the environment within which
patients experience treatment and care, and the outcome of that treatment and
care. The review also explored different models of support for cancer patients
that might be applicable in the context of the long-term use of the St. Luke’s
Hospital campus, within the parameters set by the National Cancer Control
plan and the HSE model of primary and acute care services. However, from
the outset it was agreed that the patient narrative, which records the stories
and life experiences of St. Luke’s patients, should constitute the primary
focus of the study.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
1.2 Background to the Study
‘Our mission is to establish St. Luke’s as a centre of
excellence in radiation therapy and as a leading hospital for
cancer treatment, care, research, education and prevention.
In striving for this, the holistic needs of our patients must be
at the forefront of what we do. In continuing to develop St.
Luke’s as a centre of excellence, the needs of our patients
and their families will be paramount.
St. Luke’s Hospital Mission Statement
St. Luke’s Hospital is a public hospital with a Board appointed by the
Minister for Health and Children that has, for fifty years, provided a specialist
oncology service to cancer patients in Ireland. The hospital has developed into
a national centre for radiotherapy, treating in the region of 4,000 patients each
year. Some 500 staff is employed with an annual turnover of €40 million. The
hospital has been the beneficiary of substantial public investment over the
past decade resulting in a modern well-equipped specialist centre for
radiotherapy and chemotherapy treatment.
The Friends of St. Luke’s Hospital was established 26 years ago with the
goal of supporting the hospital in the development and delivery of care and
support to patients. During this period, the Friends have raised some €30
million for investment in the hospital. The Friends, whilst a separate legal
entity from the hospital, is located on the hospital grounds and works very
closely with the Hospital Board and CEO to support patient services. Until
2005, St. Luke’s provided the only public radiotherapy service to every
county in the Republic of Ireland, with the exception of Cork and Kerry. The
service included the provision of 16 regular clinics outside Dublin.
In June 2006, the Department of Health and Children published the National
Cancer Control Plan. This plan endorsed the outcome of the report of the
Expert Group on Radiation Oncology Services (aka The Hollywood Report),
which stated that radiotherapy should be delivered on the campus of large
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
academic teaching hospitals. It was decided, and announced in July 2005, that
in Dublin this will mean transferring St. Luke’s services to the campus of both
St. James’s Hospital and Beaumont Hospital. The Minister for Health and
Children also stated that the long-term use of St. Luke’s campus in Rathgar
would be considered in the context of the best interests of the health services.
The decision to transfer St. Luke’s services has been very challenging for the
Board, the staff, the Friends, and many patients who have received care in St.
Luke’s. The Board and Executive has accepted the decision on the basis that
international best practice dictates that radiotherapy should be located on a
campus where there is ready access to the full range of medical specialities.
Others have decided to fight the decision through lobbying and other
activities. Two of the main groups that are engaged in public action to save St.
Luke’s Hospital are the St. Luke’s Patients Action Support Group, which is
comprised of patients and former patients; and the Save St. Luke’s Campaign,
which has a relatively broad membership and has organised a number of
public protests2.
2
http://savestlukes.files.wordpress.com/2007/12/stlukesleaflet-1.jpg.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
1.3
R
esearch Approach
The information detailed in this report has been gathered from a variety of
sources using different research methods, including in-depth personal
interviews, focus
groups, telephone interviews,
and self-completion
questionnaires. During the five-month period of the research, the consultants
visited St. Luke’s on 20 separate occasions. A total of 370 participants took
part in the research (Table 1).
Table 1 Number and Category of Interviewees
Interviewees
Patients
Number
200 interviews
3 focus groups
Staff
22 interviews
111 questionnaires
Stakeholders
20 interviews
1 focus group
Total
370
The patients were chosen from the different sections of the hospital, including
current and review patients. In order to minimise disruption to patients and
their families, only patients deemed to be in ‘good health’ were asked to
participate. This was decided ‘on the day’ in consultation with staff members
on duty and the response from patients themselves. Each patient was informed
of the nature of the research, what was expected of them, and the totally
voluntary basis of the research.
The research was guided by the ‘Ethical Guidelines’ of the Sociological
Association of Ireland (Sociological Association of Ireland, 2004), the
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
‘Ethical Guidelines’ of the Social Research Association (Social Research
Association, 2003), guidelines issued by the Department of Applied
Psychology, UCC, and the writings of experts who have conducted social
research, particularly in a cancer context (Mcilfatrick et al., 2006). Underlying
these guidelines and protocols are a number of core principles, including:

Participants were informed of the purpose of the research.

The voluntary basis of their participation was made clear on a number
of occasions.

All reasonable steps were taken to ensure the confidentiality of the
data and subjects’ identity.

Participants are made aware of the intended use and dissemination of
the data.
Further to the ongoing debate on the meaning and scope of informed consent
(Corrigan, 2003, Miller and Boulton, 2007), all potential participants were
informed of the research in writing prior to being contacted by the researchers
and given an opportunity to participate in, or withdraw from, the research
process. Respondents were also informed of their right to disregard any
questions they deemed too personal or inappropriate. They were also provided
with a contact number for appropriate counselling should they feel the need
following the interview.
The response from patients and staff was overwhelmingly positive, with only
a few individuals choosing not to participate for personal reasons.
Furthermore, while it was originally decided to confine the narrative to the
participants’ experiences of St. Luke’s Hospital, rather than intruding on the
more private story of their personal cancer journey, most patients
spontaneously spoke about their cancer journey. While this extended the
length of the interview and much of what they said was outside the scope of
the present study, the patients were not rushed in any way and care was taken
to ensure interviews were conducted in a sensitive manner. The response
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
from staff was also very positive, with more than one hundred and thirty three
staff completing a questionnaire or participating in a personal interview.
1.4 Structure of the Report
Following this introduction, the results of a literature review of studies
exploring potential links between the environment within which patients
experience treatment and care, and the outcome of that treatment and care will
be presented in chapter two. This will be followed in chapters three, four and
five, with a summary of the main findings from the patients, staff, and
selected stakeholders. The details of a number of salient models of cancer
support and rehabilitation services are summarised in chapter six, followed by
a short commentary on the future of St. Luke’s. Two prefaces and an
Executive Summary of the study findings precede this introduction.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
CHAPTER TWO
LITERATURE REVIEW: THE IMPACT OF
HOSPITAL DESIGN ON PATIENT TREATMENT
AND CARE
‘Some places are romantic and some places are depressing.
There are places that are confusing, places that are peaceful,
places that are frightening, and places that are safe. We like
some places better than others. Place matters’
(Frumkin, 2003, p.1451)
2.1
Introduction
The principal modalities involved in the management and cure of cancer are
surgery, radiation therapy and chemotherapy (Hollywood, 2003). The efficacy
of these treatments on the control of cancer is not disputed in this report.
Neither is the value of providing care in centres ‘characterised by high
caseload, earlier access to care, multidisciplinary care, integration of care
delivery, availability of sub-speciality expertise, availability of support
services (e.g., intensive care, specialised nurses, specialist therapy services,
support services), availability and quality of technology, and the existence of
training and research facilities’ (National Cancer Forum, 2006, p.26).
Accordingly, for the purposes of this study, the role and significance of these
medical factors in the prevention, cure and care of cancer are taken as selfevident (World Health Organization, 2007).
However,
healing
is
a
complex
process,
encompassing
physical,
psychological, emotional and spiritual aspects (English et al., 2008, MacNutt,
1974). An increasing amount of empirical research suggests that a range of
‘non-medical’ factors, such as the design of the built environment, the
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
external landscape, diverse forms of complementary medicine, psychological
support services, spirituality, and staff can have a tangible impact on public
health within hospitals (Ulrich et al., 2004, Ulrich, 1984, Johnson, 2000).
While this is something that many patients, staff, supporters and visitors to St.
Luke’s Hospital have felt intuitively (Farmar, 2007), the evidence has, until
relatively recently, tended to be more anecdotal than ‘scientific’. Accordingly,
the main aim of this chapter is to undertake a systematic review of the
literature on health care environments and their impact on patient outcomes. It
will be argued that there is a credible link between the environment within
which patients experience treatment and care, and the outcome of that
treatment and care (Ulrich, 1992). For instance, researchers have identified a
number of instances where changes to the physical and social environment of
a health care facility have positively influenced patient outcomes (Davidson,
1994, Ulrich, 1984).
The review will seek to utilise all relevant research, regardless of discipline,
epistemology or methodology, which is deemed to valid and rigorous. Whilst
research can be conducted in a variety of ways, the basic characteristic shared
by different types of research is that ‘they are, or aim to be, planned, cautious,
systematic and reliable ways of finding out or deepening understanding’
(Blaxter et al., 2001, p.5). Thus, while randomised control tests (RCTs) are
often regarded as the ‘gold standard’ of medical research (Carter, 2003), it is
increasingly accepted that qualitative research can be just as valid and
rigorous as quantitative studies, even if different methods are employed to
achieve these qualities (Day, 2007, Neuman, 2003, Mason, 2002, Sarantakos,
2004). Furthermore, exponents of qualitative research generally, and
complementary medicine specifically, would argue that the scientific
paradigm underlying RCTs may be inappropriate for testing the efficacy of
holistic interventions that are typically more complex than testing the efficacy
of a single medication in a controlled environment.
Insofar as possible, the evidence will be taken from published articles in peerreviewed journals, together with published books and reports from reputable
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
authors and sources. The review was focused on a number of key areas,
including hospital design, the physical environment, complementary
medicine, and spirituality. Each of these areas was investigated using a range
of on-line databases and publications, including Academic Search Primer,
JSTOR, PubMed, Science Direct, and Medline.
2.2 Hospital Design
‘Many studies have shown that well-designed environments can,
for instance, reduce anxiety, lower blood pressure, and lessen
pain. Conversely, research has linked poor design – or
psychologically unsupportive surroundings – to negative effects
such as higher occurrence of delirium, elevated depression,
greater need for pain drugs, and in certain situations longer
hospital stays’.
(Ulrich, 2000)
Traditionally, hospital designers and administrators have emphasised concerns
such as ‘functional efficiency, costs, and providing effective platforms for
medical treatments and technology’ (Ulrich, 2000). Until relatively recently,
little attention was given to other aspects of hospital design, such as the
therapeutic effect of gardens or the health implications of the quality of air
and the efficiency of ventilation systems (Bardana, 2001, Cooper Marcus and
Barnes, 1995). Increasingly, practioners and academics from a variety of
disciplines are studying the relationship between health-care facility design
and patient outcomes in the belief that a relationship exists between medical
care and the buildings in which it is delivered (Gesler et al., 2004). Easter, for
example, argues that ‘the delivery of high-quality, comprehensive cancer care
and the treatment environment go hand in hand with the patient’s recovery’
(Easter, 2005, p.11). Others point to the healing qualities of design and colour
and the hope that can be instilled with bricks and aesthetics (Carroll, 2005).
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The central premise of this section of the report is that the built environment
can affect patient outcomes and that research exists to indicate that ‘changes
in the healthcare environment to make it more comfortable, aesthetically
pleasing, and informative have been shown to decrease stress and improve
patient satisfaction’ (Fountain, 2005, p.30). If one accepts the premise, for
instance, that hospitals are essentially stressful environments for many
patients and their families (Ulrich, 2000), it follows that ‘environmental
factors such as natural light, pleasant views, artwork, and even use of certain
colours have the potential to transform what would otherwise be a highly
stressful and frightening encounter into one that imparts a powerful healing
and therapeutic effect’ (Fouts and Gabay, 2008, p.28).
Writing from a direct knowledge of a highly rated cancer facility in the USA,
Cedars-Sinai3, Fouts and Gabay believe that a ‘patient environment designed
to impart wellness and comfort in all dimensions – mind, body and spirit - is
as vital to cancer care as science and technology’ and that if implemented
effectively, ‘healing-focused and evidence-based design can potentially
improve a cancer patient’s ability to cope with the emotional and physical
aspects of the disease and its treatment – and, ultimately, increase patient
satisfaction’(ibid). Research within the mental health field also supports the
notion that the physical environment in which treatment occurs has an impact
on both the treatment process and its outcome (Gross et al., 1998).
The nature of the evidence has become more scientific and rigorous in recent
years to coincide with the emergence of ‘evidence-based design’, which may
be defined as the process of basing decisions about the built environment on
credible research to achieve the best possible outcomes (Hamilton, 2003).
Supporters of evidence-based design believe that research can assist designers
to create better hospitals that may help patients recover faster, improve staff
retention, enhance staff performance, and make hospitals safer places for
3
Designed by a world-renowned architectural firm, the Cedars-Sinai Outpatient Cancer Centre at the
Samuel Oschin Comprehensive Cancer Institute in Las Angeles features an award-winning design
created around the special needs of cancer patients and their families (www.csmc.edu). Myra Fouts is
vice president, Medical Affairs, Aptium Oncology Inc. and Diane Gabay is director of business
development for Cedars-Sinai Outpatient Cancer Center.
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receiving medical and surgical care. Just as clinical choices are informed by
research evidence, ‘healthcare design is increasingly guided by rigorous
research linking the physical environment of hospitals to patients and staff
outcomes’ (Ulrich et al., 2004, p.2).
It should be noted that evidence-based design is not without its critics, with
some writers expressing concern about the limited predictive ability of
evidence-based design studies when compared with medical evidence, and the
problematic nature of drawing conclusions from the relatively small number
of studies conducted to date (Stankos and Schwarz, 2007, Schwritzer et al.,
2004). Becker and Parsons (2007) believe that evidence-based academic
research is ‘necessary but not sufficient’ for the development of facility
planning and management, as it is ‘a never-ending process of knowledge
accretion’ (Becker and Parsons, 2007, p.267). Rather, they argue that such
research provides ‘insights that can guide decisions’ and that the ‘great value
of academic research is that the findings are likely to be more robust than
other forms of enquiry because they have used methodologies designed to
reduce the likelihood that the results occur by chance, or simply reflected
personal values and preferences’ (ibid).
In a recent review of the literature, researchers at Texas A & M and Georgia
Institute of Technology identified more than 600 rigorous studies that
demonstrated the impact of hospital design on outcome measures, including
reductions in staff errors and stress, as well as the amount of pain experienced
and medication required by patients. They concluded that studies show that
‘the conventional ways that hospitals are designed contributes to stress and
danger’ and that improved physical settings can be ‘an important tool in
making hospitals safer, more healing, and better places to work’ (Ulrich et al.,
2004, p.3).
Some of the salient findings on design that are evident in the literature are
summarised in the following pages. The review draws on research by
Professor Roger Ulrich, Rubin and her associates, and other pertinent studies
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(Ulrich, 1992, Ulrich, 1997, Ulrich, 1999, Ulrich, 2000, Ulrich et al., 2004,
Ulrich, 1984, Rubin et al., 1998, Devlin and Arneill, 2003). The review will
commence with some of the general points made in the literature before
focusing on the perceived benefits of garden landscapes.
Nature: Research shows that stress can be effectively reduced by nature,
whether real or simulated (Parsons and Hartig, 2000, Ulrich, 1999). Clinical
studies have shown than viewing nature is evident from physiological
changes, such as in blood pressure and heart activity (Ulrich, 1991). Stress can
also be reduced by relatively minor design changes that make the environment
more comfortable, aesthetically pleasing, and informative. Studies have
reported a strong association between patient and environmental satisfaction,
such as colour schemes, general layout, and furniture (Leather et al., 2003,
Harris et al., 2002).
Air Quality: Hospital air quality, which affects patient and staff satisfaction
levels, can be improved and airborne pathogens reduced by good ventilation
systems which are well maintained (Lutz et al., 2003). Studies also show that
bright light, both natural and artificial, can improve health outcomes such as
depression, agitation, sleep, circadian rest-activity rhythms, as well as length
of stay in demented patients and persons with seasonal affective disorders
(Beauchemin and Hays, 1996, Benedetti et al., 2000, Federman et al., 2000,
Herbert et al., 1998). Exposure to bright morning light has also been shown to
reduce agitation among elderly patients with dementia (Lovell et al., 1995).
Studies also show that patients hospitalised for severe depression reduced
their stays by an average of 3.67 days if assigned to a sunny rather than a dull
room overlooking spaces in shadow (Beauchemin and Hays, 1996). Another
study found that patients undergoing elective cervical and lumbar spinal
surgeries who were exposed to an increased intensity of sunlight experienced
less perceived stress, less pain, took 22 percent less analgesic medication per
hour and had 20 percent less pain medication costs (Walch et al., 2005).
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Mental Health: The mental health of psychiatric patients has been linked to
design elements that affect their ability to regulate social interaction and
insufficient daylight is reliably associated with increased depressive
symptoms (Evans, 2003). A growing empirical literature indicates that there
are psychological benefits to windows in a variety of settings, including the
work-place, schools, hospitals, prisons and residential contexts (Finnegan and
Solomon, 1981, Biner et al., 1993, Boubekri et al., 1991, Kaplan, 2001,
Leather et al., 1998). In a study of office workers and health care providers,
for example, Finnegan and Solomon (1981) found that job satisfaction and
work attitudes were significantly related to the presence of windows in the
work-place. While some people believe that the content of the window view is
largely unimportant (Collins, 1975), several studies point to the importance of
view content (Moore, 1981, Ulrich, 1984, Verderber, 1986).
One of the pioneers of evidence-based design, behavioural scientist Roger S.
Ulrich, tested the impact of design on medical outcomes in a landmark study
in the 1980s which found that twenty-three surgical patients assigned to rooms
with windows looking out on a natural scene had shorter post-operative
hospital stays, received fewer negative evaluative comments in nurses’ notes,
and took few potent analgesics than twenty-three matched patients in similar
rooms with windows facing a brick building wall (Ulrich, 1984). Conversely,
research on intensive care units suggests that the absence of windows is
associated with higher rates of anxiety, depression, and delirium compared to
rates for units with windows (Keep et al., 1980). The view from a hospital
window can also affect people with depression. In a study conducted in a
Canadian hospital, research found that patients hospitalised for severe
depression had shorter stays if assigned to a sunny rather than a non-sunny
room (Beauchemin and Hays, 1996).
Single Rooms: A number of studies have found that infection rates are usually
lower in single-bed rooms. A study by Passweg et al. (1998), for instance,
found that the combination of room isolation and HEPA filtration reduced
infection and mortality in bone marrow transplant patients (Passweg et al.,
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
1998). Research studying burn patients has also shown that single rooms and
good air quality substantially reduce infection incidence and reduce mortality
(McManus et al., 1994, McManus et al., 1992, Shirani et al., 1986, Thompson
et al., 2002). Placing patients with TB, measles or other similar diseases is
also safer in single rooms (Gardner et al., 1973). Other benefits of single
rooms over multi-bed units summarised by a recent publication by the Irish
Hospice Foundation (Hospice friendly Hospitals Programme, 2008) include,
an increase in privacy for patient-relative interaction, enabling staff to
examine patients more effectively due to enhanced privacy, and responding to
patient preferences in end-of-life situations (Mlinek and Pierce, 1997, Joseph,
2006, Kirk, 2002, Ulrich, 2006). Similar studies are also cited in the NHS
2005 report, Ward layouts with single rooms and space for flexibility.
Noise and Music: A number of studies have documented negative effects of
noise on patient outcomes, such as elevated blood pressure, increased heart
and respiration rate, and increasing sleeplessness (Johnson, 2001, Blomkvist
et al., 2004, Gabor et al., 2003, Meyer et al., 1994, Parthasarathy and Tobin,
2004). Noise and poor acoustics can also detrimentally affect workplace
performance of staff ((Evans and Cohen, 1987, Blomkvist et al., 2005).
Research suggests that hospitals are excessively noisy places due to the
numerous sources of noise and the prevalence of sound-reflecting surfaces in
hospitals (Blomkvist et al., 2004, Ulrich et al., 2003). Similarly, Cooper
Marcus and Barnes (1995) found that users of healthcare gardens reacted
negatively to urban sounds, such as traffic noise (Cooper Marcus and Barnes,
1995).
Ulrich believes that there ‘appears to be sufficient evidence on negative effects
of noise to justify the recommendation that noise reduction should be a major
consideration in the design of new healthcare buildings’ (Ulrich, 2000).
Conversely, music activity and music therapy is increasingly a feature of
health care. A survey of cancer care providers in the UK, for instance, found
the use of music to be widespread within their organisations, with just under
half of respondents reporting the provision of formal music therapy (Daykin et
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al., 2006). Several studies across a variety of patient groups have shown that
pleasant music can reduce anxiety or stress, and help some patients cope with
pain, confusion, and functional deficits (Standley, 1986, Mengazzi et al.,
1991, McCaffrey, 2008).
Staff Health: Staff health and overall effectiveness can be enhanced through
the provision of good ventilation, ample lighting, reduced noise levels, the
availability of numerous, well designed workplaces, easily accessible alcoholbased hand-rub dispensers or hand washing sinks, and equipment that is
ergonomically well designed. A study conducted following the SARS
epidemic in China, for instance, found that isolating SARS cases in wards
with good ventilation could reduce the viral load of the ward and might be the
key to preventing outbreaks of SARS among healthcare workers (Jiang et al.,
2003). In one nursing home study, Garg and Owen used the information
gathered from evaluating manual tasks deemed stressful by nursing staff to
select patient-transferring devices and to modify toilets and shower rooms,
resulting in a reduction of back injuries of almost 50 per cent (Garg and
Owen, 1992). Hendrich’s research showed that decentralised nurses stations
reduced staff walking and increased patient-care time (Hendrich, 2003). Other
studies indicate that better-designed health facilities can improve working
conditions and staff safety, and enable staff to do their job more effectively
(Rechel et al., 2009).
A national survey of more than two thousand nurses in the UK found that
many respondents felt that patient dignity was affected by a wide range of
environmental factors, including aspects of the environment that maintain
physical and informational privacy (e.g., curtains, doors, screens and private
rooms for consultations); aesthetic aspects of the physical environment (e.g.,
space, colour, music, furnishings); and the provision of single sex
accommodation, toilet and washing facilities (Baillie et al., 2008). The
survey’s results indicated that ‘while some nurses work in environments
which support dignity in care, many others struggle with poor physical and
human resources’ (ibid, p.46).
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The principal conclusion of these and related studies is that evidence is
increasingly highlighting the significance of environmental factors in the
creation and nurturing of a healing environment in hospital settings. The
‘components of a healing environment’ according to Fouts and Gabay (2008)
can best be defined as ‘those that nurture and restore balance to the mind,
body, and spirit through each of the five senses’ (Fouts and Gabay, 2008,
p.30). One of the ways in which people are ‘healed’ is through viewing and
experiencing garden landscapes. The main findings of research into the impact
of gardens are summarised in the following in the following section.
2.3 Healing Gardens
‘Research exists to support the notion of nature as healer.
Studies have been conducted that confirm the clearly positive
benefits to patients, staff, and visitors of hospital outdoor space.
(Marcus and Barnes, 1999, p.2)
A significant body of research has focused on the relationship between place
and varied therapeutic processes (Smyth, 2005, Williams, 1998). While much
of this research has focused on the relationship between healing properties that
may be associated with particular extraordinary landscapes, such as Lourdes
(Gesler, 1996), more recent research has studied the healing that is associated
with gardens and landscapes in healthcare settings (Cooper Marcus and
Barnes, 1995, Hartig and Marcus, 2006). Whether the gardens are extensive or
restricted to a rooftop or atrium, the beneficial effects are perceived to be
present (Wallace, 2006). Empirical research conducted by The Center for
Health Design in California, for example, which investigated the use and
possible benefits of gardens in hospitals, concluded that 95% of people in the
gardens ‘reported a therapeutic benefit. Employees said they were more
productive, patients spoke of feeling better and having more tolerance for
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their medical procedures, and friends and relatives felt relief from the stress
of the hospital visit’ (Cooper Marcus and Barnes, 1995, p.65).
While it is acknowledged that there is a shortage of research focusing directly
on gardens (Ulrich, 1999), the number of writers advocating the therapeutic
effects of healing gardens and landscapes is growing (McCaffrey, 2007,
Lauer, 2008, Johnson, 2007, Raver, 1995, English et al., 2008, Ulrich, 2002).
An increasing number of studies are confirming what people instinctively
knew: providing access to the natural environment can have tangible benefits
for patients and non-patients. Evidence pointing to the psychological and
psychological benefits of nature generally has increased relatively rapidly in
recent years (Altman and Wohlwill, 1983, Francis and Hester, 1990, Hartig
and Evans, 1993, Hartig et al., 1991, Kaplan, 1973, Kaplan and Kaplan, 1989,
Kaplan, 1995b, Relf, 1992, Velarde et al., 2007, Maller et al., 2005).
One strand of research that supports the restorative benefits of nature
emphasises the importance of recovering the capacity to focus attention
(Kaplan, 1995a), while a second strand places most emphasis on the
restorative benefits of nature in stress reduction (Ulrich, 1983, Ulrich et al.,
1991, Ulrich, 1999, Velarde et al., 2007). This latter approach argues that
since the majority of persons with illness experience stress, with many
experiencing acute stress (Burish et al., 1987, Ott and Levy, 1994, Taylor and
Aspinwall, 1993), it follows that if gardens or natural landscapes can be
shown to lessen unwanted stress, then this is a significant finding.
In a review of relevant literature in the behavioural sciences and health-related
fields, Ulrich (1999) concludes that it is ‘justified to propose that gardens in
healthcare situations are important stress mitigating resources for patients
and staff’ (Ulrich, 1999, p.36). More specifically, it is believed that gardens in
healthcare situations reduce stress to the extent that they foster:

