1. Frances Kraus, Candle Project Leader, St Christopher’s Hospice, London With thanks to Nigel Hartley, Director of Supportive Care The St. Christopher’s Schools Project - promoting healthier attitudes to death and dying

2. Health Promotion in End of Life Care Social – friendships, recreation, work, ‘normality’ Psychological – anxiety, depression, loss Spiritual – meaning, reconciliation, reunion Physical – ‘health’ versus ‘sickness’ …we mustn’t forget that in many circumstances dying is ‘normal’ and can be ‘managed’…

3. Why do it? “As a society we do not discuss death and dying” End of Life Care Strategy DOH 2008

4. A few facts… End of life care strategy 2008 Rising expectations of healthcare Split and dispersed families Single person households Changes in demographics and disease BBC poll 2005 – little change in public attitudes Healthcare Commission 2007 – 54% of complaints were about how a death was handled Constrained financial and professional resources

5. How To Do It? Public education meetings Art exhibitions Talks with community groups

6. The St. Christopher’s Schools project working through change why children? aims/objectives structure funding information pack

7. Structure Ages Timing Relationship with head/class teacher Parental Consent Introduction/preparation First session at school First visit to Hospice

8. Structure cont…. 2 nd and 3 rd meetings children and patients working together artists and artwork final meeting/celebration parents feedback changing views of both life and death

9. Safety and responsibility: Prepare and support Children Staff from hospice and other institutions – colleagues Parents and families/carers – engage, respond Appropriate personnel and skills

10. Recent development & current innovations: Care Homes and schools working together Arts council England proposal – 15 care homes a year joined with local community group such as schools, college, faith group, pub, scout group etc.

11. Recent developments & current innovations (cont.): Four week projects supported by St Christopher’s staff Expectation that care home and community group will carry out project annually – sustainability St Christopher’s as a ‘hub’ Quarterly education and support sessions at St Christopher’s

12. Project endorsed by Sir Mike Richards – National Clinical Director for Cancer and End of Life Care “ I thoroughly commend the approach and I would be delighted to see similar projects being developed across the country”

13. NHS NW Project Conference Blackpool Feb 2009 100 attendees Workshops in April 2009 Conference Feb 2010 50 attendees, feedback from 3 new projects

16. Evaluation – some comments from children: …I felt happy doing the art – it took my mind off death and put my mind on understanding that we all have to die someday… …my grandmother died in the hospice and I wasn’t allowed to go…I enjoyed seeing that it was OK really… …at the start I felt a bit scared and shakey ‘cos I thought it would smell and be full of sick people, but they were just normal… …I enjoyed hearing the stories and making the art – the food was good too… …I felt very happy and proud of myself when my parents came to see what we’d learned …it wasn’t anything like a hospital… …I felt really nervous and it made me feel a little sad… …I was happy when my mum and dad came and they were happy… …I thought it was going to be boring, but I had fun at the party…

17. Evaluation - some comments from patients …I loved the kids coming here – it makes it all feel so normal and OK… …Watching the staff and others talk to the children – it showed me a way to talk to my own grandchildren… …I’m glad you take this seriously – I feel I’ve got something that the children can learn from… …I came alive again when the teenagers were here – they’ve got all their life ahead of them

18. An excerpt from a letter from the class teacher: …thank you so much for the thoughtful and creative journey you led the children, staff and parents on this term. We learned much about ourselves, each other and our community. We have all signed up to the hospice fundraising walk, and hope that our input will make a difference. The wonderful banners which are now on display at the school look fantastic – next years year five are already asking about coming along next year…

19. Example …I am old and wrinkly I wonder if I could have had kids. I hear voices of an owl. I want another life. I am old and wrinkly. I pretend to be in heaven. I feel cold inside. I touch the fur of my cat I worry about the time I die. I cry when things die I am old and wrinkly. I understand that people have to die sometimes. I say that I care for animals I dream that I will get to do different things I try to keep my cat healthy I hope my plants will grow I am old and wrinkly I want to thank everyone who helps me I am old and wrinkly… (written by 9/10 year olds during a St. Christopher’s ‘Schools Project’)

22. Promoting healthier attitudes to the end-of-life makes sense It is our responsibility to make it happen!