WHEN Rachel Street was in her 20s, she had a favourite dress: a peach-and-green Karen Millen number that made her feel ready for anything. It was the outfit she turned to for every big moment, every special occasion – one that filled her with confidence and optimism.
Fast-forward more than two decades, and that very same dress found its way back to her – in the most unexpected of places.
Having moved to Jersey with her family (two sons aged 10 and 13, a husband, and a cat) this summer to take up the role of chief executive of Jersey Hospice Care, Mrs Street popped into the charity’s town shop while waiting for her family’s belongings to arrive from the UK.
Their furniture had made it to the Island, but it had “quickly become apparent that the only two wardrobes we had with us wouldn’t fit up the stairs”, so she had set off to borrow some clothes rails.
“I decided to have a mooch around the shop, and there at the end of one of the ‘vintage’ rails was a beautiful peach and green Karen Millen dress.
“There it was again, in a size up from 25 years ago, as am I, sparkling at me in Jersey Hospice Care Town Shop in my first week of being on-island. It was a sign!”
It was not the only signal that she had made the right choice.
After some time in accounting, Mrs Street started working in healthcare and eventually landed at Heart of Kent Hospice, a “lively” and “buzzy” hospice where she was the chief executive officer from 2021.
While she was therefore familiar with the demands of working in a hospice, she knew that one on a 9×5 island would come with its own unique challenges.
But, just like her predecessor Mike Palfreman, Mrs Street realised just how special the role would be just moments after landing at Jersey Airport.
In previous interviews, Mr Palfreman had fondly recalled how his taxi driver praised Hospice for its “wonderful” support when his father-in-law died there.
Mrs Street said she received a similar warm welcome.
“Taxi drivers love Hospice!” she laughed.
“Hospice has been around for over 40 years. There’ll be people who generationally, are coming up to the second or third generations of their family that have been cared for by Hospice.
“It would have been grandparents and then parents and perhaps now loved ones and spouses.”
Her arrival in Jersey started with a round of introductions ranging from Government to other charities, and a six-day handover from Mr Palfreman, who retired in July after four years in a role he had described as being “a bit like conducting an orchestra”
“I really do feel like he’s handed me a bit of a gift,” Mrs Street said.
“There’s still lots to do, there’s still lots we can improve on. Demand for palliative care in the Island is only ever going to increase with an ageing population, so there is more we need to do with the resources we’ve got.”
Resources have been a challenge since the pandemic.
Hospice ran at what Mr Palfreman described as a “significant deficit” during the pandemic, and, despite having some cash in the bank, nonetheless had to make cuts to some “behind-the-scenes” operations to keep on an even footing.
The charity realised that more income would be required, and a new contract saw government agree to fund 43% of its operations until 2027, with the rest being made up from fundraising and retail.
For Mrs Street, rejuvenating day services that stopped during the covid-19 pandemic and never returned in full is at the top of the agenda.
Peer support, education sessions, or visits to doctors and nurses all form part of a modern hospice, whose role goes far beyond the stereotype of palliative care.
“Hospices are typically seen to be a ‘place’ – but, actually, Hospice goes out much wider than just this building.”
Its work extends to the Hospital and care homes, as many patients prefer to die at home or in their care home. It’s the role of Hospice staff to make sure that they can get these needs met.
Education is “a really important piece of that”.
Carers, health staff and relatives of patients can all benefit from new programmes, and work is “ongoing” to help the wider population learn to talk more openly about death and dying – something Mrs Street describes as a growing movement across the hospice sector.
“Everyone does a birth plan when they’re having a baby,” she explained, “Very rarely do people do a death plan, but it’s the one thing that we will all face at some point in our lives.”
She said she would encourage people to gently start introducing their wishes into conversation: what kind of a funeral would they like – burial or cremation? And where and how would they like to be cared for?
Getting what she calls “death admin” done is important too – things like writing a will or arranging lasting power of attorney.
“Life admin is bad enough!” she joked.
“I’m sure lots of people have experienced the death of a loved one, where they’ve had to try to work out what to do next and unpick somebody’s affairs and try and get it all in order, when you’re already grieving the loss of someone.”