Sense of control and access to privacy: Research indicates that
people who feel they have some control over their circumstances deal
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better with stress and have better health than persons who lack a sense
of control (Evans and Cohen, 1987, Taylor, 1979, Ulrich, 1999). Many
patient experiences in hospital are stressful in large part because they
are uncontrollable – for instance, unavoidable and unpleasant
diagnostic
procedures,
chronic
pain,
and
impaired
physical
capabilities, loss of privacy, loss of control over eating and sleeping
times, lack of authority over what to wear, inability to adjust room
lighting and temperature, and way-finding difficulties in complex and
unfamiliar buildings (Ulrich, 1999). Evidence from studies of nonpatients in parks and other natural environments, together with a
smaller number of studies of patients in hospital environments,
indicate that ‘stress mediation is the most consistently important
perceived benefit’ (ibid, p.40). Studies show that people benefit from
temporarily escaping a stressful environment, either passively, such as
gazing out of a window at a pleasant garden view, or actively, by
going to a park (Knopf, 1987).

Social support: Ulrich (1999) reports that a large body of research has
shown that people who receive higher levels of social support are
usually less stressed and have better health status that persons who are
more socially isolated (Cohen and Syme, 1985, Sarason and Sarason,
1985, Schwarzer and Leppin, 1989, Schumaker and Czajkowski,
1994). Within the context of healthcare, a number of studies have
consistently found that higher social support improves recovery in
heart attack patients, survival length in patients with metastatic cancer,
and immune functioning in family care givers of Alzheimer’s patients
(Spiegal et al., 1989). English et al. (2008) report that research has
demonstrated that social support is important for helping women cope
with, and overcome the negative psychological effects of breast cancer
diagnosis and treatment (Arora et al., 2007, Kroenke et al., 2006,
Shannon and Bourque, 2005)
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Ulrich (1999) also cites a number of studies that suggest that people
achieve psychological benefits, such as companionship, being with
friends, and family kinship, from open spaces (Driver and Brown,
1986). Research of gardens in healthcare centres indicates that people
use the gardens for social interaction, and to a lesser extent socialising
(Cooper Marcus and Barnes, 1995). To summarise, ‘a small but
growing amount of research suggests that gardens can be important
and effective for fostering social contact, and that the social contacts
occurring in healthcare gardens probably include emotionally
supportive interactions of the type known to mitigate stress and
improve medical outcomes (Ulrich, 1999, p.45).

Physical movement and exercise: Physical exercise is associated
with a range of health benefits, including physiological and
psychological outcomes, such as reducing depression (Bannon and
Feist, 1997).

Access to nature and other positive distractions: Positive
distractions can be thought of as environmental design elements that
effectively promote restoration from stress in patients, visitor, and
healthcare staff (Ulrich, 1992). In addition to nature, the following
positive distractions have been identified in the literature within the
context of healthcare: comedy or laughter (Cousins, 1983), companion
animals (Beck et al., 1986, Friedman et al., 1980), dance (Sandel et al.,
2005)and music (Moss, 1988). There is increasing evidence that
viewing nature can reduce stress and, by default, improve medical
outcomes (MacRae, 1997). Evidence cited earlier in relation to the
impact of viewing nature on health outcomes suggests that visual
exposure to nature can significantly reduce patient stress.
In conclusion, the studies cited in this review suggest that contact with nature
promotes health and well-being, whether this is access to nearby natural
settings (Kaplan and Kaplan, 1989), the provision of views of nature (Ulrich,
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1984, Lewis, 1996), fostering recovery from mental fatigue (Kaplan, 1995a),
and overall well-being with positive impacts on blood pressure, cholesterol,
stress reduction, and outlook on life (Moore, 1981, Lewis, 1996, Kaplan and
Kaplan, 1989, Ulrich, 2000, Maas et al., 2009). In the words of Roger Ulrich
(1999): ‘certain types of nature views can have significant restorative effects
on emotional, physiological, and behavioural components of stress in
patients’ and ‘gardenlike scenes apparently mitigate pain’.
2.4 Hospital Design in Practice
The credibility of the research suggesting a link between hospital design and
the outcome of treatment is further enhanced by the increasing number of new
and renovated hospitals that are using research recommendations in their
design process. One major initiative in the USA, for instance, sought to
provide researched and documented examples of healthcare facilities whose
design has made a difference in improving patient and staff outcomes, as well
as operating efficiency. Launched in 2000, the Pebble Project is a research
initiative of The Center for Health Design and selected healthcare providers.
Their research programme began with four partner hospitals that agreed to
implement and study evidence-based design. It currently has 44 active
partners.
One of the original partner hospitals was the 348-bed Bronson Methodist
Hospital in Kalamazoo, Michigan. Based on research with patients, families
and staff, the new hospital incorporated the following design elements: single
patient, individual thermostats, larger windows with layered shades, intuitive
signage, horticultural garden and fishpond in the main foyer, and natural light
penetrating most parts of the building. Fouts and Gabay (2008) note that
within the first year of the hospital’s construction, the hospital had
documented nursing vacancy rates at half the state average; it had experienced
a decrease in patient transfers; increased patient sleep quality; increased their
market share; and increased overall patient satisfaction to 97%.
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Other examples of health care facilities that have incorporated the value of
design into their healthcare facilities include the following:

The Maggie Cancer
Caring Centres (UK):
The
design
and
aesthetics
of
the
buildings
are
key
elements of the Maggie
Centre
philosophy.
They are all designed by
famous architects and
each of the centres is
different to the others. The founder of Maggie’s, Maggie Keswick Jencks,
believed that architecture could deeply affect how a person feels. Accordingly,
they aim to ‘create uplifting buildings that surprise, revive and refresh your
spirit’. Maggie's Centres greatly value the power of environment and design to
lift the spirits and subsequently their Centres attract the world's leading
architects, the most prominent example being Zaha Hadid who designed
Maggie's Centre Glasgow (www.maggiescentres.org).
o Breast Cancer Haven (UK): Breast
Cancer Haven was founded by Sara
Davenport in 1997. It operates day
centres that deliver free programmes
of care to complement and enhance
conventional breast treatment. There
are three centres at present, in
London, Hereford, and Leeds. Breast
Cancer Haven in London is housed
in an old Welsh Presbyterian church which has also been used as a dance and
drama school. It was virtually derelict when Sara bought in 1998, but with
the support of many generous individuals and companies, and the expertise
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of architect Martin Hay, the building was transformed into the wonderful
peaceful and healing environment which is now Breast Cancer Haven which
was opened in February 2000. It won first prize in the ‘Healing Spaces
Award’ in 2008. The award is for buildings that best reflect the part played
by architecture, interior design, and the use of sound, light, colour, or new
ways of using healthcare space creatively.
 The Oxford Cancer Centre: The new Oxford Cancer Centre and adjacent
facilities, designed by Steffian Bradley Architects opened its doors to its first
patients in March 2009. The Cancer and Haematology
Centre include surgery and diagnostic facilities and a
private patient wing is part of the Oxford Radcliffe
Hospitals NHS Trust. The award-winning Cancer
Centre contains a range of environmental measures to
make it one of the most energy efficient NHS centres
in the UK. Central to the design is the welfare of the patients and staff,
through the focus on natural light, air and materials. Their website states that
the architecture constantly connects to the outside world and nature, as this
has been proven to greatly enhance the recuperation process of patients.
The building has a deep-plate ground floor, where much of the diagnostics is
carried out, with three pavilions above, which each surround courtyards. All
patient areas in the pavilions are naturally lit and ventilated, with corridors
ending in windows, rather than blank walls and skylights are widely used.
Two quotes from people associated with the design and operation of the
hospital highlight the perceived importance of the external environment for
patient
care.
Ron
Vestri,
Studio
Leader
at
SBA,
said:
"From a medical point of view, the design is cutting edge. A large element
within this philosophy was getting as much natural light into the building as
possible and enabling people to see pleasant views outside. If people can see
green fields and smell fresh air they feel better. It's something built into our
psyche."Vickie Holcroft, Director of Relocation, Oxford Radcliffe Hospitals,
said "We are immensely proud of our new facilities. It will deliver not only
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
clinical excellence but also benefit our patients and staff in providing
services in a beautiful, eco-friendly, light and natural environment".
 The Cedars-Sinai Outpatient Cancer Center: Design is an art rather than a
science, as demonstrated by the design of the Cedars-Sinai Outpatient
Cancer Center at the Samuel Oschin Comprehensive Cancer Institute which
opened in 1985 and moved to its current facility in 1988. At the time, the
Centre’s award-winning design reflected the current thinking around healing
design. The underground building featured 30-foot ceilings, hard edges, and
industrial surfaces. From the architects’ perspective, these choices reflected a
‘deconstructivist’ strategy aimed at providing comfort and confidence to
patients by acknowledging the realities of fighting cancer. However, the
patient’ experience was quite different, with some patients describing the
centre as ‘scary, like going into a tomb’. In 2005, the Centre launched a
patient-focused Healing Design Survey, resulting in the inclusion of
American Art around the facility, and rooms being painted in warmer,
earthier tones. The result was immediate patient approval (Fouts and Gabay,
2008).
There are other examples of healthcare facilities which have been designed by
renowned architects to make life better for cancer patients, including:

The Hillman Cancer Centre (Pittsburgh, USA).

New Orleans Cancer Centre (USA).

