When Sandie Foxall-Smith was appointed chief executive of St Peter's Hospice in June 2008, it very quickly became clear to her that she needed to make some major changes.
One of the Bristol hospice's two main sites, an 112-year-old building in Knowle, south Bristol, was in need of extensive refurbishment that was likely to cost the charity about £300,000. Coupled with a fall in income from investments and legacies because of the recession, this work was something the hospice could not easily afford.
After consulting its trustees, Foxall-Smith decided to close the building, relocate some of the hospice's services to its second site in Brentry, north Bristol, and use the savings to provide more care in the community. It seemed like the only sensible decision - but nothing could have prepared her for the backlash that followed.
"Everything hit the fan," she says. "We knew it would, because people had great fondness for the building and felt it was where the hospice had started. But it was unbelievable."
Although she had the support of the charity's trustees, Foxall-Smith faced strong opposition from many of the hospice's 1,700 volunteers and members of the local community, whose friends and relatives had died at the Knowle hospice. "No matter how many times we went through it, they didn't want to hear," she says. "Unfortunately for us, it was just before the election, so a number of local councillors got on our case. They stirred up the press and it became very vitriolic. The councillors used it as a political tool, which was unreasonable. I thought it was an outrageous way to behave."
Local residents who opposed the changes set up a campaign group, Save Our Hospice, and started a petition to reverse the decision. Even Foxall-Smith's children, who were 15 and 16 at the time, did not escape criticism. "They were challenged at school, and someone screamed at me in the supermarket and made my son cry," she says. "Nothing prepares you for that kind of personal attack."
Foxall-Smith forged her career in the pharmaceuticals industry before spending 10 years running the Bupa Hospital in Bristol. She has also been involved with the voluntary sector throughout her career, most notably as chair of a business forum at Beating Bowel Cancer and as chair of Business in the Community's Action on Homelessness initiative in south-west England. She remains a trustee of two charities: the Charity of Alderman Steevens, an almshouse charity, and Badminton School for Girls.
"I had always done charity work but I had never worked for a charity, so it was very interesting to be on the other side," she says.
"I just assumed that charities were run like businesses - especially one like St Peter's Hospice, which is a very large charity. But a lot of people don't think a charity should be run that way.
Even with some of my own trustees, who are fantastic, I have to be very careful of the terminology I use."
Foxall-Smith saw it as her job to challenge everything the charity was doing, from the front-line services to the stationery budget. "It's very hard to helicopter up and look down on an organisation, so when someone like me comes in, questions get asked - and often people don't know the answers," she says.
Her changes included an overhaul of the charity's IT systems. It had been relying on donated computers from local businesses and had been using the same machines for 15 years. "Those computers had been thrown away for a reason," she says. "A business wouldn't accept that, so why should a charity? If anything, charities should be even more efficient than businesses. It's even more important that we sweat our pound."
Foxall-Smith also scrutinised the cost of the materials the charity was using for its mailshots. "When I looked at our stationery budget, I realised we had never put it out to tender," she says. "We had been using the same supplier for years because we had a deal with them in which they were giving us some freebies. But on closer inspection it became clear that it didn't add up."
However, the most controversial decision by far was the closure of the Knowle building. "The volunteers were the biggest barrier," says Foxall-Smith. "We did roadshows, tea parties and events where they could come and discuss the plans. We were very open. We showed them the finances and the end-of-year accounts - a lot of organisations wouldn't have done that. For three months, my bum didn't touch my chair, that's how much time I was giving."
The building finally closed in late 2009, but that hasn't stopped the campaigners. Sarah Falber, a founding member of Save Our Hospice, tells Third Sector that the group remains opposed to the decision. It has now changed its name to the South Bristol Hospice Action Group and has been meeting with the local primary care trust, which is doing work to establish the need for palliative care in south Bristol. "I think they could have kept it open," she says. "Overnight, it was gone - and it was very upsetting. There was a huge amount of sadness and hurt."
Mark Wright, a local Liberal Democrat councillor who wrote to the Bristol Evening Post opposing the decision, also stands by his criticisms. "There was a perception that the closure was a business plan-driven change, not a service-driven change," he says. "Everyone agrees that providing more people with care in the community is a good thing, but there are some people who will always need an institutional bed. It's not really reasonable to say the Brentry facility could serve all of Bristol."
Yet Foxall-Smith believes the closure of the Knowle building has allowed the charity to improve its provision. "We had a leaking bucket of a building that would have cost £300,000 just to keep running," she says. "I wanted us to save that money and spend more on home services. It's a tough message when people love the building, but most people actually want to die at home. We drew on evidence from a national government consultation that said home is where people feel most comfortable."
Foxall-Smith says the charity will deliver the same care in 2010/11 for £400,000 less than the projected figure in the budget when she joined, allowing the organisation to break even, rather than run at the predicted deficit. She says the hospice has been able to use some of the money it has saved to hire two full-time nurses in Brentry.
But it hasn't been an easy ride. "Charities have to think seriously about how they are run," says Foxall-Smith. "There are a lot of barriers to business people coming in. You need to be incredibly resilient and you have to be professional to help the charity deliver more. The more professional you are with the management, the more you will deliver."
CV - SANDIE FOXALL-SMITH
2008: Chief executive, St Peter's Hospice
2007: Director of development, Circle Health
1997: General manager and director, Bupa Hospital, Bristol
1995: Founder, Advantec Consultancy
1990: General sales manager, UK and Eire, Lundbeck
1985: National sales and marketing manager, Allergan Pharmaceuticals
1980: Hospital and product marketing specialist, Astral Pharmaceuticals
1975: Management executive, Marks & Spencer