Clare Montagu: Running a hospice during COVID, how to die well, being a special advisor to government; economics of a hospice.

Clare Montagu was the Chief Operating Officer of one of London’s largest hospice groups, Trinity Hospice. Before that, she was a UK government minister special advisor.

We talk about the challenges and joys of running a hospice. Much of great hospice care is looking after people in their own homes and in the community. Hospice care goes beyond the medical. For instance, letting a patient die in the garden under a tree because that’s their wish. This is care a hospital can not give. The hospice is staffed 24/7, pets can come, family can stay. The hospice is part of the community.

We chat about the importance of death admin. You don’t want to have your stash found by your parents or the state to take your inheritance estate. We speak on why Clare uses straight forward language about death and why we don’t talk about death enough.

Clare reflect on the challenges of COVID and gives her insights into how difficult running the hospice during the pandemic. She gives a sense of what being on the frontlines meant. How to find protective supplies, mortuary bags and and the lack of plans from the state.

We discuss the economics of a hospice. UK hospices are not state funded but mostly funded by charity. Clare had a GBP15m operating budget or closer to GBP10m for healthcare operations (excluding the costs of running charity shops etc) this looked after 2,500 - 3,000 people in a typical year. (In a year, in the UK about 9,000 people die for every 1 million of population; London has c. 9 million population and so 80,000 Londoners die very year).

We debate the difficulty of what funding a minimum service hospice would be like.

We discuss the challenges of state capacity decisions in the light of swine flu and why governments will always tends to spend on a problem now rather than have insurance in stock piles.

Clare gives insights into the life of a special adviser, some of the highs and lows and the comedy moments, and some of the policy she is proud of (helping Children in care).

Clare suggests that while governments often get things very wrong, they are also have to deal with particularly conflicted issues and trade-offs such as security versus liberty.

Clare has volunteered at a charity doing a manual warehouse job recently and she offers insights into that type of job and we discuss jobs that can have “purpose” and jobs where it is difficult to think you are on a “mission”

Finally, Clare reflects on how to have a good death and her life advice. “show up and do something about the stuff that you care about”.

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