The Lisbon Research and Clinical Centre (Portugal).
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2.5 Complementary Therapies
In addition to hospital design and healing gardens, patient well-being is also
allegedly improved by the use of complementary therapies4, such as herbs,
acupuncture, Reiki, yoga, massage, spiritual healing, meditation and
reflexology to mention but a few (Baum et al., 2006). The fact that some of
these therapies are being used in some of the most prominent hospitals in the
world, such as the Memorial Sloan-Kettering in New York, adds weight to
their value for cancer patients. From the outset, it is important to note that this
review concentrates on complementary rather than alternative therapies5.
Furthermore, there is no evidence to suggest that Complementary and
Alternative Medicine (CAM) can cure cancer and there are relatively few
studies to indicate the efficacy of complementary therapies generally.
However, increasingly evidence is being produced that supports the benefits
for some patients that can derive from some forms of CAM through enhancing
symptom relief, overall well-being and self-help, with used in conjunction
with appropriate medical interventions.
In general, complementary therapies tend to emphasise a patient-orientated
system of treatment, while medical interventions tend to be disease orientated
(Mock et al., 2005). While they do not offer a realistic alternative to
conventional cancer treatment, complementary therapies are intended to
provide a range of psychological, emotional and spiritual support and help
with symptom control. Research indicates that the use of CAM is increasing
throughout many parts of the world (Molassiotis et al., 2005, Barnes and
Bloom, 2008, Garvey, 2005, Shih et al., 2009). A study conducted by the
University of Manchester in 2005 found that a third of cancer patients across
4
The National Center for Complementary and Alternative Medicine in the USA classifies CAM
therapies into five categories: alternative medical systems, such as traditional Chinese medicine or
Ayurveda; mind-body interventions, such as meditation, prayer, healing or support groups; biologically
based therapies, such as herbs, dietary supplements or vitamins; manipulation and body-based
methods, such as massage, chiropractic or osteopathy; and energy therapies, such as Qi Gong, Reiki,
and bioelectromagnetic-based therapies.
5
Alternative therapies are used outside of mainstream medicine and their efficacy is largely based on
personal testimonials. Conversely, complementary therapies are used with mainstream medicine and
are supported by some credible evidence, even if not always ‘scientific’.
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Europe used complementary and alternative therapies, and that this figure had
increased significantly since a similar review in 1998 (Molassiotis et al.,
2005). A study in the USA reported that almost four in ten adults in the USA
had used CAM therapy in the previous 12 months, with the most commonly
used therapies being nonvitamin, nonmineral, natural products and deep
breathing exercises. The study also showed that between 2002 and 2007
increased use was seen amongst adults for acupuncture, deep breathing
exercises, massage therapy, mediation, naturopathy, and yoga (Barnes and
Bloom, 2008). It would appear that cancer sufferers are some of the biggest
users of CAM.
One of the problems encountered by researchers into CAM treatment for
cancer is ‘unclear and inconsistent definitions of what constitutes CAM’
(Adler, 1999, p.214). Accordingly, an overview of complementary therapies
listed by the Irish Cancer Society in their patient guide is presented below,
together with a summary of the ‘known benefits6’ of these therapies (Table 2,
overleaf). The Irish Cancer Society describes complementary therapies as
‘therapies that can be used together with conventional medicine... to promote
well-being and to manage symptoms related to cancer and its treatment. They
include meditation, relaxation, visualisation, gentle massage, aromatherapy,
reflexology, nutrition therapy, Shiatsu, yoga, acupuncture and hypnotherapy’.
They further add that these therapies ‘are not used to cure cancer’ and that the
‘benefits of some of these therapies has been proven for certain uses, yet in
many cases it has not’ (Walker et al., 2007)
6
The booklet also notes the known risks associated with the therapies. Overall, they stress the
importance of receiving treatment from an experienced and qualified therapist, and for some people,
with emotional or mental difficulties to avoid the therapies.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
Table 2 Complementary Therapies
Complementary
Therapies
Known Benefits
Counselling and selfhelp methods
Therapies such as cognitive-behavioural therapy (CBT) and psychotherapy are
helpful for people dealing with the emotional effects of cancer. These therapies
are provided by conventional and complementary therapists.
Stress management can help patients cope with some side-effects of
chemotherapy, such as pain, fatigue, anxiety and depression.
Support groups and self-help groups can help people feel less isolated and
distressed, and improve the quality of their lives.
Spiritual healing
(e.g., faith healing,
prayer, therapeutic
touch, a visit to a
religious shrine, a
strong belief in God).
The effects of spirituality on cancer are unknown, although the guide states that
‘there is lots of evidence that a person’s spirituality can help them cope with
illness. People whose faith is deep and personal also cope better. Spiritual
support can improve coping and boost your quality of life. It may help to raise
your energy levels too and you may develop a feeling of personal growth. It may
promote peace of mind, reduce stress, relieve pain and anxiety, and strengthen
your will to live’.
Mind-Body methods
Aromatherapy – useful in reducing stress in cancer patients and promoting a
sense of relaxation and well-being.
Autogenic training: Relaxing and relieving stress and pain.
Biofeedback: Reduce anxiety and stress.
Colour Therapy: Relaxing and boosts self-confidence.
Hypnotherapy: Improved nausea and vomiting related to cancer treatments, such
as chemotherapy.
Guided Imagery/ Visualisation: Helps relax people.
Meditation: Help relieve chronic pain and anxiety.
Creative arts therapies: Releases fear, anxiety and anger by allowing people to
express their feelings and emotions.
Creative Writing: Improve self-esteem and personal growth.
Dance therapy: Help develop a positive body image; improve self-esteem;
reduce stress, anxiety and depression; decrease isolation, chronic pain and body
tension; increase communication skills; and encourage a sense of well-being.
Music therapy: Reduce blood pressure and calm the mind and body; reduce pain
and anxiety.
Source: The Irish Cancer Society (2007), Understanding Cancer and Complementary Therapies.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
Table 2 Complementary Therapies (Continued)
Complementary
Therapies
Known Benefits
Alternative medical
systems
These are alternative medical and healing systems and beliefs
that have evolved over time in different cultures and parts of the
world. In Western culture, the best-known examples of
alternative therapies are homeopathy and naturopathy. In
general, these alternative systems focus on treating the whole
person – mind, body and spirit.
There is no proof that alternative medicine has cured cancer,
even though it can sometimes promote feelings of well-being.
Thus, while some studies show positive effects of homeopathic
preparations, it is uncertain if these beneficial effects are caused
by the medicine given or power of positive thinking or the
placebo effect.
Energy therapies
Based on the belief that the body has energy fields that can be
used to promote healing and well-being.
Acupuncture – Studies show that acupuncture is useful for
treating nausea and vomiting after chemotherapy or surgery. It
has also been known to improve back pain, dental pain and
migraine, and reduce blood pressure and anxiety in some people.
Magnetic therapy: No scientific evidence to support claims of
pain relief.
Photodynamic therapy: Unproven.
Reiki: Aid to relaxation and relief of stress.
Qigong: Reduce stress.
Exercise therapies
Examples include, Pilates, Qigong, and Tai chi. Benefits include
increased strength, flexibility, body awareness, improved mental
concentration, reduced stress, and enhanced well-being.
Body-based therapies
Therapies involve body contact or manipulation of bones and
muscles to promote healing. These include massage, reflexology,
chiropractic and osteopathy. They can relieve pain; instil a sense
of relaxation and well-being. In general, gentle massage appears
to be of most benefit to cancer patients
Source: The Irish Cancer Society (2007), Understanding Cancer and Complementary Therapies
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Increasingly, patients with cancer are opting to supplement conventional
treatments with a range of complementary interventions (Davidson et al.,
2005, Salmenpera et al., 2001, Ernst and Cassileth, 1998). However, rather
than seeking a cure for cancer, a number of studies suggest that the majority
of cancer patients who use CAM are looking for greater control over their
symptoms (Cassileth and Chapman, 1995, VandeCreek et al., 1999). This is
also the view expressed by some service providers, such as the Bristol Cancer
Health Centre7.
A number of studies indicate that the use of complementary therapies, such as
massage and reflexology can fulfil important psychological, emotional and
physical needs for some cancer patients (Carlsson et al., 2005, Davidson et al.,
2005, Wright and Crowther, 2002, Russell and Beinhorn, 2008, Milligan et
al., 2002). Massage is one of the suite of ‘Touch Therapies’ provided by the
Memorial Sloan-Kettering hospital, in addition to reflexology, Shiatsu, Reiki,
and aromatherapy.
Art therapy is also believed to lead to increased awareness of the self, as
well as improved ability to cope with symptoms, stress, and traumatic
experiences (Devlin, 2006). Research has found that art therapy lowers stress
by giving patients an alternative focus from their illness. While much of the
evidence for these and similar claims are based on case studies or nonexperimental reporting (Favara-Scacco et al., 2001, Gabriel et al., 2001,
Deane et al., 2000, Appleton, 1993, Luzzato and Gabriel, 2000), a study by
Nainis et al (2006), which utilises a quasi-experimental, pre- and post-design,
substantiates the beneficial effects of art therapy for cancer patients (Nainis et
al., 2006). Nainis et al (2006) used the Edmonton Symptom Assessment Scale
(ESAS) and the Speilberger Scale-Trait Anxiety Index (STAI-S) prior to and
after the art therapy to quantify symptoms, while open-ended questions
7
The philosophy of the Bristol Cancer Health Centre is underpinned by a belief that complementary
therapies can provide a useful adjunct to conventional cancer treatment at different stages of the
patient’s cancer journey (www.bristolcancerhelp.org).
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
evaluated the subjects’ perceptions of the experience. They found statistically
significant reductions in eight of the nine symptoms measured by the ESAS,
as well as significant differences in most of the domains measured by the
STAI-S. They concluded that their study provides beginning evidence for the
efficacy of art therapy in reducing a broad spectrum of symptoms in cancer
inpatients (Nainis et al., 2006). The authors of this study also listed a number
of other studies that indicate ‘good anecdotal support’ for the efficacy of art
therapy in relieving anxiety and other emotional symptoms.
Other studies also indicate the efficacy of art therapy for patients. A
randomised controlled trial of mindfulness-based art therapy (MBAT) for
women with cancer in the USA found that the MBAT group demonstrated a
significant decrease in distress, when compared with the control group, and
significant improvements in key aspects of health-related quality of life
(Daniel Monti et al., 2006). Another study by Bar-Sela et al (2007) found
anthroposophical art therapy resulted in an improvement in depression scores
(Hospital Anxiety and Depression Scale) and, to a lesser degree, in fatigue
scores (Brief Fatigue Inventory) following anthroposophical art therapy
intervention for cancer patients during chemotherapy treatment (Bar-Sela et
al., 2007). Finally, a recent study by a team from Bari University in Italy
found that patient care could be improved by hanging attractive paintings in
hospitals and that patients experienced less pain when they were admiring
what they considered to be ‘beautiful’ works of art (Irish Medical Times,
2008).
The link between spirituality and health is complex, confusing, and
ultimately unresolved. While some research has shown that one’s religious
and/or spiritual beliefs can positively impact a person’s physical and mental
health, the main body of ‘scientific’ evidence does not support this
conclusion. Thus, while some research indicates that a person’s relationship
with God may function as a resource in coping with prostate cancer (Gall,
2004), or that there is a significant association between religious involvements
and blood pressure, such that individuals who report higher levels of religious
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
involvement have lower blood pressure, a lower risk of hypertension, and
lower rates of depression (Koenig et al., 1998, Gillum and Ingram, 2006,
Koenig, 2009), other studies dispute these findings (Brown and Gary, 1994,
Yeager et al., 2006, Buck et al., 2009).
A recent publication by the IONA Institute identified many studies that
suggest a link between religious practice and diverse psycho-social benefits,
including suicide, depression, bereavement, psychosis, marriage, faith healing,
mind/body connections, and mental health (Casey, 2009). However, while
religious practice may help people feel better (Clark and Lelkes, 2006), be
associated with lower levels of depressive symptoms than the average (Baetz
et al., 2004), and possibly reduce anxiety through religious rituals (Anastasi
and Newberg, 2008), it would appear that the weight of ‘scientific’ studies in
this area indicate that there is little evidence to suggest a link between prayer
and clinical outcomes (Shreve-Neiger and Edelstein, 2004). A review
conducted by the Cochrane Review Group, which involved ten studies with
over 7,000 subjects, found no significant differences in the health related
outcomes of patients who were allocated to be prayed for and those who were
allocated to the other group (Roberts et al., 2007).
Thus, while there is insufficient evidence to prove a link between
religion/spirituality and health outcomes, the importance of spirituality in
helping people to cope with long-term illness is more widely accepted
(Vachon, 2008, Hamilton et al., 2007). Accordingly, it is something that needs
to be taken into account when addressing the holistic needs of patients (Olsen,
2003).
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
2.6 Concluding Comment
Healing is a complex process which incorporates diverse physical, social,
emotional and spiritual aspects. The review of literature presented in this
chapter strongly suggests that the environment within which patients
experience treatment and care can have a tangible impact on the outcome of
that treatment and care. The evidence summarised in this chapter suggests that
health can be affected by a variety of ‘non-medical’ factors, including the
design of the built environment, the presence of a garden landscape, diverse
forms of complementary medicine, psychological support services, and a
person’s spirituality. In some instances, the impact is related to the physical
condition of the patient, such as lower blood pressure, less pain, and lower
levels of depression, whilst in other situations, changes in the healthcare
environment has been shown to decrease stress and improve patient
satisfaction.
The results of the literature review suggest that St. Luke’s Hospital should be
highly regarded by patients, staff and visitors alike. It has many of the features
that are highly valued by patients and staff, including easy access, ground and
landscape designs, social and public spaces, safety, personal space and access
to the outside (Douglas and Douglas, 2005). Furthermore, the hospital
facilities, the specialist and caring staff, and the relative calm of a non-acute
hospital, should all add to the distinctive environment of St. Luke’s Hospital.
The extent to which St. Luke’s Hospital fulfils these expectations was
empirically investigated by means of a comprehensive research programme
with 370 patients, staff and stakeholders. The findings from the research,
summarised in the following three chapters, confirm conclusively that St.
Luke’s Hospital is a medical facility, which has significantly contributed to
the healing of patients, staff and visitors. The extent of this healing is clear
from the words and emotions of those surveyed.
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CHAPTER THREE
THE VIEWS OF PATIENTS
‘My family and I couldn’t praise St. Luke’s enough. They have
vowed to support St. Luke’s in any way they can. It was a real
holiday home for me and I felt that I was the most important
person in my ward even though there were people with worse
complaints. After the treatment I felt I was going to die and I
didn’t want to die but nobody could convince me otherwise, until
one lady doctor happened to come in. I asked her if there was
any light at the end of the tunnel and she said, ‘You were sent
here to be repaired and that is what we are doing’. Those few
words meant everything in the world to me. Thanks be to God for
St. Luke’s. I will never forget St. Luke’s’.
3.1 Profile of Patients
This chapter is based on the views expressed by more than 200 patients and,
in a minority of cases, their relatives. The patients were selected to represent
the different types of patients that are cared for in St. Luke’s, including age,
gender, residential location, hospital category, and type of cancer. The profile
of patients that participated in the research (Figures 2 and 3, overleaf)
indicates the majority of participants are aged 50-70 years of age, living in
Dublin or other parts of Leinster, in-patients or outpatients under review, and
with either breast or prostate cancer. The relatively low number of
participants from the Day Ward is explained by their health status, with many
too unwell to be interviewed.
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3.2 Patients’ Reaction to Hearing They Had Cancer
Initially, the discussion with patients focused exclusively on their care in St.
Luke’s Hospital rather than engaging in any specific discussion of cancer.
This was done in the interests of the patient and sensitivities that surround
cancer. However, we soon discovered that patients wished to talk openly
about their cancer and their treatment. In many cases, patients said that the
discovery of their cancer was discovered fortuitously, either by their doctor or
dentist during a regular check-up, or by personal checks. Quite a number of
people said they had not felt any symptoms or experienced any pain prior to
the diagnosis. Accordingly, it was not surprising to learn that the initial
reaction to hearing they had cancer for the vast majority of respondents was a
combination of shock, fear, depression and surprise (Figure 4). However, over
time, most patients said they had accepted their situation and were committed,
or at least resigned, to getting treatment and fighting the cancer.
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While many respondents had difficulties with the word ‘cancer’, with most
referring to the illness as ‘it’, men were outwardly the most stoic and
unemotional in their discussion of cancer. However, during the interview, it
became clear that everyone, men and women, was deeply affected by their
illness even if they chose not to express it openly. Some patients, especially
women expressed feelings of guilt, feeling ‘they had let people down’ or that
they were selfish in taking so much of their families’ time. Some found solace
in their religious faith. The following verbatim comments from patients,
selected at random from the many hours of taped interviews, illustrate a range
of patient reactions to receiving a diagnosis of cancer.
First Reaction to Hearing You Had Cancer
I was shocked but I knew myself. No-one listened to me. It took them five years
to diagnose it and then they told me over the phone that there was something
abnormal. I am a teacher and I had to go home. My worst fears were
confirmed. I had similar emotions to grief, the full spectrum of emotions. I
didn’t know what to expect from the treatment and the impact on my career.
Would I lose my independence and not be able to function properly? There is
a fear factor with the word cancer.
Why me? It is hard not to be angry. I had mixed emotions. Definitely fear –
cancer is a very emotive word. It is a dreaded word and I felt the blood drain
down to my feet. In the past cancer meant death. But my faith made it easier
for me to accept.
I was feeling unwell and things were coming out of me but God I was really
shocked when they told me. I didn’t think I had it but I got over it fairly
quickly.
I was slightly shocked but not too surprised. I am over 50 and it is to be
expected.
I knew myself. I was shaken but I knew.
I just wanted to get on with it. I had a serious operation a year ago and I
recovered from that. I have strong faith.
Shock and disbelief. For a long time I couldn’t say a word!
I was terrified coming in to Luke’s.
I was in total shock but I am in great form now, much more positive.
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First Reaction to Hearing You Had Cancer (Continued)
My wife was with me. I was shocked and I had a cry with my wife. I came to terms
with it immediately and I said I’d leave it in the hands of the professionals. You can’t
hide away in a corner.
It didn’t hit me too bad but my wife was in shock. We kept going and decided to fight
it.
Shocked. I thought it had no effect on me but I did mind. The children were
devastated. They came in to visit me and I don’t remember it. My mind just shut down.
I felt very annoyed about the whole situation but I felt better when I learnt more about
it.
Total shock. I felt so well and I had loads of energy. I cleaned the house and gradually
it sank in that the situation was this – I had to fight this and be positive from the
beginning.
This is my third cancer. I am shock proof! I was a little surprised when I thought
about it but you are never cured of cancer. It is a sneaky disease. I learnt to accept
what the Lord has sent me and do the best. I am a fighter and the best way is help
yourself by being positive.
Shocked initially. After a day it sank in and I got the strength to say I was going to
fight it and beat it.
I am a very positive person and if you have it, you have it. I knew because of my age
and a history of cancer in my family. Cancer is less frightening nowadays and a lot of
people are cured.
I didn’t think it was happening to me. My mother died of breast cancer. My father had
lung cancer and my sister is going through secondary cancer. They sit the other side
of the desk and tell you all the stuff but it goes completely over your head. You don’t
take anything in. All you hear is the word cancer. You can’t find words to put it into
perspective but then I saw a child aged 7 with cancer and she didn’t look so bad. I
was afraid to go out for months.
I was shocked by the way it was told to me, like I had the flu. I still haven’t spoken
about it. I get up and go to work. I have never missed a day in work. I have had a lot
of knocks in my life and I don’t need counselling.
Terrible. You think of the local graveyard. As time went on, the doctors assure you the
treatment will work and I took his word for it. I trust the doctors 100%.
I kind of knew. I have great faith and what will be will be.
I was in shock. I just thought I’d have surgery. I didn’t think it would be cancer. My
life is on hold and I have some good days and some bad days.
It didn’t knock a feather out of me. I didn’t give it a second thought or allow it into
my head. I kept doing my work the same as usual and carried on with my life as
usual.
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First Reaction to Hearing You Had Cancer (Continued)
You are just scared when you hear the word cancer.
Stunned. I sat there saying no, no, no to my consultant. I agreed to have tests
done and read up on everything. I never thought I would get chemotherapy or
radiotherapy at my age. They told me my options and I thought, let’s get
started now and get it over and done with and get my life back as fast as
possible.
When I experienced the blockage and was told I had it, I accepted there was no
more I could do. I left my life in his hands. There is no point worrying at my
age (59) and the consultant has a good sense of humour.
I had a stroke at work and they did an X-ray and found cancer. That was it! It
is very hard to describe. I thought I was letting people down. It is not that bad
initially but knowing there is nothing you can do about it and that you depend
on other people is hard. I am now resigned to fight this thing. There is a stigma
attached to cancer but not when you get here.
When you are told by the doctor that there are cancerous cells there, it stops
you in your tracks. I think a lot of men here, although they don’t let on, they
are in deep shock. Men are worse patients than women; they go into
themselves and worry makes them sick.
I thought it was a mistake! I felt that I would be clear following the biopsy
results but no!
Why me? What did I do? I couldn’t speak, like someone had hit me over the
head. I couldn’t believe it. It is a strange disease – once you mention cancer,
you think of getting things in order and the next life. I did jobs around the
house I had never done before!
It still amazes me how little it knocked me; there is so much going on in my life.
It has not yet fazed me but maybe I am camouflaging it by crying double for
other things and maybe shedding some of those tears for myself.
I am a tough kind of fellow but I was devastated. No-one likes talking about
‘that word’ – it’s kind of the unmentionable. You basically move around it, on
the periphery all the time.
Gobsmacked! I couldn’t believe it. The hair loss is horrific. With all that is
going on I worry about the machines and if they are too old. When I get the all
clear, will it be genuine?
I didn’t feel good to be honest but said I would have to fight it and that’s it!
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3.3 Patients’ Preconceptions of St. Luke’s Hospital
The majority of patients had never been to St. Luke’s prior to their first visit
for treatment. Accordingly, it is not too surprising that patients should have
had different images of St Luke’s, with a substantial proportion having quite
negative views and others more positive (Figure 5). However, regardless of
their preconceived notions of St. Luke’s, the vast majority of patients who had
misgivings about the hospital were pleasantly surprised by their first and
subsequent visits to St. Luke’s.
When asked what, if anything, they had heard about St. Luke’s before coming
as a patient, approximately one third of patients said that St. Luke’s had a
‘bad name’ in the past, where people went in the front gate and came out in a
box! However, many of them qualified their comments by saying they now
knew this to be untrue and unfair from their own experience of the hospital.
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The following verbatim quotes illustrate the predominantly negative image of
St. Luke’s in the past and, by comparison with their subsequent impressions
reported later in this chapter, how much progress has been made in the
interim.
WHAT ST. LUKE’S MEANT TO ME BEFORE ATTENDING
AS A PATIENT
You didn’t talk about it – you came here to die.
Luke’s and cancer were stigmatised in the past. Both meant death.
A place to die.
Years ago when someone went to St. Luke’s, you were dead and
buried. I never told anyone I had prostate cancer.
A neighbour spoke very highly about the place and told me I would
get the best of treatment. I spoke openly about Luke’s but people
didn’t know what to say or they avoided me in the streets.
A death trip. When my girls heard I was going to Luke’s, it looked like
a death trip. I thought that myself. You hear so many horror stories
but it is not like that now.
It is the last place you would think of coming. You went to Luke’s and
that was it. It used to have a very bad name.
It was the end of you. I was amazed at how lovely it was; the people
are so gorgeous, like a hotel.
A cancer hospital. A death hospital. I was very surprised when I came
in – the best hospital I have ever come across.
A place people come to die – a death sentence. Once you mention
Luke’s, a green cloud of cancer automatically comes over your head
but there is no equal to Luke’s anywhere.
The dreaded Luke’s. I associated it with a hospice and dying. If you
went in, you didn’t come out.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
3.4 St. Luke’s Response to Patients’ Initial Concerns
Most patients felt nervous or apprehensive on their first visit to St. Luke’s, with
others scared, fearing the unknown, or resigned to their fate. Conversely,
approximately one fifth of all respondents felt positive and ready to start their
treatment (Figure 6). Regardless of their initial feelings, most patients
subsequently believed that St. Luke’s had addressed their concerns effectively.
The role of the staff is perceived to be paramount in addressing the concerns of
the majority of patients, by their overall caring approach to patients and their
willingness to take time to answer patients’ questions and explain procedures.
The positive role of the atmosphere in St. Luke’s was also highlighted by a
number of respondents (Figure 7 overleaf).
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
The following verbatim comments (overleaf) illustrate in more detail, the positive
way in which most patients perceived the care and treatment they received when they
came to St. Luke’s.
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The Response from St. Luke’s to Patients’ Fears and Anxieties
‘They weren’t intrusive but they were there if needed; someone to approach
who was sensitive to your needs. The nurses are always at the desk and they
would speak to you coming in and out
‘They tried their best but they don’t have cancer. They are all very
sympathetic and if you have a problem they would sort it out immediately. I
got better treatment than before.
‘I wasn’t too nervous. Everyone (other patients) was chatty and lovely, and
telling their own story and comparing notes on their treatment and how
treatments left.
The girls in radiotherapy are very nice. They don’t rush you in and out and
they will talk to you if you wanted to talk.
The patients help you get over your fears more than the staff. You are never
left alone. Everything is explained and there is ample opportunity to ask
questions. The facilities are fantastic and the Lodge is out of this world.
They cater for all your needs.
They were very nice and good. They explained things and I was told to say if
I had problems. I had a room to myself and my partner could stay. I settled
in very quickly.
The doctors and nurses talk to you. They explained everything and gave me
courage. The treatment and care is excellent and their smiling faces. They
never say no.
I was terrified coming in and they helped me get over cancer. You can ask
doctors questions here. I wouldn’t talk to doctors anywhere else but it is not
a problem here. They made me feel at home. I wouldn’t be here except for
my doctor’.
They explained everything and talked to me. They were very helpful and they
put me at my ease. They talked to my family too and calmed them down.
They are experts and you know they know what they are doing. The Lodge is
brilliant.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
The Response from St. Luke’s to Patients’ Fears and
Anxieties (Continued)
All kinds of things go through your mind – death, cancer, what is
treatment going to be like, how long is it going to last? I had an
awful lot of questions and they answered them all honestly and
directly.
The machines break down so often – you wonder if they are doing
what they are supposed to be doing and if the underlying fault is
fixed.
No-one has a bad word to say about Luke’s. It’s like going to a
cattle mart to see for yourself. I have been here three weeks and
no complaints.
The doctors minimised the risk and told me the facts. The grounds
really impressed me. Everyone is in the same boat and we have
laughs about different side-effects but don’t dwell on it. The
women tell you all about it but not the men.
I haven’t met anyone who is nasty. If you need help, they will give
it to you. You can talk to nurses, doctors, radiotherapists… You
can’t get annoyed with them when the machines break down. The
hospital is so spotless, you feel so safe in here.
I don’t know what we would do without the grounds. It’s such a
boring thing, waiting around for treatment all day. It is the best
hospital I have ever come across. It’s not a nice place to come to
but if you have something wrong with you, it is.
They don’t look at you as if you are ill. Everything is explained
simply by everyone, even consultants.
The atmosphere here is like walking in your own hall door. All
the staff are so friendly and they don’t treat anyone any different.
I always got the best of treatment here and I have no complaints.
I felt the brightness. Everybody’s attitude was so lovely and you
are not treated as on a conveyor belt. Everyone is on first names
terms and it made it more together. From the time you walk in the
door you are home. I met lovely people here and we still keep in
touch. The doctors make you feel safe.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
3.5 Overall Satisfaction with the Care and Treatment in St. Luke’s
These patients were quite unequivocal in their views of the medical treatment
and overall care they received while in St. Luke’s. More than nine in ten
patients indicated they were completely satisfied with both their medical
treatment and overall care (Figure 8).
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
3.6 What Patients Value About St. Luke’s Hospital
In the central part of the interview, patients were asked what they valued most
about their time in St. Luke’s Hospital. More specifically, they were asked to
name the three most important things about St. Luke’s Hospital they felt
helped them most, including medical and non-medical factors. Their
responses, illustrated in Figure 9, clearly demonstrate the perceived value of
staff, the hospital environment, the medical treatment, and the support of
other patients:

