Funding dilemma for pioneering hospice care

The NHS review poses a threat to hospice finances, if only by its silence on the matter, writes James Hanratty
"SORRY, there is nothing more to be done." Those watching at the bedside of their dying relative will be haunted by these chilling words in their subsequent bereavement. This bleak helplessness in treating the distress of terminal illness was commonplace not all that long ago — 25 years or so. Terminal illness was rarely even mentioned in medical training and tended to be regarded as a medical failure. How different it all is nowadays.
St Joseph's Hospice in Hackney, opened in 1905, was one of the few institutions concerned specially with the care of those who are dying, but the principles of the care were not formulated or propagated until Dame Cicely Saunders began. her work at St Joseph's Hospice as recently as 1957, subsequently moving on to St Christopher's Hospice.
The philosophy of hospice care ensured: relief of distressing symptoms by medical and nursing treatment of the highest quality; coping with loneliness and fear by providing ample time for relaxed and open communication; provision of spiritual, emotional and social support in accordance with the needs of the patient; the dying patient is still a living person and should be enabled to live not just exist throughout the terminal illness. This requires the provision of recreational, occupational and other activities in accordance with the patient's preferences; care of the family extending into the bereavement.
The great benefits of this philosophy soon became apparent. and it has been pressure from the general public for the provision of hospice care which has led to the proliferation of hospices throughout the UK.
Hospices are mostly funded by the efforts of the local community where they are held in high esteem. Currently there are 130 hospices in UK providing the whole range of in-patient, home and day care. Many others provide a partial service.
If the voluntary hospices did not exist there would be a correspondingly greater load, and considerable extra cost, for the NHS hospitals. While recognising the value of this service the words of appreciation from the NHS are not always matched by adequate financial contributions. Some hospices receive little or no financial aid, and only a few receive even 50 per cent support; the average is about 25 per cent. Currently the average cost for patient care is approaching £700 per patient per week.
As the white paper issued by the Department of Health made no mention of hospice funding,
a deputation led by Help-theHospices met the minister last year. Subsequently a grant of £8 million for 1990 and another £8 million for 1991 was made to be divided among voluntary hospices in England. To assist with the distribution of the £8 million Help-the-Hospices sponsored a group of hospice experts which has produced a definition of hospice and guidelines of hospice care and practice.
While the extra funding is welcome, hospices are worried about funding after 1991. An across-the-board annual grant of 50 per cent of running costs from the NHS would be an acceptable solution.
The hospice movement has now come of age. Palliative care is now recognised by the Royal Colleges as a speciality and is on the curriculum of medical and nursing schools.
There is probably little need for many more hospices. What is essential is to ensure the continued excellence of those we have got . It is also vital for us to extend teaching facilities so that every doctor and every nurse whether in hospice or hospital will acquire the expertise to treat their dying patients with competence.
Dr Hanratty OBE, KSG was formerly medical director of St Joseph's Hospice, Hackney, and is co-chairman of Help The Hospices.