Getting your affairs in order is therefore a “real gift to leave to your loved ones”, she noted.
Helping others to better support their loved ones and colleagues during bereavement is another key workstream.
“We do some work with some of our corporate supporters at the moment, looking at loss and bereavement in the workplace – because that’s something that’s really difficult to handle. If you’ve got a colleague who’s lost someone, you don’t know what to say.”
So, what should you say?
“Someone once said to me: the worst thing has happened, whatever you say is not going to be as bad as the bad thing that’s just happened.
“One of the things I’d like to do while we’re here is do some training around compassionate conversations. It’s very early days and we haven’t developed what that might look like. But there are some great resources out there.
“It’s about asking slightly deeper questions, like, how are you doing today? How were you yesterday? What’s worrying you today? Is there anything you want to talk about or something I can help you with?
“Or it’s small, practical things, like taking them lasagne, because someone might not be feeling in the mood to cook for themselves. Those little practical things can have a meaning for people when they’re feeling sad or bereaved.”
As a leader in palliative care services in Jersey, Mrs Street will also need to contend with plans for an assisted-dying service.
The States Assembly last year voted in favour of setting up an assisted dying service in Jersey for islanders with terminal illnesses and neurodegenerative diseases.
The proposed legislation was due to be debated and voted on before the end of this year, but it was decided that the debate should be delayed until January after some politicians raised concerns about the amount of time available to review the proposals.
Hospice has a role in the conversation. It has been clear for some time that they wouldn’t be involved in administering the service, though they will support patients with whichever route they choose.
“We are, I suppose, still in the process of trying to work out what it means for Hospice. There’s still quite a number of unanswered questions, but as an executive team and as a team of trustees, we’re working through what that means for us.”
Leaders in the sector have argued that with the introduction of assisted dying, patients are better served if they also have access to good palliative care.
This, Mrs Street said, is where Jersey has been exemplary.
“What I think Jersey have done really well is make that case, and I hope and pray that the UK looks towards Jersey as a model of: if the UK do go ahead with assisted dying, how have Jersey tackled it?
“Jersey has certainly recognised that they need decent palliative and end-of-life care.”
Jersey Hospice is also far better supported in terms of funding than the UK, where many hospices are “really poorly funded and really, really struggling”.
“I do hope that if the debate continues in the UK, that perhaps Jersey can be a role model for them about how it could be done.”
While Mrs Street sings the praises of her field now, she admits that when she first moved from healthcare to her first job in a hospice that she held a misconception that it would be a “sad and dark and gloomy” place.
But, she said, “I remember walking out… and the emotion I felt was happiness. The hospice was lively, it was buzzy, it was noisy. It was a beautiful sunny day, the gardens looked amazing.
“Hospices are nice places, they’re very calm. There are tears, there is sadness, of course, but there’s also a lot of laughter and a lot of love and a lot of care.”
This warmth is reflected in Jersey, too – and not just because of the beautiful gardens and views over St Aubin’s Bay from the Jersey Hospice building on Mont Cochon.
“I’m totally in love with the Island. We’ve been so warmly welcomed. Everybody that we’ve met has been absolutely lovely and friendly and told me all their stories of Jersey.
“They’ve all got their own views on the pros and cons of Jersey, but, underlying all of it, everyone has said it’s a great place to live, it’s a great place to bring up children, and that Jersey Hospice Care is massively well-respected and has got a huge place in the hearts of all the Islanders. I’ve certainly seen that.”
There is no timeframe on Mrs Street’s time in Jersey.
“We’ve chosen to move my whole family out here to enjoy this new Island life, and I hope that I can look back and be proud that the people of Jersey have access to outstanding palliative and end-of-life care for anyone that needs it, and that we have a wide range of services that meets everyone’s needs.”
While she will be steering the ship through this new phase, supported by the charity’s board, Mrs Street was clear that it is Islanders who should feel a sense of ownership.
“As far as I’m concerned, the Hospice belongs to Islanders. It doesn’t belong to the charity – it belongs to Islanders, and I want them to feel like it’s theirs.”