9
8% of patients spontaneously8 highlighted the contribution of staff
members;

8
9% mentioned some aspect of the hospital environment,

2
7% made reference to their medical treatment, and

1
5% mentioned the positive impact of being with other patients.
8
The spontaneous nature of these and other questions is important as they indicate what
respondents felt was important to them without any prompting from the interviewer. The
percentage of responses is based on 100 per cent of all responses.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
Following subsequent discussion, the patients elaborated on each of these
factors and gave details of what precisely they deemed most important about
staff, the hospital environment, medical treatment, and other patients. As may
be seen in Tables 3-5 below, the patients emphasised the importance of the
personal touch of staff, the grounds and general atmosphere of the hospital,
and the medical expertise of staff9.
Table 3 Why Staff is Perceived as Important by Patients
THE STAFF
9
% of Responses
Their personal touch/ Caring and
understanding/ They knew you by
name/ Friendly
57
They took time to explain and answer
any question/ Upfront
16
They are professional and good at
19
Patients were allowed to give more than one response to these questions.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
their work.
Miscellaneous factors
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
Table 4 Why the Hospital is Perceived as Important by Patients
THE HOSPITAL
% of Responses
The Grounds – spacious, well laid out,
calming, therapeutic, fabulous.
31
The atmosphere/ not like a hospital/
free to come and go.
30
Facilities and services
9
Clean and hygienic
12
The size of the hospital
3
The Lodge
6
Everyone in the same boat/ Don’t feel
I have cancer
5
Miscellaneous factors
4
Table 5 Why Medical Treatment is Perceived as Important by Patients
THE MEDICAL TREATMENT
% of Responses
Treatment is excellent/ The staff are
experts in cancer care.
The personal touch is very important
It is usually punctual – little waiting
around.
Flexible and catering to patients’
needs.
Complementary therapies
Miscellaneous factors
40
19
19
6
5
11
Some verbatim comments from patients clearly illustrate their feelings and
identify what they most value about St. Luke’s (overleaf).
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
What Patients Value About St. Luke’s
The sense of calmness you don’t feel in yourself. The setting and the
grounds to walk around. Private places to be on your own or with people.
The staff are extremely supportive and nurturing. They can have fun too.
Everyone is in the same boat – you are not a pariah. We bolster each
other up. You have good days and bad days. When you have cancer, you
need to be supported and Luke’s is a specialist hospital that can do that.
There is more awareness amongst Luke’s staff. I had a bad experience in
the past but here, the nurses give you their number to phone at anytime.
I don’t think I would have managed so well outside Luke’s. It has such a
lovely atmosphere; it really saved me. Such a healthy environment. It is
all around you. You can see it from wherever you are. It has a nice
canteen and it is not too big or impersonal. It is an atmosphere for
recuperating.
The Lodge is fantastic. I wouldn’t have lasted anywhere else for 8 weeks.
You have privacy and patients around you are the same as yourself and
they are a support group from day 1. It is unbelievably friendly – all the
staff.
The prostate nurse is really great! They are 101%. They put you at your
ease and talk to you. You are not just a number. The attitude of doctors is
different here and not as condescending as in some other hospitals.
It is very relaxed. You are free to do your own thing
It is like a hotel and you are spoiled rotten. It is lovely to see the same
faces and the staff, from the top to the bottom, talk to you for ages.
The majority of people here are of the impression that they will leave
here cured and that is a great psychological boost to everyone even if you
are not feeling that well yourself. I dreaded going into hospital. I had
never been in hospital before but the Lodge was unbelievable. You would
think you were on holidays, just no sunshine. The facilities are great and
the food lovely, and you make good friends. I couldn’t say enough about
it.
The nurses give you all you need. Their whole approach is so good. They
know you are apprehensive when you come in and they know how to
handle it.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
What Patients Value About St. Luke’s (Continued)
The nurses are something special. They are kinder than normal nurses. All
the staff are kind, caring and patient. They are specialists in cancer care
here. My refuge.
Everything about the place. It is like a hotel or holiday.
They always seem to have time to talk. In (other hospital) the staff are under
pressure all the time. The chapel is comforting – it is a special place.
They make you feel you are the only one in the hospital. The staff all make
you feel relaxed. Their kindness is above and beyond the call of duty, 24/7
whole caring.
They know you by name and they take time to talk to you. I will always
remember it for the helpfulness and friendliness of the nurses and doctors. It
is a brilliant place. You couldn’t ask for better if you are going into hospital,
except maybe have machines that don’t break down so often. It is not like St.
James’ where the nurses always seem to be run of their feet.
I was so happy here. It is like a holiday. I have no responsibilities and there
is no fuss. My husband is a fussy man. I had the picture of the Divine Mercy
in front of me the whole time and I went out into the gardens. I counted 32
plants on one side of a bed and said to myself I would love to see them
growing. The nurses and doctors are so kind and they all want to help you.
When I was dropped off here, I was told by the driver that if I was to die, I
would want to die here. I love the gardens and the Lodge. There is a lovely
feel to the hospital; it is so lovely and peaceful. Everyone is so nice. It is the
most tranquil place on earth and the gardens are lovely to sit in.
There is no pain here. You get immediate attention and you don’t ever have
to ask. The staff are so nice. They remember your name and they use it – they
make you feel part of the hospital community.
St. Luke’s helped me live with cancer. The ambience of the place is so
relaxing and you are not stuck in bed or afraid to go out. The grounds are
lovely.
It helps me feel better and get better, much more so than if I were in a bigger
acute hospital. They do more for you here. You just have to ask and they
keep you informed.
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What Patients Value About St. Luke’s (Continued)
Emotionally and mentally this place gives you a break and a lift. I believe
this place is exceptional. They care with quality. It’s so relaxing. If you
bring pressure from your own life here, it is lessened. There are no private
patients. Emotionally I need to heal many wounds and adapt to a new
situation. Life is not taken for granted anymore. They care much more than
your physical problem, they care for the whole person. This is very
important and uplifting for people who are still sick from chemotherapy.
The staff are very committed to the care of patients.
It’s a lovely place but I will be glad to be getting home. I can understand
people who live alone getting used to the company and going home to an
empty house but I want to forget St. Luke’s and move on.
I had never been in hospital before and I never realised it could be so
comfortable, with such company. I don’t know if you would get it anywhere
else. A home from home. People don’t go around in dressing gowns and
slippers. There is no us and them. We are all one. The nurses are wonderful
and every detail is looked after. I feel the surroundings and atmosphere
help with recovery. You are bound to feel better than sitting in a hospital
ward.
The Lodge and the kindness of the nurses who do everything for you. That is
half the battle and there is light at the end of the tunnel. The mental strain is
taken away. You are not tied down to a hospital regime – you have freedom
and this takes the pressure away.
I felt awkward on the first day, like my first day at school. I even sat down
the back but you could see everyone was so comfortable with each other.
Everyone here is the same as me and I am not different. It is very easy to sit
down beside people once you are welcomed. You open up without realising
it. At home, I feel really selfish talking about myself because your family are
already uncomfortable with you and you don’t know what to say. I don’t
know how my children feel and maybe I am not being fair to them by not
talking about it. Here, we talk about everything.
Everything is so clinical and clean. The atmosphere in St. Luke’s is just so
warm from the time you walk in the door – you just feel it in the air – you
don’t get the smell of hospitals and it helps you to relax. It makes such a big
difference to they way you are feeling. You have a spring in your step going
for treatment. I am convinced that mind matters in healing and I definitely
believe that if your surroundings are comfortable, the care is different. You
are allowed to feel better here. Since coming here I know I will cope.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
3.7 What Patients Will Miss About St. Luke’s Hospital?
Almost two thirds of patients said they would miss something about St.
Luke’s when their treatment is finished. For most, it is the camaraderie of
other patients, followed by staff, the reassurance and routine of the treatment
and check-ups, knowing everyone has cancer, the grounds and particularly the
Lodge, leaving responsibilities outside the gate, and always having enough to
do.
I will miss the company of people in the wards. We are all in the same
situation and we can talk to one another. When you go home, you don’t
want to be going on all the time about yourself. People have to go
through the same situation before they really understand and to really
say, I know what you are talking about.
Everyone is in the same boat here in the Lodge. When you go home,
people are sympathetic but it is not the same. You miss your friends and
the food and knowing you can get immediate advice and attention from
your consultant. At home, your GP is busier and less expert.
I felt sad leaving. You miss coming up and down. It was a routine thing
I did everyday and I didn’t know what to do when I was finished. I miss
the chit chat with other patients and the nurses.
Conversely and not surprisingly, perhaps, a substantial number of patients
(40%) indicated they would be happy to leave St. Luke’s when their treatment
is finished if it means they are cured.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
3.8 Comparisons with Other Hospitals
Allowing for the many differences between the services provided at St.
Luke’s and other hospitals, the respondents were asked how St. Luke’s
compares with other hospitals that provide cancer care in Ireland. Just over
half of all respondents were of the opinion that St. Luke’s was better than
other hospitals, while one third just couldn’t make a valid comparison, and 12
per cent said they were ‘just different’. The main reasons given by
respondents for believing St. Luke’s is better than other hospitals reiterated
points made in response to previous questions (Figure 10).
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
3.9 Patients Rating of Specific Aspects of St. Luke’s
Patients were given a list of statements relating to different aspects of St.
Luke’s facilities, environment and service, and asked to what extent they
agreed with the statements. Their responses are detailed in the following
charts. Overall, very high levels of satisfaction were expressed with most
aspects of St. Luke’s services, environment and facilities. The areas that
scored least favourably were: location (access, convenience, and parking), the
quality of medical equipment, and having enough to do during the day.
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72.
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3.10 Suggested Changes to St. Luke’s
The penultimate question asked patients if they would like to see anything
changed with any aspect of St. Luke’s environment, facilities or services that
would improve the wellbeing of patients. Most patients were very reluctant to
suggest any improvement for fear that it would cast any doubts on their
overall satisfaction with St. Luke’s and the future of the hospital. However,
when pressed, the single most common suggestion was the hope that St.
Luke’s would get new and better equipment (Figure 15).
Finally, the vast majority of patients spontaneously said that they would like
to see St. Luke’s remain open, with quite a few stating the proposed transfer
of services was ‘madness’.
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3.11 What Does St Luke’s Mean for Patients
The final question was undoubtedly the most emotive and the most revealing
for many patients. It asked patients to say in a few words what St. Luke’s
means to them. Their words speak for themselves and are presented verbatim
without comment or analysis.
To me, St. Luke’s means ….
The reality of cancer and my life interrupted. I am trying
to stay positive and being here is as positive as it possibly
could be. The Lodge makes a huge difference.
In the final analysis, it has given me a new lease of life. It
gives me hope of a cure and that is a big thing. To have all
the experts under one roof and great facilities allows me
to pass on my worries. There is a lot of knowledge and
empathy in the hospital. It was stigmatised in the past but
there have been huge improvements in recent years.
A great after-care facility, the way they look after you. You
wouldn’t have got it year’s ago.
It is good it existed. A healthy environment to receive
radiotherapy. I don’t know if I would have survived
without the quiet.
At the time, life, everything. A place I will never forget. I
made so many friends there. I pity anyone who has to go
anywhere else for treatment.
No travel. I am very happy coming to St. Luke’s –
everyone mixes very well and the staff are very supportive
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
A relaxing hospital. I would love to have St. Luke’s in
County Monaghan.
The treatment was excellent. It reassured me and the care
from nurses was excellent.
A cure and new lease of life. Years ago, when someone
got cancer, that was it.
Health and getting back to normality.
A refuge.
A haven.
A good hospital. I feel happy here and I am hopeful
something can be done.
Recovery.
Going home cured. It is a special place for me. It helped
me to get over cancer. I was terrified coming in. You can
ask doctors questions here. You wouldn’t be able to talk to
doctors anywhere else. They made me feel at home. You
can come and go as you like. I wouldn’t be alive without
my doctor.
Very good care and helpful staff.
I am here to get better.
The atmosphere. The staff seem to be hand-picked. I was
shocked with the diagnosis but I know I’m going to get
better here. It makes me feel confident.
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I feel safe getting wonderful treatment. The consultants
are easy to talk to and you can ask them anything you
want. They made me feel more confident and positive.
I got the treatment I needed. I didn’t have to travel and the
Lodge gave me time and space for myself. I availed of all
the services and that was wonderful. The day just flies and
I haven’t time for visitors! A place of rest and relaxation.
It gives me great confidence for what lies ahead.
Hopefully I will get better. Positive thoughts. If I had to
come again, I’d be confident about it – good care.
The best place I ever was. The nurses check you take your
tablet.
I couldn’t ask for much better. I just hope it doesn’t close.
It is very warm and very friendly. It doesn’t feel like a
hospital. People have time for you.
It means a lot – love affair with St. Luke’s. It is an
excellent cancer care hospital and it was there when I
needed it. I will be eternally grateful for that.
It means my life. Had I not been treated in St. Luke’s, I
would not have lived. This is the place to be.
A very warm and caring hospital by all staff members
I was very apprehensive coming in at the beginning but I
would have no hesitation if I had come back for more
treatment.
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Hope – they have given me hope for a few more year.
Nice – hopefully it will make me better – that is the main
thing. I enjoyed my life here. It is so relaxing – it would
make you feel better… It means an awful lot. If I have to
die anywhere, it would be here. I love the gardens, just
sitting here, relaxing and talking to people. Everyone is so
cheerful. I thought they would be going around with long,
sad faces but no.
St. Luke’s is fantastic place and I would recommend it
anyone to come for treatment. The place is just
unbelievable – when you walk in – the atmosphere - you
are not just another number – you can ask any question
and complain if you need. It is much better than other
hospitals – they do more for you here and listen to you.
Excellent staff, friendly, efficient, co-operative – it
couldn’t be better, from top to bottom. The surroundings
are great. Please God it won’t close and will see me out.
For God’s sake, don’t change anything. It is as simple as
that. People with cancer tend to be getting on in years and
they have greater apprehension than younger people and
large buildings with large corridors puts the fear of God
into them.
I owe my life to them. I would not go to James – I lost a
brother there and he would still be alive if he had come
here.
It means everything to me. My second home in case
anything goes wrong. I like coming up here to make sure
everything is ticking over all right. I look forward to my
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
annual visit and more so the journey home when I know
everything is ok.
You know you are not alone and you can always come in
or phone.
I don’t know how to express it – I am not good at word.
Everything – they have given me my life back and a hope
of returning to normality as soon as possible. The staff is
very important. If you get this right, everything else will
fall into place.
Life and death – it’s that simple. It’s a facility that should
be kept. My wife goes shopping when I get my treatment.
She knows where I am – it is not like that in a bigger
hospital.
Emotionally and mentally, this place gives you a break
and a lift. I believe this place is exceptional.
Moving this place to James is the height of lunacy. It is the
bleakest
building
and
I
imagine
there
is
no
accommodation to stay there.
First class all round. I wouldn’t like James’s. This is like a
holiday compared with James’s.
Cure.
It means so much to have my wife stay with me – it is
everything – it gives me peace of mind, security,
happiness, a home from home. You are treated as you
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should be by people who know what they are doing. You
get a good night’s sleep. It couldn’t be better.
It is an absolutely ideal situation for cancer. A wonderful
place for what we’ve got. I would recommend it to anyone.
They have really made it nice.
It’s a sanctuary to me where you come in with a heavy
load and you leave without it. You hope the physical side
will work out but definitely mentally you are a different
person. You are better able to bear the stress of having
cancer if it didn’t work out. You see people here with
much greater burdens than you.
A home from home. I know it is totally different to home
but it’s the feeling and for me that’s very important. It is
all about feeling and comfort.
This is a saviour to me. I don’t think I would be in the
position I am without Luke’s. I don’t think I would get the
same treatment anywhere else. Just look at the smiling
faces of people in the canteen. The gratitude I feel
couldn’t be expressed.
Very happy – I made the right decision to come here –
100% right decision. It has saved me. The staff know
exactly how to deal with people
.
It means an awful lot – the treatment is so important and
the care they give you.
A place I come for treatment. Hopefully, it will save me
from dying. A happy place.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
I will never forget it – the care and consideration everyone
gives you. I came here so anxious and everyone was
fabulous – a fabulous place.
A great and very positive experience – the staff are great.
A place of care and cure.
I would recommend it.
It’s my lifeline. St. Luke’s represents the next step to being
