"It does change the way you think about life," says Irene McVie.

The 66-year-old is reflecting on 18 years as chief executive of Scotland's largest independent hospice, Strathcarron, as she prepares to retire on July 31.

Spending your working life trying to help terminally people get the most out of their final months makes you wonder why so many of us waste time putting things off when we are well, adds Ms McVie.

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She said: "We keep telling people to live the best life they can when they know they’re dying, and it makes you think ‘well, why would you wait until you’re dying?’. Just go for it.

"I said that once at a Rotary Club meeting and they were like ‘well, you still need a retirement fund’ and I was like ‘no, I don’t mean blow all your money next week’ - but don’t assume you can do it in 10 years time.

"If your life ambition was always to go to somewhere in particular, how long can you afford to leave that?

"Because when you’re dying you have lots of bereavements – gradually there’s less and less that you're fit to do.

"We help people make the most of what they can do, but you might still be having to compromise on things that - if you were fit - you wouldn’t have to compromise on.”

Ms McVie, who moved from Gloucestershire to Scotland with her Scottish parents when she was 11 ("every childhood holiday was spent in Saltcoats"), swapped a career in NHS management to take over the running of the Falkirk-based hospice in September 2006.

It means she is unusually well-placed to understand what she describes as the "cynicism" of NHS executives beholden to a bottom line and the best way to wring extra funds out of them - namely, by proposing initiatives designed to save the health service money, as well as improving the patient experience.

This was at the heart of one of the biggest changes she spearheaded with the creation of Strathcarron's trailblazing Hospice at Home service in August 2014.

The inspiration came after Ms McVie attended a series of meetings in London as the then-Scottish representative on the advisory council to Hospice UK, a body representing some 200 hospices UK-wide.

Ms McVie was intrigued by developments in England at the time where a number of providers were starting to run hospice-at-home services, enabling patients at the very end of life to get round-the-clock palliative nursing care equivalent to that available in a hospice while remaining at home.

The model had originated in the United States, where it was credited with cutting healthcare costs, and Ms McVie wondered why nothing equivalent was being offered in Scotland.

Irene McVie pictured with staff at Strathcarron hospice in DennyIrene McVie pictured with staff at Strathcarron hospice in Denny (Image: GordonTerris/Herald&Times)

“It just seemed so self-evidently logical that you should be able to do that," she said.

"A lot of people are really terrified of looking after someone at home at the very end of life - that’s really pretty scary.

“So I came back and I spoke to our director of nursing, and it just seemed obvious that we ought to think about it.”

For the first five years, the scheme was fully funded by the Big Lottery - the charitable arm of the National Lottery responsible for supporting good causes - which also paid £20,000 for an external evaluation.

The analysis found that Hospice at Home reduced the number of days a dying person spent in hospital in the final two weeks of their life by an average of six, compared to people dying from the same conditions across Forth Valley without Hospice at Home support.

It also cut A&E attendances and ambulance callouts.

At a time when demand for hospital beds is far outstripping supply, the advantage of Hospice at Home was that it could free up beds in the NHS for other patients.

Today, the service costs Strathcarron £650,000 annually with its team of nurses supporting roughly 500 patients a year to spend their final days at home.

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Despite its success, budget constraints have made it difficult to extract as much financial support from the NHS as Ms McVie would like.

She said: “The difficulty now is that we straddle several [Integrated Joint Boards] so you need them all to agree to fund it – otherwise would you do it in the Falkirk area, but not Stirling?

"Last year, we asked for 50% of the running costs but we got £96,000 on a non-recurring basis, which isn’t a lot for the number of bed days it’s saving.

“It’s really frustrating because at one point when I was talking to the medical director they were saying ‘well, we’re not sure if we can afford it’ and I said ‘well, do you want us to stop running the service?’.

"He was like ‘point taken Irene’. They don’t want us to stop running the service because where are all these people going to go, and what are they going to get?"

Strathcarron began life as the brainchild of Dr Harold Lyon, a palliative care expert who envisioned creating a space where dying patients could enjoy a friendly and relaxed environment with good symptom control, reduced anxiety, and openness between patient, family and staff.

In 1978, he and friends purchased the hospice house in Denny for £55,000 and embarked on a £247,000 renovation - all funded by donations - to convert the former dining and billiard room into a 12-bedded inpatient unit.

In April 1981 it admitted its first patient, and has since expanded to accommodate up to 24 patients while attracting "exceptional" gradings from inspectors.

Strathcarron hospice in 1985, four years after openingStrathcarron hospice in 1985, four years after opening (Image: StrathcarronHospice/NHS) An aerial view of Strathcarron hospice in Denny, Falkirk today after undergoing extensionsAn aerial view of Strathcarron hospice in Denny, Falkirk today after undergoing extensions (Image: StrathcarronHospice/NHS)

In addition to its Hospice at Home service, Strathcarron employs dozens of community clinical nurse specialists who are collectively supporting around 350 people at any one time to manage their conditions at home.

Overall, the service - which is free to users - now costs £12 million a year, two thirds of which comes from fundraising and the rest from the NHS.

Demand has soared. Referrals increased 32% between 2017 and 2022 alone as the Baby Boomer generation hit their 70s, increasing their probability of developing illnesses such as cancer.

The increase in running costs - up from £9.12m a few years ago - is also being driven by the pressure to compete with NHS salaries following two successive pay rises of 7.5% and 6.5% which have pushed the wage bill up to £500,000 a month.

"It means we haven't had a problem recruiting, but it's an uphill struggle," said Ms McVie.

"Last year we just broke even, but that was because we had a really good year of legacies.

"You cross your fingers and hope for the best.”

The complexity of patients has also changed dramatically during her two decades as CEO.

"People are also living longer. In the past there would be people here only because they had cancer or a neurological condition.

"Now they have cancer and a heart condition and arthritis and diabetes and maybe undiagnosed dementia.

“It would be unusual to have someone with just one thing wrong with them.”

As well as cancers, Strathcarron is increasingly applying its palliative care expertise to support people at the end of their lives with chronic or neurological conditions such as Parkinson’s, Motor Neurone Disease, COPD, heart failure, or kidney failure.

Ms McVie said she wanted people to know that they can be admitted to the hospice for symptom relief and still be dischargedMs McVie said she wanted people to know that they can be admitted to the hospice for symptom relief and still be discharged (Image: Gordon Terris/Herald&Times)

Ms McVie is keen to stress that an admission into its hospice is not necessarily a one-way route. 

"If you tell people anything, tell them that people get discharged from the hospice," she said.

"So many people are scared to come in because they think they won’t get back out, but actually that means they are tolerating symptoms that we can effectively treat.

"We can MOT them and get them back out there with their symptoms under control so that they can make much more of the life they have left not experiencing the pain, nausea, dizziness, or whatever it was they came in with.”

Asked what she will remember most as she prepares to bid farewell to Strathcarron on Wednesday, Ms McVie recalls a comment by a nurse who left the hospice for a new job in England some years ago. 

She said: "It sounds weird, but she was talking about how wonderful she found the hospice and she used this expression - she was talking about the relatives of the people who died.

"She said ‘we see people at their most magnificent’. I thought that was an extraordinary phrase. 

"But actually, all these relatives and friends of people who are dying, they do rise to the occasion. It is magnificent."