Contact: Sr Brigid Murphy, Director of Spiritual Excellence
St Gemma's Hospice in the Moortown district of Leeds has been revamped to create an environment where the presence of nature is thought to be critical to successful healthcare. Good, holistic hospital design of this kind offers an important model at a time when significant government funding is being invested in improving the architecture of health care settings. Meanwhile, the Joint Leeds Hospices Ethnic Minority Project has recommended that policies should reflect diversity issues throughout all aspects of the palliative care service. This article explores the extent to which the needs of ethnic communities have been considered in the landscape design which is so central to St Gemma's philosophy and structure. Impressive efforts have been made to move from a singular religious outlook to a more inclusive, multi-faith approach. Potential for further development is identified.
The vision behind St Gemma's
Founded in 1978, St. Gemma's Hospice provides physical, emotional, social and spiritual comfort to patients and families facing a life threatening illness, often though not always cancer. Nurses offer in-patient and out-patient care and social workers give practical advice and counselling for patients and carers.
St Gemma's is situated in the Moortown district of Leeds, a pleasant suburb. Leeds as a whole has about 8% ethnic minority population. Moortown has a large Irish Catholic community and a significant Jewish community the next largest in the UK after London, Manchester and Glasgow.
The building which houses the hospice was previously a school run by the Sisters of the Cross and Passion, an order of Roman Catholic nuns. In the 1970s the nuns decided to change the focus of their work from education to hospice care. In 1982 a second building was erected, expanding the number of bed spaces from 9 to 32. The Prout conference centre was built in 1991 and opened by Princess Diana. In 1998 architects Jane Derbyshire and David Kendall (JDDK) were commissioned to reorganise the campus to create more appropriate patient care accommodation.
St Gemma's Chief Executive and Director of Nursing Excellence, Steve Kirk, has a strong vision for the role of the environment in healing and this is clearly reflected in the holistic design of the site. Refurbishment has taken 2 years in the planning and 3 years to achieve. Open plan wards were replaced by four bedded rooms on each of two floors; each room having either a balcony with a view of, or French windows opening onto, a healing garden.
Award winning environment
The garden was formerly laid with a mix of trees and car parking areas, and was quite inaccessible to patients. Since the improvements, car parking has been `disentangled' and removed to one side, and the garden has been walled off, creating a feeling of shelter, safety and privacy. The garden design, which incorporates elements of the original Victorian walled garden, is now organised around a central rill, with themed planting including bog plants, scented herbs and a Mediterranean garden. A network of paths allows access for people with every degree of mobility impairment, being suitable for wheelchairs and beds. A two storey conservatory alongside the garden serves as an all weather lounge space.
The scheme was completed in 2003 and received the `Patient Environment Award' as part of the NHS Building Better Healthcare Awards, as well as winning public approval in an interent vote for the favourite healing hospital environment, organised by the Commission for Architecture and the Built Environment.
St Gemma's also provides day hospice facilities including the art room where art worker Clare works with patients to create beautiful, lasting artefacts such as ceramics, mosaics and painted glass, often using natural materials or taking their inspiration from the garden setting. Day facilities include complementary therapies and hairdressing, which are of real value to the wellbeing of those taking strong medication, particularly cancer patients.
The different parts of the building are linked by an accessible corridor overlooking an internal courtyard or `light well' which the architects have used to create a special memory garden. According to St Gemma's web site:
Our memory garden is situated in an oasis of calm by the Dales Ward. It provides a tranquil space where relatives, friends and carers can sit and reflect, receiving strength for the present and hope for the future. The Tree of Life is sculpted in steel and copper. It has detachable leaves which can be engraved in the memory of loved ones. The leaves are hung on the tree for one year. They are then safely stored to be hung on the anniversary day each subsequent year. Names are also entered in a memorial book which may be viewed in our chapel.
In an important interfaith gesture, Rabbi ? was invited to bless the memorial tree at the opening of the Memory Garden.
Leeds Hospices Ethnic Minority Project
Meanwhile, in April 2001 the Health Action Zone Joint Leeds Hospices Ethnic Minority Project set out to address the palliative care needs and perceived inequalities of Black and minority ethnic communities. It was known that take up of palliative care services by people from BME groups was low. Sister Brigid Murphy, Director of Spiritual Excellence, explained to me that St Gemma's does not tend to have a very large BME patient population at any one time at the time of my visit there was one Asian patient in residence - but often more BME out-patients are receiving care in the community.