better. It is part of my daily routine. I won’t know what to
do with myself.
It means a lot the way they care for people. They give you
the treatment that makes you better.
It is hard to put it into one sentence – it changed my whole
outlook on cancer care. It is patient centred and personal.
I experience less stress.
Somewhere to come go get help. It has a good success
rate.
I can get on with the rest of my life. Hopefully all is going
well.
The staff are friendly, exceptional, they have time for
people, the doctors show consideration – I would give it
100%.
Glad to get treatment and get a cure, please God.
It means a lot, going through what you’re going through.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
It is a nice place to be. The staff are very supportive.
Somewhere to come and relax and have peace and quiet
and calm. I was panicky and scared but they calmed me. I
wouldn’t be afraid to come back. I know it is a nice place
to come to.
Treatment is as pleasurable as treatment can be – stress
free treatment.
Get me treated and then get me out of here and I will be
away in a hack.
Excellent centre for cancer care. If I was unlucky to get
cancer again, I’d want to come here.
It means a lot – the care and treatment is excellent. I
couldn’t fault anything. I don’t know why they’re talking
of closing it. As a centre of excellence, they would never
be able to repeat it.
It saved my life and put me back on the planet. It gave me
my life back. I thought I was finished because it was my
second
time
to
have
cancer.
Cancer
care
and
radiotherapy. Treatment when I needed it.
My life. I could be dead. The doctors speak plainly and in
language you understand.
Hope.
It means a lot.
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I felt insecure when I heard I had cancer. St. Luke’s made
me feel secure. I felt I was getting better. A wonderful
place. The best hospital I have ever been in.
It means I am better now.
A welcoming and comfortable environment – excellent
treatment. I couldn’t fault it. The doctor is excellent and
lovely person. All staff are lovely.
Like a home from home. The staff are welcoming. It is very
relaxed and there is plenty to do.
I know everyone, even the receptionists and cleaners. The
staff have time to talk to you – they ask how you are.
I was treated very well. The treatment is very good.
A very nice comfortable environment – welcoming,
excellent treatment, I couldn’t fault it. The doctor is an
excellent and lovely person. All the staff are lovely.
It is easy to get to and like a home from home. The staff
are welcoming and very relaxed. There is plenty to do.
I know everyone, event he reception and cleaners. The
staff have time to talk to you and always ask you how you
are.
I am treated very well.
It means I am better now.
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St. Luke’s made me feel secure and gave me hope.
I wanted to stay here. You are sure of being looked after
and of getting the care you need.
A place where cancer patients are looked after in a caring
and relaxing environment.
Don’t close it. The environment in St. Luke’s stops you
from being scared.
Everything. I hope they don’t close it.
I get the best of attention. I would hate to see it move to a
larger place.
It means a lot. They saved my life.
A wonderful place. I hope it is not knocked down.
Somewhere that brought me back to life.
A place for cancer treatment – a terrific place.
It means a hell of a lot now. They have staff and
equipment and staff to treat me – 100%.
Hopefully it will cure me.
The best hospital to go for treatment.
It means everything. The care given to patients is A1.
Everything is considered.
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It has given me three years of comfort, pain-free, and
hope. I know I will die with cancer and not from cancer. It
is great to know a place like Luke’s exists if you get
cancer.
It is a sin if it closes. It is a great support and consolation
to me.
The staff are great. Don’t close it.
Nice feeling of serenity. A religious feeling. I could sit in
the Church for a long time.
It is excellent for cancer patients – homely and clean.
I am delighted it is here. It would lose its atmosphere if it
moves.
I have the height of praise for Luke’s. Everything about it
is brilliant.
When I heard I had cancer, I was hoping I’d be sent to
Luke’s.
I am treated very well. I didn’t feel as if It was the end of
the world.
It has a very calming effect on me. It is different to other
hospitals. A home away from home.
It means I am still alive. The treatment was great. It would
be a disgrace if they close it.
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It means everything to me – it got me out of a hovel when I
had problem.
If my treatment has done its job, it’s great. My confidence
is building up. I am not afraid to go out. I have a new life.
It is unique. A place to go with confidence. If there is a
cure you will get it..
It means a lot. I got better and when I go back for a checkup, I am not left waiting long.
It is very important for cancer patient.
I hope I never have to go back but if I did I hope St. Luke’s
is still there.
It meant a lot. There is always someone there. It is a
secure base and I would hate to see it going. It is very
relaxing and the staff are very upbeat. I made friends
there and we have remained friend.
I want St. Luke’s to stay the way it is.
It is a lovely hospital and can’t be improved on.
A place you should never be afraid of if you are diagnosed
with cancer.
It has one purpose – cure of cancer – and it is good to
have a hospital like this.
Salvation for soul and body – the whole human being…
Wonderful care for cancer patient.
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It makes me feel secure to know I’m being treated by
qualified people.
A grand place.
My life.
Hopefully the treatment has worked.
They were very helpful when I was going through a hard
time in my life. There was always someone to talk to.
I know they are there for me if I find any lumps.
Hopefully it will work out.
I don’t want to see it close.
It is a wonderful hospital – a necessity. An oasis in the
desert.
I know it is always there. I’d never have any fear in asking
any questions or ringing them. There is a sense of security
when you know there is good hospital there with dedicated
staff. I would do anything for St. Luke’s. It is a wonderful
place. It is a great solace talking to others. It is very
important to have a specialised hospital.
A home away from home to the highest standard.
It saved my life.
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A lovely place, like a holiday camp.. If I win money I’d
give money to St. Luke’s. Cancer is curable. A great place
to go and get cured. All the staff are wonderful.
Quite enjoyable.. Before when someone mentioned St.
Luke’s I was afraid of it. Now I’m not. It’s a fantastic
place to go.
A cancer treatment hospital.
It means a lot to me – it saved me.
A saviour for me, a safe haven, helpful.
A life line. You need a relaxing environment to recover
from cancer. I love to go to Luke’s and see people there.
It means a lot. Only for them I mightn’t be talking to you.
The best place. Don’t close it.
Initially fear but I learnt to trust staff and they reassured
me. I am like a baby in a happy environment. The staff are
caring and constantly checking on you to make sure
everything is going ok.
I was very happy there and I would be very sad if they
closed it. It means a lot to me. My grandchildren used to
play pitch and putt.
I feel secure I had the treatment and hope I’ll be better.
A place that opened my eyes. A place I’ll forget. An awful
loss if it’s ever closed.
Everything, a wonderful place and pleasant experience.
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A place that helped me through my illness. I didn’t mind
going. The grounds and staff make it easy for you to go.
A lovely place and I am grateful for what they did.
I was nervous going but they made me feel relaxed – the
personal touch, lovely atmosphere – it didn’t feel like a
hospital.
It means a lot I have been cured. Many people still need
the facility.
It’s unique. I was emotional leaving and saying goodbye.
A nice experience and it is nice to know that it is there
helping other people.
A life-saving hospital.
Welcoming. I feel at ease when I go there.
The staff are very good and the quiet surroundings. It
means a lot to me now.
Everything.
It has been a saviour to me and changed my life.
It is totally different to anything and very important to me.
An unbelievable place. You have to experience it to know
how much it means.
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It means life and has given me a fighting chance. It is
convenient for country people – we don’t have to go into
the city.
If I didn’t have Luke’s I don’t know where I would be now.
It is tremendous and the care is brilliant.
It means a lot confident you’re getting best treatment and
care.
Moving it to James’s would be a crime against humanity.
The cancer hospital.
Great care.
It gave me another lease of life and made me look at life in
another way.
Reassurance.
Lovely peaceful hospital.
It has helped me with my illness and to understand my
illness. They took a great interest in me.
A first class hospital.
I couldn’t improve on anything. The staff are first class. It
meant an awful lot. Some of my family died of cancer. St.
Luke’s came to my aid when I got it.
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It saved me.
It means everything to me and my family. As an old
woman I was treated as if I had a young family at home.
A hospital where I got the best of treatment. I am here to
tell the tale. I would recommend it to anyone.
I felt relaxed and could talk to other patients as we were
all in the same boat.
Survival.
The Lodge is fantastic.
Keep it open.
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CHAPTER FOUR
THE VIEWS OF STAFF
4.1 Introduction
The primary aim of this phase of the research was to identify what staff
regarded as being of particular benefit to patients in the current service. Other
issues were also covered, including: to what extent staff believe patients are
satisfied with their experience in St. Luke’s, staff rating of diverse aspects of
St. Luke’s services, and suggested improvements to patient care in the
hospital. Each member of staff was invited to participate on a number of
occasions. In the final analysis, 22 staff participated in an in-depth personal
interview and 122 staff completed a questionnaire. An overview of the staff
respondents is presented in Figure 16 below.
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4.2 Staff Perceptions of how Satisfied Patients are with their
Experience of St. Luke’s Hospital
The majority of St. Luke’s staff believe that patients are satisfied with their
experience of St.Luke’s, mainly because it is a small personal hospital, but
also because of the quality of the medical care, the beautiful grounds, the
facilities, the relaxed atmosphere, the holistic treatment, the comfort of the
hospital, the patient focus and camaraderie amongst patients. Conversely, a
minority of staff feel patients are less than satisfied because of the long
waiting times, the low level of rehab services, and the lack of provision for
special diets (Figure 17).
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4.3 What Staff Perceive to be of Benefit to Patients.
When asked what they identified as being of particular benefit to the
wellbeing of patients in the current service provided by St. Luke’s, the top
three factors identified by staff were: the grounds/surroundings, the patient
focus that is made possible by the relatively small size of the hospital, and
staff expertise (Figure 18).
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4.4 Staff Satisfaction with Care Given to Patients in St. Luke’s
The majority of staff are satisfied with the care given to patients, although
approximately one fifth are less than satisfied. While most staff highlighted
the perceived high standards of care and the personal touch of caring staff,
others pointed to some perceived failings in the service, including too many
delays, staff being too busy, and a shortage of staff in Allied Health (Figure
19). These criticisms were partly made out of frustration at the level of service
staff believed could be achieved with more resources. However, the
predominant view of the care given to patients by staff was very positive.
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4.5 Staff Rating of Specific Aspects of St. Luke’s Service
When asked to rate different aspects of the service provided in St. Luke’s by
agreeing or disagreeing with 37 statements, staff gave the following
responses.
Staff - Most Highly Rated Aspects of St. Luke’s
The hospital grounds are relaxing (99% agreed with the statement).
The staff are helpful and friendly (97% agreed).
The staff are experts in cancer care (91% agreed).
When patients have a problem, staff show a genuine interest in solving
it (91% agreed).
The current environment of St. Luke’s is a significant aspect of the
overall care given to patients (90% agreed).
The staff make patients feel valued (90%).
The food is of a very high standard (89% agreed).
The general hospital environment is safe for patients (88% agreed).
Patient support is excellent (82% agreed).
Patients feel they can ask any questions relating to their illness (81%
agreed).
Patients know what to expect (81% agreed).
There is good support for patients’ families (80% agreed).
Patients find the rooms and wards very comfortable (80% agreed).
The hospital is very hygienic (75% agreed).
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Staff - Least Highly Rated Aspects of St. Luke’s
The equipment is very reliable (13% disagreed with the statement)
Treatment is delivered promptly (15% disagreed).
There is enough parking for patients and visitors (16% disagreed).
Patients are processed without delay (15% disagreed)
There is adequate (Allied) support staff (23% disagreed).
There are significant gaps in the care given to patients (10% agreed).
More complete results are presented in the following charts.
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98.
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
4.6 Staff Perceptions on how St. Luke’s compares with other
Hospitals that Provide Cancer Care in Ireland.
Most staff believe that St. Luke’s compares very favourably with other
hospitals that provide cancer care in Ireland. The dedicated nature of the
service in St. Luke’s was singled out as a positive feature. Conversely, some
staff criticised the perceived low level of facilities and rehab services in St.
Luke’s (Figure 24).
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4.7 What Staff Value About Their Work in St. Luke’s
When asked what they value about their work, staff placed most priority on
the belief that they personally make a difference, the staff camaraderie, and
the opportunity they have been given to work in a centre of excellence (Figure
25).
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4.8 Areas of Working Life Staff Would Like to See Changed
The principal areas staff would like to see changed in their working lives
included the need for more staff support generally, more staff integration,
more staff facilities, flexible working relationships, staff training, and better
medical facilities. A number of staff in the Allied Health sector expressed
dissatisfaction with their role and resources (Figure 26).
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‘More than a Leafy Suburb’. The Story of St. Luke’s Hospital
4.9 Staff Suggestions for Improving Patient Care
The staff would most like to see improved cancer care treatment facilities and
for staff to have more time for patients as ways in which patient care could be
improved in St. Luke’s (Figure 27).
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CHAPTER FIVE
THE VIEWS OF SELECTED STAKEHOLDERS
5.1 Introduction
During the course of the research, 20 interviews were conducted with a range
of stakeholders connected with the hospital including, St. Luke’s Hospital
Board members and management; hospital management and consultants;
Council members, staff, and members of the Friends of St. Luke’s Hospital10.
The primary objective of the interviews was to identify what stakeholders see
as the value of the current environment. Other issues were also covered in the
course of the interviews, including the stakeholders’ views of the proposed
transfer of services to St. James’s Hospital.
The stakeholders were, for the most part, united in their support for the
Board’s decision to endorse the Government’s decision to transfer St. Luke’s
services ‘on the basis that international best practice dictates that
radiotherapy should be located on a campus where there is ready access to
the full range of medical specialities’. However, while some stakeholders
wholeheartedly endorsed the decision, for professional and/or personal
reasons, others felt that the future of St. Luke’s was less certain and that other
options should be explored in the interim. Accordingly, the views of the
stakeholders interviewed in the course of this research will be presented in
three separate sections: firstly, the views held by the majority of stakeholders,
regardless of their personal views on the transfer of services; secondly, the
10
A meeting was also held with representatives from the ‘Save St. Luke’s Campaign’.
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views held by those who endorse the transfer of services; and thirdly, the
views of stakeholders who personally disagree with the proposed transfer.
5.2 The Majority View of Stakeholders
The vast majority of stakeholders agreed that the standard of care provided in
St. Luke’s was excellent and underpinned by a caring ethos, holistic treatment,
a ‘magnificent’ physical environment, a highly motivated and professional
staff, and a national and international reputation. The hospital grounds and the
Lodge were most often singled out by respondents to illustrate what they felt
depicted the unique nature of St. Luke’s Hospital. A number of stakeholders
referred to St. Luke’s as an ‘oasis’ within the otherwise hectic world of Irish
medicine. Most stakeholders would have no hesitation in receiving treatment
for themselves or recommending St. Luke’s for anyone close to them.
Most stakeholders also highlighted the distinctive patient focus of the care,
which they felt differentiated St. Luke’s from many other hospitals. The
patient focus is perceived to permeate throughout the hospital, including the
attitude of staff, the physical surroundings, and the commitment of the
hospital to research and improving the lives of their patients.
One member of the medical staff expressed her experience of the total patient
focus in the following way:
‘An important part of patient focus is the individual care we
provide, such as allowing patients to wear their own clothes
and to have the freedom to move about once they are there
for treatment. It is very important that when a person comes
into hospital, they are not turned into a weird kind of person
in pyjamas and that patients keep their identity. We give
patients one-to-one attention. There is always someone there
to listen to their stories and to give them treatment. Cancer is
very traumatic and patients need to know they won’t be left
in pain. Everyone is an advocate for patients. We all know
what makes a difference to oncology patients. People leave
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here ‘walking on air’, feeling understood and cared for. I am
told the care is almost spiritual – the whole person is taken
into account. We build up their spirit, their hope and allow
them the flexibility to be what they are. There is no sadness’.
The perceived value of St. Luke’s specialist oncology environment for cancer
patients and their families was also emphasised by a number of stakeholders.
Not only is this environment perceived to be a place where patients can feel
confident that they are receiving the best of care, but it is also a place where
patients are not made to feel different from other patients by virtue of their
cancer.
‘The 100% oncology environment in St. Luke’s means that
everyone, staff and patients, know everyone is in oncology.
No longer are they made to feel different by their cancer
diagnosis. Rather, to a degree, cancer makes them normal’.
Everyone, including stakeholders who fully endorsed the Government’s
decision to transfer St. Luke’s services to St. James’s Hospital, praised the
distinctive nature of the care provided in St. Luke’s.
‘I think the service provided by Luke’s is really excellent. I
think the whole ethos of care is really good. I think the
