Exploring and visualising the purpose, concepts and development of hospices in England from the perspective of hospice chief executives

Greenhalgh, Stephen (2024) Exploring and visualising the purpose, concepts and development of hospices in England from the perspective of hospice chief executives. PhD thesis, University of Glasgow.

Abstract

This study sheds new light on the purpose, concepts and development of independent charitable hospices in England serving adults. Hospices in the UK are the largest charity group sharing a combined annual income of over £1.6 billion. The majority emerged in the late twentieth century to meet the needs of dying people that had been neglected by the NHS. Today, over 200 hospices function in very different health and socio-economic contexts across the UK. Hospice chief executives (CEOs) have oversight of all aspects of hospice operations and this is one of the first studies to identify their varied perspectives about why hospices are here, their conceptual basis, dynamic construction and developing contribution to end-of-life living, dying and death.

Adopting a qualitative methodology, 31 hospice CEOs were interviewed during 2019/20 with 17 taking place during the beginning of the Covid-19 pandemic in England. Their responses were analysed using thematic analysis and a social constructionist approach that drew on Gergen’s concept of intelligibility nuclei and his application of Greimas’s semiotics with context provided from hospice history, organisation, business and leadership studies. The study found a kaleidoscope of views amongst respondents which revealed awareness of tensions between science and humanity, medical and social needs, intimacy and scale. There was a consensus that society is still not dealing well with death and that many people are still missed by the system. Revealing the complexity of the hospice mission, the concept of hospice was understood in a variety of ways, for instance as: a vehicle to deliver care; a safe place to do things differently; a quality of care; a philosophy and belief; a community resource and a social movement. The study showed that hospices have many potential and actual strategic roles, such as those of provider, exemplar, collaborator, empowerer, explorer, agent, broker and disrupter. Significant obstructions to development, including physical threats to CEOs, were also identified.

The study is unique in having mapped this intricate and varied social construction of hospices through Gergen’s application of semiotic squares. This visual device enables the variety of perspectives held within hospices and the landscape in which they are embedded to be presented in a way that has not been seen before. It therefore has relevance for the future development of hospices both locally and nationally, and for their impact on British society in the twenty-first century.

• Item Type: Thesis (PhD)
• Additional Information: Financially supported by Martin Ainscough and St Catherine’s Hospice, Lancashire.
• Colleges/Schools: College of Social Sciences > School of Social & Environmental Sustainability
• Supervisor's Name: Whitelaw, Dr. Alexander and Krawczyk, Dr. Marian
• Date of Award: 2024
• Depositing User: Theses Team
• Unique ID: glathesis:2024-84129
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 15 Mar 2024 13:38
• Last Modified: 16 Apr 2025 12:06
• Thesis DOI: 10.5525/gla.thesis.84129
• URI: https://theses.gla.ac.uk/id/eprint/84129