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The hospice movement is one of the great success stories of modern medicine. It largely owes its origin to a single pioneer, Dame Cicely Saunders. Trained successively as a nurse, then social worker, then physician, she became passionately devoted to the care of the dying. In 1967, she founded St Christopher's Hospice in south London, the first hospice in the world to combine pain and symptom management with clinical research, teaching and compassionate care. As a result of her energies and those of her followers, there are now over 200 hospices in the United Kingdom (UK), while the hospice movement has also spread to North and South America, Asia, Australia and New Zealand. Hospices have also encouraged a move towards providing terminal care in patients' own homes if they wish, generally delivered by hospice-trained staff working in the community alongside general practitioners (GPs) and primary care. Partly as a result of this impressive work, over 60 per cent of people in England say they would prefer to die at home, with around a further 30 per cent wishing to die in a hospice, and only a small minority expressing a wish to die in hospital.1
In spite of all this success, there is still a large gap both in the UK and elsewhere between the kind of care people hope for at the end of life and what they receive. Only around a quarter of all deaths in England take place in hospices and at home. The majority still occur in hospital. Most hospitals now have a small, …