The project aimed to bridge language barriers, increase care providers' knowledge of the needs of BME communities and to develop more inclusive methods of health care. Community link workers were appointed to reach out into the Bengali, Pakistani, Indian, African Caribbean, Chinese and Vietnamese communities, to raise awareness within those communities of hospice services and to help the palliative care providers in Leeds, including St Gemma's, to meet the cultural needs of each ethnic group. The project deliberately targeted `visible minorities' rather than encompassing the Irish and Eastern European communities since there were `greater concerns' about these groups accessing services. (It seems that these concerns are based on anecdotal evidence.)
A number of issues were identified and an action plan developed, covering areas such as wider recruitment; diversity training for senior staff to cascade to all hospice staff; improved patient monitoring; translation and interpretation services; improved facilities to cater for cultural needs. The project report states that, policies should reflect diversity issues.
Cultural awareness training took place in 2003 covering
Pakistani and Bangladeshi culture history and attitudes to illness
India history and attitudes to illness
Care of African Caribbean hair and skin
A conference is planned, to take place in the Prout Conference Centre at St Gemma's in October 2004 addressing Attitudes to death and dying across cultures.
A resource base of books and multi-faith resources relating to ethnic minority care has been established at each of the Leeds hospices, including basic information about countries of origin, languages, health care and naming systems.
In the chapel of St Gemma's, Sister Brigid showed me one area with a Catholic shrine, reflecting the spiritual origins of St Gemma's; another icon-free area, with a lovely stained glass window depicting a peaceful seascape; and 2 quiet rooms for meditation or prayer. She pointed out that religious texts for each of the major faiths are available.
Positive action to improve staff recruitment from BME communities is on the agenda but is a slower process. Palliative care is of course a specialist branch of nursing and Sister Brigid referred to a trend for Asian people to go into medicine rather than nursing. She noted that St Gemma's has employed two Chinese nurses.
Linking holistic philosophy, access and diversity
As previously mentioned, policies should reflect diversity issues. This means that all that hospice's facilities need to be geared to providing a culturally appropriate health care setting.
I asked Graham Fox, Facilities Manager, about any multicultural influences upon the garden design at St Gemma's, and opportunities for ethnic communities to engage with the hospice through the garden. He told me that consultation during the several phases of development had been focussed internally, rather than reaching out to ethnic communities in Leeds. Hospice staff and volunteers had wanted the garden to provide a range of sensory experiences for patients and visitors to enjoy, so touch and smell have been considered alongside colour in the planting scheme. We discussed the challenges of `retrofitting' diverse cultural features into an existing environmental design.
Mr Fox sees the garden as an evolving project, with a five year plan including a Victorian style glass house, for which a donation has recently been secured from a local trust fund. He acknowledges that the rill and other existing garden features are drawn from a rich multicultural history of garden design, and that the proposed glass house would provide a suitable environment for raising plants familiar to people from various countries of origin. He had not yet identified ways to develop the potential of these elements to provide culturally appropriate factors to meet the needs of BME patients and their families.
Garden maintenance and development is one possible avenue for increasing ethnic community awareness and understanding of the work of St Gemma's. The hospice currently employs only one full time gardener, with a part time post about to be advertised shortly. The garden also benefits from significant volunteer input, varying by the seasons. (When I visited Leeds in August 2004 the rain was so heavy, people were calling it the monsoon season!) The Halifax Building Society staff periodically send teams of 8-10 volunteers to help with gardening chores. Volunteer recruitment, like staff recruitment, operates on an equal opportunities basis, and at present there are no mechanisms for outreach to BME communities, although this is something Sr Brigid is hoping to address in the near future.
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Post Script - Leeds Hospices Woodland
St Gemma's Hospice provides an excellent palliative care service but this is a costly undertaking and the work is funded 35% by NHS, while St Gemma's have to find 65% of their budget through fundraising.
Leeds Hospices Woodland, in Meanwood Valley, is a partnership between Wheatfields and St. Gemma's Hospices and Leeds City Council, offering people a chance to sponsor the planting of trees in memory of loved ones, to mark occasions, celebrate anniversaries and so on. This helps to raise funds for the hospices, while improving the environment, reducing the effects of pollution, providing homes for wildlife and creating a place of beauty to be visited by generations to come.