environment they have in the hospital is excellent for patients
in terms of the physical environment. I personally value the
ethos of the place in terms of the people and the atmosphere.
You know you are not in a chaotic, acute hospital when you
walk into Luke’s. You know you are in a place that provides
calm, caring professional care’.
The passionate support for St. Luke’s shown by many current and former
patients was also remarked upon by a number of stakeholders, reasoning that
if patients and their families are so supportive of St. Luke’s than ‘it must be
doing something right’. Many patients make a point to say how much they
appreciate their time in St. Luke’s and how different it is to other hospitals. It
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gives them an opportunity to face their illness in a supportive and specialist
oncology environment.
‘After six of seven weeks, they don’t want to go home,
especially Lodge patients. They make such good friends and
are allowed to have cancer. Everyone is in the same boat and
they are allowed to be ill. At home, they have to be strong for
the rest of the family. Here, they get time to think about
themselves. A lot of ladies have said that at home they are wife
and mother. Here, they are Mary or Joan. It’s not that they
don’t want to go home. They just miss the camaraderie here
and many people leave here in tears.
Most stakeholders, especially those that have been associated with St. Luke’s
Hospital for a number of years, also mentioned the significant improvements
in the operation and fabric of St. Luke’s since the 1990s. Not so long ago, the
wards were ‘big and shabby’ but now the hospital is ‘just so bright, cheerful
and modern – a proper hospital’. Patients who return to St. Luke’s can’t
believe the improvements to the hospital and the grounds. There is no smell of
a hospital and the general atmosphere is free and relaxed. It is a place where
people can find hope.
The perceived improvements were summarised
succinctly by one stakeholder as follows:
‘The hospital has gone from a Second World War hospital in
the early 1990s, with totally outdated equipment,
demoralised staff, inadequate building structure and
infrastructure, to where it is now. It has been totally
transformed. It now has state of the art equipment, a very
modern, efficient hospital structure, an internationally
recognised medical staff and, most importantly, it has an
amazing caring culture. The place is in a very good shape’.
Finally, most stakeholders felt that it is unlikely that the distinctive ambience
of St. Luke’s hospital could be replicated in an acute hospital setting.
However, while some felt the move would have a significant adverse impact
on the quality of patient care, others were more optimistic that the key
elements of the ethos and practice of care could be transferred quite
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effectively to a new site. The views of this latter group of stakeholders are
further elaborated upon in the following section.
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5.3 The Views of Stakeholders Who Personally Agree with the
Transfer of St. Luke’s Services
This group of stakeholders were very much in favour of the proposed move to
eight designated centres outlined in the National Cancer Strategy, which they
felt was in line with international best practice. Essentially, they held the view
that the optimum approach to the diagnosis and treatment of cancer is by
having multi-dimensional teamwork and the best of facilities in the one place.
‘The most important decisions taken in relation to cancer are
the first decisions. Accordingly, best medical practice
suggests that the environment in which the cancer is
diagnosed and the decision regarding treatment are really
important. Therefore, it makes sense to consolidate that
decision-making process in the eight designated centres. All
the evidence indicates that the principle of the designated
centres is the best way forward for the treatment of cancer
patients’.
They believe that St. Luke’s is too small of a site to be a Centre of
Excellence. Not only will it lack sufficient facilities to provide the full range
of cancer treatment, it will also prove more difficult to attract and retain staff
of the highest calibre because of the limited training and research
opportunities.
‘I believe in Centres of Excellence. What patients need
fundamentally is multidimensional care, where all options
are considered in the context of multiple services on the one
site. It is most important to get the most appropriate
treatment at the appropriate time. When it comes to the
treatment of cancer, most patients receive a combination of
therapies and these can only be provided on a larger site’.
It should also be noted that some of this group were not convinced of the
genuine therapeutic effects of St. Luke’s environment, believing that any
impact came a long way behind fast diagnosis, and timely and appropriate
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treatment. Furthermore, they believe that if it is accepted that there is merit in
a pleasant environment, then it should be possible to recreate much of the
underlying ethos and caring environment of St. Luke’s Hospital in a
sensitively designed hospital.
‘There is no doubt that the ambience around St. Luke’s is
very special. The grounds are very special and it a lovely
place to visit. It may well prove difficult to have that in St.
James’s and it is important as it goes some way towards the
psychological battle against cancer, but St. James’s is a very
fine hospital and you can do a lot with buildings if they are
sensitively designed. You certainly won’t be able to replicate
the Lodge or the gardens but assuming most of the staff will
move to the new site, it is the people who create the
atmosphere. It is most important that people feel heard and
cared for and enabled to deal with their issues, where they
are given time and where staff ease their burden’.
They believe there is no reason to suggest that staff in St. James’s or
Beaumont is any less committed or professional in their work. Furthermore,
they point out that many of St. Luke’s consultants also work in St. James’s
and Beaumont. Some stakeholders criticised the high number of beds in St.
Luke’s, which is substantially higher than is generally found in radiotherapy
settings. They pointed out that many of these beds are unlikely to be needed
following the implementation of the National Cancer Strategy when patients
will have shorter distances to travel.
The lengthy waiting time for radiotherapy was a significant issue for one
stakeholder, which is perceived to be partly due to inadequate capacity and
‘inertia’ in the organisation to change. Finally, some stakeholders felt that the
claims made for the care in St. Luke’s can be exaggerated. Thus, while the
standard of care and facilities afforded to patients in the Lodge are justly
acclaimed, these facilities are not offered to most of the patients in the wards
or to outpatients.
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Overall, these stakeholders, while generally supportive of the care and
treatment
provided
in
St.
Luke’s,
would
prefer
to
follow
the
recommendations of international best practice in the treatment of cancer,
which indicates that ‘radiotherapy should be located on a campus where there
is ready access to the full range of medical specialities’.
When asked for their views on the future of St. Luke’s, a number of suggestions
were made, as follows. If the central thrust of the National Cancer Strategy is
accepted, then one scenario would entail selling part or the entire Rathgar site
and dedicating the funds to the development of a new facility in St. James’s
Hospital, which replicates, insofar as possible, the specialist cancer environment
that is currently available in St. Luke’s. Central to this view is the belief that St.
Luke’s is more than the Rathgar site and that any decision should be made
outside the obvious emotional attachment to the site in the best interests of
patients. Others went further and argued for the redistribution of St. Luke’s
assets in whatever ways best served the needs of cancer patients - ‘Identify the
needs of oncology patients and determine if St. Luke’s is the best place to meet
their needs. If not, then it would be better to sell St. Luke’s and to address the
needs of patients in another purpose-built facility’.
A second possible use for the Rathgar site might entail developing St. Luke’s
as a palliative care centre or step-down facility, focusing on the provision of
human, emotional care to cancer patients who do not require specialist
medical care. In essence, St. Luke’s would provide respite care for patients on
their cancer journey as they learn to live with cancer. A state-of-the art Lodge
could be developed from the sale of part of the site, with transport links
between St. James’s and the new facility. This would have the advantage of
improved survival rates from the more integrated service in the redeveloped
St. James’s site and a continuation of St. Luke’s unique patient focus. In
essence, St. Luke’s could be part of the St. James’s Campus but remain on its
own site in Rathgar. It is also possible that the site could be developed to
cater for the needs of elderly people approaching end-of-life, many of whom
require palliative care.
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A third option is the redevelopment of part of the site as a Centre of
Excellence for cancer research. This facility could be a stand-alone research
centre or, more likely, run in conjunction with St. James’s Hospital. There
should also be opportunities for other cancer organisations to collaborate in
the facility by moving some or all of their services onto the site. Finally, the
idea of selling the site and dedicating the funds to the treatment and research
of cancer was also suggested by one individual.
5.4 The Views of Stakeholders who Question the Merits of
Transferring St. Luke’s Services.
‘In the business world, I depend on gut instinct when logic
says something else. Not ignoring logic, but people do get
better if they are looked after in a caring environment and if
they are more than a number. Not everyone does but some do
and why get rid of something that works’.
This group of stakeholders believe that St. Luke’s Hospital is already a
‘Centre of Excellence’ that should be replicated rather than closed or
diminished in any way. Not only do these stakeholders wholeheartedly
endorse the positive points made about St. Luke’s above, but they also
believe that the standard of care transcends the more general ‘malaise’ in the
Irish health system. Furthermore, they feel that there is serious danger that
many of the important supports and facilities that are available to patients in
St. Luke’s will be lost if the services are transferred to another site. While
many aspects of the St. Luke’s ambience may be replicated to some degree in
the transfer if it is approached in a sensitive manner, these stakeholders
believe that the positive wellbeing that is promoted by the hospital grounds
and the spirit that permeates St. Luke’s will inevitably be lost.
For the most part, this group of stakeholders believe that patients are treated
differently in St. Luke’s, that the staff as a totality understand and can
respond to the needs of cancer patients better than in any acute hospital, and
that the unique environment of St. Luke’s helps patients come to terms with
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their cancer. Some intuitively feel that a pleasant environment must help
patients feel better and perhaps, also get better quicker than would be the case
in another, less pleasant environment.
‘The jury is out on the medical benefits of complementary
therapies or nice surroundings but we know people feel
better. A patient’s psychological state of mind and how they
feel about themselves and how they deal with cancer are all
part of the patient’s total wellbeing. It is largely uncharted
but you have to think it is doing them good. Just ask any
patient….. You only hear glowing accounts from patients, so
we must be doing something right ….The activity centre has
proven to be a great success and that can only be good’.
They believe that patients feel and appreciate the ‘patient first’ ethos that is
promoted within the hospital. It is different to an acute hospital where the
environment is inevitably more hectic and where cancer patients are
perceived to be just another group of people seeking to use increasingly
limited resources. A number of stakeholders felt that the relatively small and
specialist environment of St. Luke’s was a positive feature for patients and
staff, alike.
‘It’s a different place here. Everyone in Luke’s is here with
the same illness. They are all in the same boat. Patients are
not looked at as if they have death on their faces. A big part
of getting people better is how you are around them. If you
look at someone and say you are going to get better, there
are people who will get up out of bed and walk regardless of
how bad their tumour is’.
While not wishing to question the acknowledged benefits of having all
facilities on one site or the principle underlying the eight designated sites, this
second group of stakeholders feel that the benefits of St. Luke’s adds
something significant to the care of cancer patients. Furthermore, since St.
Luke’s is relatively close to St. James’s, the minority of patients who require
surgery could be transferred between the two hospitals relatively quickly. For
this group, St. Luke’s is an asset that should be enhanced rather than lessened.
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When asked to give their views of the future of St. Luke’s Hospital, this
group of stakeholders proposed a future that entailed ‘business as usual’ and
possible expansion of St. Luke’s services. According to this view, St. Luke’s
is one of the successes of Irish medicine and is at the leading edge of cancer
care in Ireland. It also represents a successful partnership between the State
and the voluntary sector11, so why close it?
‘There is no justifiable reason for retaining Luke’s from a
business perspective in terms of economy of scale but my
heart is telling me that there is a role for St. Luke’s Hospital
if we are to retain some kind of humanity and semblance of
respect for patients rather than allowing them to be treated
like cattle in an acute hospital’
While understanding the strategic role of the national cancer strategy, this
group generally feel it would be a serious mistake to close St. Luke’s and
diminish an already stretched cancer service. Rather than simply maintaining
the status quo, exponents of this view believe that St. Luke’s needs to expand
and to ‘make sure it stays at the leading edge by continuing to modernise, by
having the best of equipment, by retaining its high quality staff who are
internationally recognised in their specialist fields, by promoting research,
and by continuing to focus on the patient’. Some stakeholders indicated that
lateral thinking will be required to see how St. Luke’s can be incorporated
into the National Cancer Strategy more or less intact. Others argued that if St.
Luke’s is to remain open, it will have to change work practices so that new
technologies are used properly – ‘we buy new machines and then don’t use
them properly’.
The invaluable role of the Friends of St. Luke’s was noted by a number of stakeholders, one of
whom stated: ‘St. Luke’s would have gone under if not for the Friends. They are extraordinary and to
be found in every village and town of Ireland. Their strength is their support from the real people of
Ireland. They are very committed, very well informed, and they are always there, and the hospital
benefits greatly from their activities and presence’
11
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5.5 Concluding Comment
The primary aim of the research with stakeholders was to identify what a
range of people associated with the hospital valued about the current
environment. Allowing for some difference of opinion on the impact of the
environment on patients and the wisdom of the proposed transfer of services,
the information presented in this chapter suggests that most of the
stakeholders are very much of one voice in endorsing the superior standard of
care provided by St. Luke’s Hospital and the underlying patient ethos which
permeates most aspects of the hospital. However, they differ in terms of how
they perceive the future role of the hospital.
A number of different models of care are detailed in Chapter Six to illustrate
some options that are available to St. Luke’s in the provision of cancer care
and treatment.
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CHAPTER SIX
SUPPORT AND REHABILITATION SERVICES
6.1 Introduction
St. Luke’s Hospital is one of a number of national centres providing specialist
radiation oncology services in Ireland. It currently treats in the region of 4,000
patients each year, employs some 500 staff, and has an annual turnover of €40
million. However, further to the findings of the Report on 'The Development
of Radiation Oncology Services in Ireland (Hollywood, 2003), the current
Government policy is that radiation oncology services will be provided
through four larger centres in Dublin (at St. James’s and Beaumont Hospitals),
Cork University Hospital and University College Hospital Galway and two
integrated satellite centres at Limerick Regional Hospital and Waterford
Regional Hospital.
One of the objectives of the study was to explore different models of support
for cancer patients that might be applicable in the context of the long-term use
of St. Luke’s Hospital campus, within the parameters set by the National
Cancer Control plan and the HSE model of primary and acute care services.
The review is not intended to be complete, given the considerable number of
health facilities offering services to cancer patients throughout the world.
Rather, its aim was to stimulate discussion and debate on possible future
scenarios for St. Luke’s Hospital in order to facilitate the Friends of St. Luke’s
and the Board of St. Luke’s make an informed decision regarding their longterm goals.
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A number of models of support and rehabilitation were considered in the
report12. It should be kept in mind that these are models, which suggest
possible directions for the future of St. Luke’s Hospital, rather than templates,
which are more directive and restrictive in nature. The models reviewed in the
report are:
i.
Specialist oncology hospitals which provide a comprehensive range of
holistic cancer care programmes e.g., The Royal Marsden NHS
Foundation Trust, London.
ii.
Acute hospitals with oncology departments and related services e.g.,
St. James’s Hospital, Dublin.
iii.
Specialist cancer centres which are attached to a larger oncology
hospital e.g., The Memorial Sloan-Kettering Cancer Centre.
iv.
Palliative care facilities e.g., Seasons Palliative Care Programme,
Chicago; St. Christopher’s Hospice and Marie Curie Cancer Care, UK.
v.
Independent cancer care centres:
a. Located close to hospitals e.g., Maggie centres.
b. Primary focus on complementary care in a stand-alone setting
e.g., Penny Brohn Cancer Care.
6.2 Model A: Specialist Oncology Hospitals
These hospitals are typically large and capable of providing a comprehensive
range of oncology treatments, care, and research, including diagnosis, diverse
forms of surgery, radiotherapy, chemotherapy, psychological and pastoral
support for patients and relatives, specialist staff, oncology training, and
research trials. Examples of this type of include The Royal Marsden in
12
Most of the information on the hospitals and care centres was sourced from their respective websites.
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London, the Christie NHS Foundation Trust (Manchester), Barts and the
London Cancer Centre which is based at St. Bartholomew’s Hospital in the
City of London.
The Royal Marsden (London)
Background
The Royal Marsden Hospital is one of the
pioneers in cancer treatment and research.
Today, the hospital with its academic
partner, The Institute of Cancer Research,
forms the largest comprehensive cancer
centre in Europe with over 40,000 patients seen every year. The Royal
Marsden NHS Foundation Trust is ranked as one of the top NHS trusts in the
country in the NHS national performance rankings. They consistently meet
their targets for quality, performance, and financial management.
Services
The Trust provides inpatient, day care and outpatient services for all areas of
cancer treatment. It provides a comprehensive range of oncology services,
including:

Holistic care programmes from diagnosis, through all treatments to
recovery or palliative care. Its Directory of Services lists a
comprehensive range of treatments performed, including: diverse
forms of surgery, radiotherapy, chemotherapy, genetic counselling,
genetic testing, genetic screening, clinical trials, hormone therapy,
staging, novel therapies, and a one-stop clinic that is managed by a
multidisciplinary team.

Pastoral and psychological care for patients and relatives.
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
Dedicated and highly skilled staff.

Specialist research centre with the largest drugs trial unit in Europe.

Training more post-registration cancer nurses than any other UK
hospital.

One of the largest UK training schemes for oncologists.

Education services for GPs.
Research
The Royal Marsden, in partnership with the Institute of Cancer Research,
conducts over 450 projects each year to improve evaluation and treatment of
patients with cancer. They research the cellular and molecular causes of
cancer, and develop and test new anti-cancer drugs. The hospital has attained
international recognition for its work in the prevention of cancer in patients at
an increased risk of developing the disease because of their family history. It
is also known for its innovative work in developing novel methods of
treatment and improving the quality of life of cancer patients through
advances in symptom control. Research extends across the causes, prevention,
diagnosis and treatment of cancer, with emphasis on six major programmes:
cancer genetics; cancer therapeutics; imaging; radiotherapy; pathology; and
Health services research, including nursing, psychology and rehabilitation.
Relevance of Model A to St. Luke’s Hospital
The Royal Marsden Hospital and other specialist hospitals operate at a very
high level in terms of the range of services provided and the resources at their
disposal for the treatment and care of patients with cancer. Accordingly, it is
not a model that is likely to be appropriate to St. Luke’s or, indeed, any other
hospital in Ireland at the present time. Conversely, it may also be argued that
St. Luke’s has unique strengths and facilities, many of which have been
highlighted in this report, that are unlikely to be found in larger specialist
hospitals. These features will be explored further in subsequent models.
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6.3 Model B: Acute Hospitals with Oncology Departments
Acute hospitals are the norm for most medical interventions outside the
primary care model in Ireland. Typically, they are large facilities and provide
a wide range of medical and related services, including diverse forms of
surgery and a range of clinics, palliative and pastoral care, ambulance
services, social workers, psychologists, cancer care and so forth. St. James’s
Hospital is one example of an acute hospital currently providing cancer
services in Dublin.
St. James’s Hospital (Dublin)
Background
St. James’s Hospital’s fundamental purpose is the delivery of health treatment,
care and diagnosis, together with health promotion and preventative services
at catchment, regional, super-regional and national levels. It is also an
academic teaching hospital and is committed to the creation of an environment
and the circumstances in which education and research in the health sciences
and allied areas are made possible. The hospital focuses on four major crossspeciality
programmes:
cancer,
cardio-vascular,
rehabilitation,
and
pharmaceutical.
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Services
St. James’s provides a range of specialist services, including: Plastics, burns,
reconstructive surgery; Haemophilia services; Bone Marrow Transplant Unit;
Maxillo-Facial Surgery; National Medicines Information Centre; National
Pharmaco-Economics
Centre;
National
Demential
Information
and
Development Centre; National MRSA Reference Laboratory; National TB
Regerence Laboratory; Genito-Urinary Medicine/ Infectious Diseases;
Oesophageal Surgery; Cardiac Surgery; Vascular Surgery; Cardiology;
Gastro-Intestinal Medicine; Clinical Haematology; Medical Oncology;
Respiratory medicine; Endocrinology; ENT; Gynaecology; Rheumatology;
Thoracic Surgery; Major emergency unit; Major care of the elderly centre;
Orthopaedics (trauma); Palliative care; Dermatology; Neurology; General
medicine; General surgery; and Urology.
The Cancer Centre
St. James’s is one of the eight cancer centre of the HSE National Cancer
Control Programme (NCCP), and one of two centres in the Dublin MidLeinster Networks. The Centre provides cancer services to a regional
catchment, which includes south-west Dublin, Kildare, Wicklow, Laois,
Offaly, Longford and Westmeath. The range of services encompasses
diagnosis, staging and all aspects of cancer treatment except for radiation
services provided by St. Luke’s Hospital. An on-site radiation oncology
facility is currently under construction and is expected to be completed in
2012.
All cancer sites are treated at St. James’s except brain tumours and liver or
bone tumours requiring surgery. The national and supra-regional services are
in haematological malignancies, lung, oesophageal, head and neck,
maxillofacial, and gynaecology oncology, and regional for breast, colorectal,
skin and urological. There is a 5-surgeon plastic and reconstructive unit which
connects with the management of many cancer types. St. James’s is an
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academic medical centre. The cancer programme at St. James’s and Trinity
includes genetic and molecular research and clinical and translational clinical
trials. The integrated programme unit for each cancer is well developed and
underpinned by well established corporate and executive structures, including
clinical directorates, cancer site-specific interdisciplinary teams and
supportive corporate functionality, as well as a well-structured synergistic
interface with Trinity College in cancer research and education.
The Medical Oncology department provides a comprehensive medical (nonsurgical) service for patients with cancer. Each patient with a suspected or
confirmed diagnosis of cancer has his/her case discussed at a multidisciplinary
team meeting, where an individual treatment plan is agreed. Inpatient and
outpatient chemotherapy is provided, together with non-surgical treatment of
cancer and supportive and palliative care. All patients have access to an
oncology liaison nurse who can provide information and advice.
Relevance of Model B to St. Luke’s Hospital
As is the case with model A, this second model is most unlikely to be of direct
relevance to the future of St. Luke’s Hospital, without a change in government
policy and a substantial increase in the amount of resources, particularly
surgical, dedicated to the hospital. One possibility is that St. Luke’s could
operate in partnership with St. James’s Hospital and provide radiation
services. The merits or otherwise of this proposal are outside the scope of this
review. The Hollywood Report concluded that while there are advantages
associated with the ‘hub and spoke’ model, which amalgamates large and
small centres, their considered opinion is that the ‘greatest opportunity for
success is through the initial co-ordinated development of larger treatment
centres that must provide appropriate outreach services to other hospitals in a
partnership model’ (Hollywood, 2003, p. 104). It may, however, be possible to
form a different form of partnership with St. James’s, where the medical
treatment is provided in St. James’s and St. Luke’s is primarily a centre for
support, and rehabilitation, with some provision for education and research.
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6.4 Model C: Specialist Cancer Care Centre Attached to Oncology
Hospital
The Memorial Sloan-Kettering Cancer Centre: Integrative
Medicine Service (New York)
Background
The Memorial Sloan-Kettering Cancer Centre is the world’s oldest and largest
private cancer centre. Founded in 1884, as the New York Cancer Hospital, it
established the Sloan-Kettering Institute in 1948. Some 32 years later, the
institute and the hospital were unified into a single entity, the Memorial SloanKettering Cancer Centre. Today, the Centre employs more than 10,000 staff.
In 2008, more than 22,000 patients were admitted to Memorial Hospital and
Memorial Sloan-Kettering accommodated 466,000 outpatient visits at its
Manhattan and regional sites combined.
The Integrative Medicine Service
The Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center
was established in 1999 to complement mainstream medical care and address
the emotional, social, and spiritual needs of patients and families. The Service
includes inpatient and outpatient clinical care, together with research, and
education and training. In addition, the Service provides access to information
about over-the-counter products and unproven cancer treatments and their
impact in the context of cancer care via their Herbs Database. All services are
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provided in a stand-alone building which is described as a ‘beautiful spa-like
setting’.
Integrative medicine combines the discipline of modern science with the
wisdom of ancient healing. For people, it can transform the physical,
emotional, and spiritual dimensions of their lives. Integrative medicine may
also be valuable for those who are not ill but wish to increase self-awareness,
enhance well-being, and help prevent health-related problems. The Service is
clear that in treating disease, complementary therapies are not substitutes for
mainstream medical care. Rather, they are used in concert with medical
treatment to help alleviate stress, reduce pain and anxiety, management
symptoms, and promote a feeling of well-being.
The Integrative Medicine Service offers a variety of individual therapies,
classes, workshops and educational programmes.
Individual Therapies
o
Touch Therapies – aromatherapy massage, massage, reflexology,
Reiki, Shiatsu, Thai massage, and Urban Hiker Tune Up.
o
Mind-Body Therapies - meditation, mindfulness medication for
wellness and recovery, guided imagery, self-hypnosis, and pre-surgery
hypnosis programme.
o
Creative Therapies – music therapy, sound therapy.
o
Acupuncture – acupuncture, restorative facial acupuncture, Tui Na
acupressure.
o
Nutrition – nutrition and supplement counselling, nutrition and cancer
basics.
o
Consultation with a clinician to learn more about the Service.
o
Education – workshops and lectures.
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Classes: Physical Activity and Fitness
o
Training for treatment.
o
Yoga.
o
The Alexander Technique.
o
Qi Gong.
o
Other e.g., Fitness Conditioning and Ab Attack; Chair aerobics; Arms,
Legs; Abs; Circuit training; Focused fitness for women; Strong bones;
and Trim and tone.
Workshops and Educational Programmes
They offer programmes for patients, caregivers, and professionals, including a
broad range of written and consultation information about complementary and
alternative medicine, including herbs and other over-the-counter remedies,
herb-drug interactions, and toxicities associated with unproved cancer
therapies. They also offer training programmes for licensed massage
therapists, reflexologists, and acupuncturists, as well as family members who
desire to learn how to provide safe and gentle massage to patients. For the
healthcare professional, they offer visiting professorships and graduate student
internships.
Research
The Integrative Medicine Service research programme has two major
components:
Quality of Life Studies: These studies address the ability of Memorial
Sloan-Kettering Cancer Centre's Integrative Medicine services to relieve
pain and other symptoms. Research currently underway or under
development includes studies of acupuncture for fatigue, shortness of
breath, hot flashes, nausea, and pain. They have also initiated a project to
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look at music therapy's benefits in the recovery room. In addition, they
are working with Memorial Sloan-Kettering's Pain and Palliative Care
Service to construct a controlled trial of the benefits of massage therapy
for terminally ill patients.
Botanical Therapies: Research suggests that some botanicals may have
important benefits against cancer. Their botanicals research program, The
Memorial Sloan-Kettering Cancer Center Research Center for Botanical
Immunomodulators, in collaboration with the Institute of Chinese
Medicine, in Hong Kong, systematically investigates immune-modulating
botanical supplements, their composition, and mechanisms of action.
Relevance of Model C to St. Luke’s Hospital
The third model (C – specialist cancer centre attached to a larger oncology
hospital) is possibly better suited to St. Luke’s Hospital as it has sufficient
space to expand and a commitment to research and education in cancer
prevention, treatment, care and cure. The existing education and research
centres within St. Luke’s could be expanded to specialise in integrative
medicine, provided the required specialist staff could be recruited and
sufficient resources dedicated to the expansion of facilities. Workshop and
educational programmes could also be provided, together with specialist
research programmes. However, in view of the considerable investment that
would be required to upgrade St. Luke’s Hospital to the required level, this
model would also appear to be beyond the capacity of St. Luke’s Hospital.
Furthermore, it would require a partnership with a larger oncology hospital
beyond that which is proposed in the national cancer strategy.
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6.5 Model D: Palliative Care Facilities
Palliative care is increasingly recognised as a need for many elderly people
and others with a wide range of illnesses, due in part to enhancements in lifeprolonging treatments. The Irish Hospice Foundation document, A Baseline
Study on the Provision of Hospice/ Specialist Palliative Care Services in
Ireland’, for instance, estimated that 70% of cancer patients with advanced
disease and 20% of non-cancer patients require access to palliative care
services (The Irish Hospice Foundation, 2006). Increasingly, palliative care
facilities differentiate themselves from hospice care. The Chicago based
Seasons Hospice & Palliative Care facility, for instance, identifies the
following differences between palliative and traditional hospice care (Table
6).
Table 6 Palliative and Traditional Hospice Care
Palliative Care Requirements
Traditional Hospice Requirements
Greater than 6 month’s prognosis.
Less than 6 months prognosis
Active treatment phase.
Goals of care include:
- increased quality of life.
Patients may be undergoing curative Pain and symptom management.
treatment or accessing skilled long- Caregiver support.
term care days.
Emotional and spiritual support.
Patients are not ready for hospice.
Source: www.seasons.org
A number of examples of palliative care in the UK are summarised overleaf,
including the Sir Michael Sobell House facility, St. Christopher’s Hospice,
and the Marie Curie Hospice.
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Sir Michael Sobell House
Background
Sir
Michael
opened
in
Sobell
House
1976
is
comprehensive
a
specialist
palliative care service jointly
funded by Oxford Radcliffe
Hospitals
NHS
Trust
and
charitable contributions. It is
also a World Health Organization Collaborating Centre for Palliative Care.
.Sir
Michael Sobell House is an NHS facility to care for people who have a
life threatening illness and for their families. They are helped in their work by
a large team of volunteers and by the Sobell Hospice Charity.
Their aim is to offer physical, psychological, social and spiritual care to those
facing life threatening illness, death and bereavement. In partnership with all
involved, they focus on quality of life, respecting the uniqueness of each
person. They seek to contribute to the development of palliative care through
education and research.
Services
The services provided by the centre include: Inpatient unit; Hospital palliative
care service; Community palliative care service; Lymphoedema service; Day
hospice; Outpatients’ clinics; Out-reach day hospice; Volunteer service;
Bereavement service; Research; Education; Art and music therapy; and
Spiritual care. The main focus of the Sobell Study Centre is on delivering
education and training programmes, together with research, international
activities and support for continuing professional development.
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St. Christopher’s Hospice (London)
St. Christopher’s Hospice was founded in 1967 and is a
centre of excellence in hospice care. Each year St.
Christopher’s supports over 2,000 dying people and those
close to them in its South London catchment area. All
services to patients and families are free of charge. It is committed to
improving care at a national and international level through clinical research,
publications and extensive programmes of education and training. Like St.
Luke’s, St. Christopher’s is surrounded by gardens. Its services include
homecare, inpatient care, a day unit, outpatient clinics, a library and bookshop,
art sessions, and bereavement support. Care is provided by a team of Allied
Health Professionals – physiotherapists, occupational therapists, speech and
language therapist, and a dietician, together with social workers and welfare
officers.
Marie Curie Hospice (Belfast)
Marie Curie Cancer Care operates nine hospices across
the UK, including Belfast. The hospices offer specialist
support
in
a
relaxed,
friendly
and
comfortable
environment, and no charge is ever made to patients or their families. The
hospices depend on voluntary contributions, together with statutory
government funding.
Set in the leafy suburbs of East Belfast, the Belfast purpose-built hospice
offers a range of services, including complementary therapies, such as:
acupuncture, aromatherapy, reflexology, Indian head massage, and massage.
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The hospice provides day services, in-patient care, home care, bereavement
support, and social, spiritual and family support.
Relevance of Model D to St. Luke’s Hospital
In many respects, St. Luke’s is quite well suited to palliative care from the
point of view of scale and its caring ethos. The underlying ethos of St. Luke’s
hospital is to provide patients with the best possible care in a safe and
supportive environment. St. Luke’s offers both day and in-patient services,
with appropriate facilities and staff in place. Furthermore, there is an
increasing demand for palliative care services in Ireland. However, the ethos
of St. Luke’s Hospital is to care for patients with cancer and their families.
Accordingly, a move to palliative care would represent a significant shift in
the underlying ethos of, and care provided in St. Luke’s Hospital.
6.6 Model E: Independent Cancer Centres
An increasing number of independent cancer centres are emerging, whose
main role is to provide a comprehensive range of complementary therapies.
The main features of two prominent examples of these centres are summarised
below:

Maggie’s Cancer Caring Centres

Penny Brohn Cancer Care (UK, Bristol).
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Maggie’s Cancer Caring Services
Background
Maggie Keswick Jencks saw from her
own experience of cancer the need for
people affected by the disease to have
access to information, psychological
and emotional support and advice on
other areas such as nutrition, exercise
and relaxation. She envisaged them
receiving such support at a Centre
located near the hospital providing
their treatment.
From the time Maggie was diagnosed, she began to realise that taking an active
role in her treatment helped her to feel more positive. She also saw that the
wealth of information available to people with cancer was overwhelming,
particularly in the absence of an authoritative person to help you negotiate it.
Each individual had their own path to tread, but to do this they needed
information and reliable guidance. Through considering her own needs, and by
talking with her husband, the architectural writer Charles Jencks, and her
medical team (chiefly her oncologist, Bob Leonard, and nurse Laura Lee), she
began to outline her first thoughts for a cancer caring centre. The Centre would
be sensitively designed by an architect with the vision to provide a domesticscale environment that could boost the spirit of people seeking support away
from the hospital. The Centre was to be a space that the visitor could use as their
own, whether they simply wanted a cup of tea and a conversation in a friendly
kitchen or to attend a weekly support group led by a clinical psychologist.
Maggie imagined that each person visiting the Centre would be helped to find
his or her own way of coping with the disease. There was to be no ‘right way’.
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The Centre would provide a relaxed environment for people to choose the
support they needed at any particular stage of their cancer. Each Centre was to
be distinct in appearance and spirit to the clinical environment of the hospital
where people receive their treatment. At the same time, the positioning of the
Centre right beside the hospital would be key to offering the best possible cancer
support. Maggie’s Centres work hand in hand with medical staff, often part of
the clinical team at the NHS hospital who deliver treatment, and Maggie’s has
been invited by local NHS Trusts to build Centres on or near their grounds
because the health service recognises the value that emotional and psychological
support can add to the lives of people affected by cancer.
The first Maggie centre opened in 1996 in Edinburgh and since then, new
centres have opened in Glasgow, Dundee, Highlands, Fife, and London. Interim
centres are in Oxford, South West Wales, Lanarkshire, and Hong Kong. Centres
are planed for Nottingham, North East, Cotswolds, and Barcelona.
Every Maggie’s Centre:

is built beside an NHS cancer hospital. That means they’re easy to get to
if you are receiving treatment at the hospital but also reflects a close
relationship with the NHS.

is individual and built to stand out from the hospital beside it.

is built around the kitchen. There is a large central table and the kettle is
always on.

has interesting artwork on the walls, comfortable furniture with plumped
cushions and refreshing views. The flowers are fresh and the fruit bowl
full.

has an open plan design. There are no long corridors or rows of shut
doors. There are no signs on doors or arrows to point out your way.

