Hospice leader Simon Allan signs off with Arohanui
Dr Simon Allan, ONZM, has soothed and cared for thousands of patients in their last months, days and moments of life.
As director of palliative care at Palmerston North’s Arohanui Hospice, his practice has been the epitome of hospice principles, treating each person as an individual, with all their complications, and he has been ceaseless in the quest to make excellent care even better.
And now he is retiring, sort of. At least, he is stepping away from his leadership role while keeping open opportunities to advise, provide locum cover and encourage research in palliative care. Arohanui chief executive Clare Randall described him as ‘‘the godfather of palliative care’’. Lorraine Vincent, who chairs the trust board, said his influence had rippled out beyond Arohanui to other care services regionally and nationally. Most recently, he has been at the heart of a partnership with Hospice Whanganui, putting people before boundaries. A Scottish-qualified medical oncologist, he arrived at Palmerston North Hospital in 1989, two years before Arohanui opened the doors on the first iteration of its Heretaunga St in-patient unit.
While working at the hospital in the regional cancer treatment service, the next 20 years saw him spending more and more time at Arohanui, eventually taking over as director of palliative care. Looking around the 10-bed unit, which has gone through two major building extensions, Allan said he felt he had left a task for the board and his successors to recreate it for greater efficiency.
But the remarkable thing, reflecting the way practices had changed, was that 10 beds, currently only six of them open as a Covid-19 management measure, were still enough, he said.
Thirty years ago, the hospice service looked after about 20 patients in any week. Today, that number was about 250 each week, with no increase in bed numbers. That reflected the desire of most patients and the people caring for them to be at home, whether that was their own home, or in a rest home where staff were trained and supported to provide end-of-life care.
‘‘People must feel safe, preferably at home, regardless of circumstances or geography.’’
Allan said providing the best care for each individual had become increasingly complex over three decades. The complexity came with the age of patients and their multiple needs, broken and blended family structures, the influence of drugs in some families and people’s expectations about what medicine could do. Poverty was also an increasing issue.
Allan said for each patient, there was an average of 2.7 significant others who needed close care, and about 15% of the bereaved experienced ‘‘complicated grief’’.
The hospice team kept on expanding and learning, so it could provide for all needs – with some 120 clinical staff members, including a near full muster of nurses, four social workers, and recently, the first kaiawhina, Di Noble, to help staff members to be comfortable when incorporating cultural values in the way they worked.
Allan was determined that everyone who needed palliative care should receive it, tailored to what they needed as an individual, be it physical, social, cultural, or spiritual – in the broadest sense of that word.
It also included those who were contemplating or wanting, or eligible for, assisted dying.
Arohanui held true to the hospice pledge to neither hasten nor postpone death. Neither its staff nor its premises were used for an assisted death, but all other aspects of care were offered.
‘‘There is a desire amongst some to have it [the eligibility document] on the shelf, in case they do undergo significant suffering,’’ Allan said.
‘‘For some, it’s a safety net. I have also seen patients who have died a natural death without it.’’
Allan leaves Arohanui with a team of doctors – in another one of his endeavours, he has helped to grow its own team of specialists.
Dr Jenny Fernando will be the director of palliative care and will provide the connection to Palmerston North Hospital as medical lead for palliative services. Dr Wendy Tsai, who qualified two years ago as a palliative medicine specialist, is a joint appointment to Arohanui and Whanganui.
Alongside them, former Pahīatua GP turned palliative care specialist Delamy Keall will work almost full time at Arohanui.
They are supported by medical officer Janet Neale, Richard Isaacs on call, and Pauline Blackmore. There is also a nurse practitioner in training.
The medical team was strong, Allan said, and the nursing team was ‘‘marginally’’ fully staffed. Governors were frustrated because hospice nurses did not have pay equity with Te Whatu Ora nurses, and the trustees did not have the funds to pay them better.
Allan said one of the greatest things about Arohanui Hospice was the sense of community ownership. ‘‘We are a lean organisation, and it is important the community knows we do our best within the confines of the dollars given. Everything we have done to expand our services, the community has supported.’’
But taxpayer funding for palliative care was geographically inconsistent and ‘‘stalled’’, and the gap between that and what was needed was sitting at $3.4 million this year.
‘‘That’s probably unsustainable beyond a couple of years,’’ he said.
As he leaves (sort of), Allan will maintain an active interest in encouraging collaborative research projects to improve quality of care. One topic is to gain a better understanding of delirium and whether there are alternative cultural and spiritual approaches to relieve it that work better than drugs. Another is how better to support caregivers to provide medication in an acceptable way to loved ones who are no longer able to swallow.
Allan will work as an adviser to Arohanui and Hospice Whanganui. He may return for a locum stint at Arohanui next year and will help out at Otago Community Hospital in Dunedin while awaiting completion of a home in Wā naka, his retirement destination.