Is designed to be different by renowned architects. Maggie Keswick
Jencks, the founder of Maggie’s, held a profound belief that architecture
and environment could deeply affect how you feel.
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Services:
A Maggie’s Centre is a place to go for help with any problems associated with
cancer. Under one roof it is possible to access information, benefits advice,
psychological support (individually and in groups), courses and stress reducing
strategies. It works closely with oncology hospitals to provide the emotional,
social and psychological care needed by cancer patients. The programmes
provided in Maggie’s Centres have five core elements in a supportive and noninstitutional environment:

Emotional and psychological support: Each Maggie’s Centre has a team
of cancer support specialists (including clinical or chartered counselling
psychologists) who facilitate group support, contribute to psychoeducational courses, and provide individual support sessions.

Relaxation and Stress Management: Structured relaxation and stress
management techniques are provided to reduce emotional distress and
help healthy psychological and physical adjustment to a cancer diagnosis.

Information: Personalised information is tailored to each individual’s
situations, with information often provided by a cancer support specialist.
The centres also run different support groups.

Benefits Advice: Financial advice is provided by experts.

Other Support for Living with Cancer: Sessions provided on Tai Chi,
cosmetic management for women, and nutrition.
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Penny Brohn Cancer Care (Formerly the Bristol Cancer Care
Centre)
Background: Founded in 1980 by Penny
Brohn and her friend Pat Pilkington to
support people living with cancer and
those close to them, the vision of the
centre is to enable world-wide access to
complementary care and support through
the Bristol Approach to cancer care,
which it pioneered.
Approach: Based on the science of Psycho-neuro-immunology (PNI), the
Bristol Approach, developed by doctors, nurses, therapists and people with
cancer uses a combination of complementary therapies and self-help
techniques to provide physical, emotional and spiritual support to people with
cancer and their families. It is designed to work alongside conventional
medical treatment. It is a programme of lifestyle advice, information,
complementary therapies and self-help techniques that are designed to help
people cope with anxiety and specific issues related to their cancer diagnosis.
Specialist Support Provided by doctors, nurses, and qualified therapists:
Psychotherapy/counselling; medical doctors; nutritional advice; self-help
techniques e.g., relaxation, meditation, imagery, breathwork, natural pain
management, gentle exercise; complementary therapies e.g., massage, shiatsu,
healing, music therapy, art therapy.
Education and Training – courses and seminars for more than 500
healthcare professionals, complementary therapists, psychotherapists and
counsellors annually. The courses are aimed at healthcare professions who
wish to integrate complementary therapies into mainstream health practices,
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and complementary therapists/counsellors who are working in cancer care and
are interested in developing their practice in order to work more effectively
with people with cancer. Training is provided at foundation and Higher
Certificate levels.
Facilities: Set in 4 acres of landscaped gardens just north of Bristol, facilities
include:

Modern and comfortable private single bedrooms, with ensuite shower
and toilet. Disabled bathroom facilities upon request.

Lift access for those with disabilities.

Sitting rooms with books and games.

Dining room offering a selection of food designed to support health.

Shop offering range of health products.

Parking.

Labyrinth.
Relevance of Model E to St. Luke’s Hospital
This final model of independent cancer centres (D) would appear to offer most
potential in considering the future direction of St. Luke’s Hospital. The
distinctive contribution of these centres is reflected in the increasing number
of such centres in the UK, with, for example, some Maggie centres open and
others in planning. Typically, these centres provide a caring and supportive
environment that is not always possible in larger, acute hospitals. Their role is
quite specific – to provide support services for patients with cancer and their
families. Given the comprehensive range of support services already in place
in St. Luke’s, it would appear logical and cost-effective to develop St. Luke’s
as a step-down rehabilitative centre for patients with cancer rather than
seeking to build up these services in another institution some time in the
future.
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6.7 Concluding Comment
The different models of support and rehabilitation described in this chapter
illustrate the range of services that exist to care for cancer patients. Each has
its own distinctive contribution to make, depending on resources and the ethos
of the sponsoring agency. As already stated, the examples described in this
chapter are not intended to be exhaustive and other services may emerge as
more relevant to St. Luke’s Hospital as those committed to its future discuss
different scenarios. It is hoped that the different models of care presented in
this chapter may shed some light on the future of St. Luke’s Hospital if and
when its present circumstances change in line with the National Cancer
Control Plan. Above all, it is hoped that any scenario will build on the
distinctive strengths of St. Luke’s.
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CHAPTER SEVEN
A POSSIBLE FUTURE FOR ST. LUKE’S
HOPSITAL
7.1 Introduction
The results of the research presented in this report possibly confirm what
many people intuitively knew already, St. Luke’s Hospital is a very special
place with a distinctive healing environment. This is the considered opinion of
370 patients, staff and stakeholders. Some of the reasons St. Luke’s Hospital
is perceived to be special are many and varied, including:

I
ts spacious and tranquil grounds which are both private and
communal.

S
taff who are experts in the treatment and care of cancer patients, but
who also ‘know your name’ and who take the time to listen to patients
and answer any questions in a simple and straightforward way.

T
he staff and hospital environment of St. Luke’s are ‘oncology
proofed’, with everyone from the porters and receptionists to the chief
executive and medical staff playing an active role in the care of
patients

S
uperior facilities such as the Lodge and a bright, clean hospital.

A
patient focus and holistic care.

M
edical treatment which is perceived to be amongst the best in Ireland.
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
T
he camaraderie and support of other patients.
Above all, St. Luke’s is an environment where everyone is made to feel the
same and where cancer is not allowed to make patients feel different. Neither
is there any distinction between private and public patients. People come to
St. Luke’s for treatment and a cure for their cancer, often in dread of its
historical reputation, and leave with hope and their lives restored. It is an
entity which is more than the sum of its parts. St. Luke’s Hospital is
effectively a centre of excellence.
St. Luke’s Hospital has a comprehensive range of care and support services,
which together with a relatively large outdoor area and a dedicated staff,
benefit cancer patients and their families (Table 7, overleaf).
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Table 7 Existing Services and Facilities in St. Luke’s Hospital
Caring and Support Services
Medical Care
Palliative Care
Nursing Care
Radiation Therapists
Facilities
175+ Beds (Wards, day centre and
Lodge).
The Lodge
OPD Suites
RT Clinic Room Suites
Linear Accelerators x 8
Physicists
Operating
Theatre
&
Central
Decontamination Unit
Nuclear Medicine
Patients’ library
Support Staff – Clerical, Clinical and Non Chapel
Clinical.
Health and social care to include Physiotherapy, Internet access
Dietetics, Art Therapy, Diversional Therapy
Social Work Department
Arts and Activity Centre.
Psycho-oncology services.
Pitch and putt; Bowling.
Clinical Nurse Specialist services.
Pastoral Care and Chaplaincy.
Facilities for GP emergency service
Complementary therapies.
Rehab & Support Centre
Support groups and programmes
Chiropody.
Corner’ Shop
Catering
Education Centre
Administrative Staff
Teleconferencing Room
Executive
Landscaped gardens
Medical Records & Associated Areas
Coffee Shop
Diagnostic Imaging
Dedicated Transport
Administrative Support
Central Booking Office – all patients
Laboratories:
Haematology, Biochemistry,
Microbiology, Pathology, Phlebotomy
Facilities/Maintenance
Linen Supervisor
Occupational Health
Purchasing
Education and Research : All Groups
St Luke’s Institute of Cancer
Medical Education (accredited RCSI)
Nursing Education (accredited ABA linked to
RCSI, TCD, DCU and UCD)
Radiation Therapy links with TCD
Physics links with UCD
Research Oncology research centre
Clinical Trials Resource centre
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A key question that was not directly addressed in this study concerns the
implications of transferring ‘St. Luke’s’ to St. James’s and Beaumont
Hospitals. While there is a strong medical argument for the transfer and this is
not disputed in this study, the research suggests that any diminution of St.
Luke’s Hospital would result in a significant loss of tangible healing
opportunities for patients, staff and visitors. This is not to disparage the
quality of medical treatment provided in either of these hospitals, as both
hospitals are very highly regarded medical facilities. Rather, it is to
acknowledge the realities of medical care in Ireland, particularly during the
present financial climate, and to highlight the distinctive healing environment
of St. Luke’s Hospital.
In some respects, any potential loss resulting from the transfer of St. Luke’s to
St. James’s and Beaumont Hospitals could be minimised or possibly
completely eradicated if sufficient resources were available to design and
build a new, stand-alone facility equal in standard to the cancer facilities
described in chapter six. It is difficult to argue against the value of an
aesthetically designed building, which takes account of best practice, and
which provides an extensive range of support services for cancer patients,
regardless of its location. There are good examples of healthcare facilities
around the world which have been designed by renowned architects to make
life better for cancer patients, such as the Maggie Centres, the Lisbon
Research and Clinical Centre, and the Cedars-Sinai Cancer Center.
Furthermore, if such a centre were built in close proximity to St. James’s or
Beaumont Hospitals, staff would possibly benefit from enhanced training and
career opportunities, while patients would be closer to a wider range of
medical care than is currently possibly in St. Luke’s Hospital. However, there
are at least two reasons why this course of action is not recommended or
regarded to be in the best interests of cancer patients.
Firstly, the results from the present research strongly suggest that St. Luke’s
Hospital is a unique healing environment that should be replicated rather than
replaced or lessened in any way. In the opinion of people who know the
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hospital best, it works and it works very well. Even if the medical treatment
facilities are transferred, there is so much more to St. Luke’s Hospital that
could and should be enhanced. Secondly, it must be asked, particularly in the
current financial climate, how realistic is it that a new medical facility, built to
the highest standards, would be constructed in the foreseeable future, if at all.
St. Luke’s Hospital already possesses many features and facilities that are
highly valued by patients, and these would be very difficult to replicate in any
acute hospital setting.
7.2 A Possible Future for St. Luke’s Hospital
One possible scenario for the development of St. Luke’s Hospital is that St.
Luke’s Hospital should be retained as a cancer care centre by continuing and
expanding its current range of services along the following lines.
7.2.1 Expanded Target Groups
It is proposed that St. Luke’s would serve the following target groups in a way
that is in keeping with the integrated focus of the national health strategy
(Department of Health and Children, 2001b).
(a) Local Community: At present, St. Luke’s Hospital provides facilities
for a GP emergency service. This could be expanded to include
additional care facilities for the local community, including a Primary
Care Team as envisaged in the Department of Health and Children’s
national health strategy (Department of Health and Children, 2001a).
Further to the national health strategy, members of the primary care
team will include GPs, nurses/midwives, health care assistants, home
helps, physiotherapists, occupational therapists, social workers and
administrative personnel. The strategy also allows for a wider primary
care network of other primary care professionals such as speech and
language therapists, community pharmacists, dieticians, community
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welfare officers, dentists, chiropodists and psychologists (Department
of Health and Children, 2001a).
(b) Wider Dublin Community: It is proposed that St. Luke’s Hospital
would be an integral part of the Dublin Cancer Care Network through
the provision of research and education services e.g., seminars for
health care professionals and a research facility focusing on cancer
research. The available conference space will need to be augmented in
line with the services provided.
7.2.2 Proposed New and Expanded Facilities and Services
The report of the national cancer strategy lists a variety of cancer support
services which it notes are regarded as important in many countries. These
services can include self-care, caregiver support, psychological support,
physiotherapy, occupational therapy, dietetics, speech therapy, patient
education and health promotion, appliance fitting, nursing services, and
community liaison (National Cancer Forum, 2006). The author and
management of St. Luke’s believe that St. Luke’s has the capacity,
experience and expertise to provide a wide range of support services to
patients and their families, either directly using its own resources or in
partnership with other agencies.
Some facilities and services that could be considered for St. Luke’s
Hospital include the following:
i.
The Lodge facility on site should be retained for accommodating
patients who are actively receiving treatment and who have to travel
long distances for treatment. Transport connections could be scheduled
with radiotherapy centres in the Greater Dublin Area, with St. Luke’s
functioning as part of the Dublin cancer network.
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ii.
Some of the existing beds could be retained in a step-down facility for
patients with cancer requiring care after radiotherapy e.g., patients with
toxicities post radiotherapy or patients who are unable to go home but
who are not palliative/end-of-life. A small number of beds could be set
aside for symptom control/ palliative care.
iii.
A shop(s) and service specialising in cancer care products e.g., wigs,
prosthesis. St. Luke’s currently provides a well-being programme. This
could be expanded in partnership with private sector companies which
specialise in cancer care products.
iv.
A range of outdoor and indoor amenities that is appropriate for cancer
patients and their families, and which can take advantage of the
considerable space in St. Luke’s e.g., hydro-therapy pool. At present,
St. Luke’s has pitch and putt and bowling facilities which are popular
amongst patients.
v.
An educational research centre which could host public lectures,
seminars for patients and their families, seminars for Health Care
professionals, and support groups. Specialist events could also be held
to promote understanding and interest in cancer research. For example,
the Memorial Sloan-Kettering Cancer Center hosted a symposium,
Major Trends in Modern Cancer Research for young people to
stimulate interest and excitement in medical discoveries.
vi.
A telephone helpline specialising in education and support services for
patients. This helpline would need to be co-ordinated with the current
helpline operated by the Irish Cancer Society to avoid duplication.
Some degree of partnership may be possible.
vii.
Facilities for patient and family support groups. Groups are currently
facilitated in St. Luke’s.
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viii.
Outpatient facilities led by doctors, nurses and AHPs to be provided
for rehabilitation and support including, information centre, cognitive
behavioural
therapy,
counselling,
social
services
entitlements,
physiotherapy providing rehabilitation pelvic exercise programmes for
patients post pelvic radiotherapy, occupational therapy, speech
therapy. St. Luke’s could act as a one-stop shop for cancer support in
the Greater Dublin Area.
ix.
A range of complementary therapies e.g., aromatherapy, reflexology.
x.
Dietetics and nutritional care.
vi.
Counselling and support.
vii.
Pastoral and Spiritual Care.
While other support services may emerge following further consideration by
interested parties, the key point is that St. Luke’s Hospital could quite easily
and effectively act as a step-down facility, providing hope and support for
patients with cancer and their families. This rehabilitative step-down facility
would be a centre for patients not ill enough to require hospice care and not
well enough to be discharged to their homes. In the main, it would be for
people who have finished their treatment but provision would also be made
for patients in the Lodge who would be actively receiving treatment in St.
James’s and Beaumont Hospitals.
Another way of presenting the support services that would be provided
through St. Luke’s is by the specific needs of tumour groups. Thus, for
example, patients with brain tumours would require the following type of
support: specialist nursing, occupational therapy, physiotherapy, speech
therapy, rehabilitation facilities, counselling and support, and leisure facilities.
Patients with head and neck tumours would require access to dental health
services and an oral hygienist, dietician and nutritional advice, counselling
and support, and information. Most patients would also benefit from health
promotion advice, particularly those with lung cancer.
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7.3 Concluding Comment
Place matters, especially when the place is perceived to be a healing
environment which is universally praised by patients and staff. The review of
literature in chapter two reported an increasing amount of credible evidence to
support the tangible impact of ‘non-medical’ factors on patient well-being and
satisfaction. Some of these factors are ingrained into the very fabric of St.
Luke’s Hospital, including garden landscapes, a peaceful and safe hospital
environment, psychological and spiritual support services, staff that are not
unduly stressed, and the provision of a range of complementary medicine,
such as art. The views of patients and staff, together with the evidence
explored in the literature review, suggest that there is a tangible link between
aspects of the environment within which patients experience treatment and
care, and the outcome of that care.
The principal aim of this research project was to capture the essence of St.
Luke’s Hospital by exploring the impact of the immediate environment of St.
Luke’s Hospital on patient well-being, care and cure from the perspective of
patients, staff, and stakeholders. The evidence from the present study
overwhelmingly endorses the view that St. Luke’s has had, and continues to
have, a very positive impact on the lives and well-being of patients. The
review of international research also supports the notion that there is a link
between aspects of the environment within which patients experience
treatment and care, and the outcome of that treatment and care.
The sentiments expressed by the majority of interviewees are aptly
summarised by the combined voices of three patients who are also members
of the St. Luke’s Patients Action Support Group (overleaf).
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‘I used to bring a book with me when I went to Luke’s and
sit in the garden. The only intrusion was the sound of birds
and the traffic in the distance. It was the most peaceful spot
on earth. I used to look forward to going. I think the
Government are making a mistake because they are totally
underestimating the impact of the environment on patients.
It is only when you are a patient that you see the true value
of St. Luke’s. They have the most extraordinary caring staff
I have ever come across. I was in James’ and received good
medical care but that was it. Only when you get to Luke’s
do you realise this is how it should be. Treating you for
cancer is about more than drugs. If this wasn’t the case, we
wouldn’t be fighting to keep it open. Cancer patients have
limited energy but we believe it is so important to keep it
open for generations of Irish people who have yet to be
diagnosed with cancer. It is just so special and no-one
realises how much people love St. Luke’s. Closing it would
be a disaster’.
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Appendix 1: Existing Services and Facilities in St. Luke’s Hospital
Caring and Support Services
Medical Care
Facilities
175+ Beds (Wards, day centre and
Lodge).
The Lodge
OPD Suites
RT Clinic Room Suites
Linear Accelerators x 8
Palliative Care
Nursing Care
Radiation Therapists
Physicists
Operating
Theatre
&
Central
Decontamination Unit
Nuclear Medicine
Patients’ library
Support Staff – Clerical, Clinical and Non Chapel
Clinical.
Health and social care to include Physiotherapy, Internet access
Dietetics, Art Therapy, Diversional Therapy
Social Work Department
Arts and Activity Centre.
Psycho-oncology services.
Pitch and putt; Bowling.
Clinical Nurse Specialist services.
Pastoral Care and Chaplaincy.
Facilities for GP emergency service
Complementary therapies.
Rehab & Support Centre
Support groups and programmes
Chiropody.
Corner’ Shop
Catering
Education Centre
Administrative Staff
Teleconferencing Room
Executive
Landscaped gardens
Medical Records & Associated Areas
Coffee Shop
Diagnostic Imaging
Dedicated Transport
Administrative Support
Central Booking Office – all patients
Laboratories:
Haematology, Biochemistry,
Microbiology, Pathology, Phlebotomy
Facilities/Maintenance
Linen Supervisor
Occupational Health
Purchasing
Education and Research : All Groups
St Luke’s Institute of Cancer
Medical Education (accredited RCSI)
Nursing Education (accredited ABA linked to
RCSI, TCD, DCU and UCD)
Radiation Therapy links with TCD
Physics links with UCD
Research Oncology research centre
Clinical Trials Resource centre
* Friends of St. Luke’s Hospital.
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