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Helping hospices develop care

Hospices need the help of GPs to dispel some myths and to create new models of care.

When GPs refer a patient to a hospice, the staff will discuss a preferred method of care with the patient (North Devonshire hospice)
When GPs refer a patient to a hospice, the staff will discuss a preferred method of care with the patient (North Devonshire hospice)

The hospice movement has gathered pace in recent years, so it is no surprise that the role of hospices and specialist palliative care services is not fully understood - even by healthcare professionals.

The modern-day hospice movement began in 1967 when St Christopher's, the first purpose-built hospice, opened in London. Soon after, a Canadian cancer surgeon coined the term 'palliative care'.

The public, GPs and other health professionals have enthusiastically embraced the hospice movement.

However, UK hospices still struggle with people's misconceptions about their role and the care they provide.

Myth: hospices are just for in-patients
One myth is that hospices are 'just buildings with bedded units'. Commonly, a GP will refer their patient to a hospice with a bedded unit in mind.

Hospices try to be flexible with the services they offer to meet each individual's needs.

While it is true that for many hospices in-patient units are an important part of their services, a hospice can provide much more.

In fact most UK hospices' services are delivered in the community rather than within the confines of their walls.

When a GP refers a patient, the hospice will discuss with them how they would be prefer to be cared for.

A high percentage of patients express a wish to remain at home, so the hospice will aim to support this wish whenever possible.

A fundamental aspect of the hospice movement is its holistic approach to palliative and end-of-life care - an approach increasingly adopted across the NHS.

As well as help with physical symptoms, patients need emotional and spiritual support.

I work for the North Devon Hospice in Barnstaple. Last year, 60 per cent of the referrals we received were not for our bedded unit. With the majority of these patients, we provided support for their children, other relatives and carers at home.

Another misconception is that hospices are principally places for end-of-life/terminal care.

All hospices share a goal: to help patients, their families and carers come to terms with the patient's illness, and make the most of their time left together.

The aim is to 'put life into days' by helping them achieve maximum quality of life, including being at peace emotionally and spiritually.

Myth: hospices are places for end-of-life care
Last year, North Devon Hospice discharged 40 per cent of patients after an average stay of seven days and provided these patients with further care and support at home.

People think hospices only care for patients with cancer, this is another myth. While it is true most referrals are cancer patients, non-cancer patients also fall within our remit.

Most UK hospices wish to extend the scope of their care to patients with other life-threatening illnesses, including end stage heart failure, motor neurone disease and other neurological diseases.

However, this can only be achieved if hospices work closely with GPs and other primary and secondary care clinicians to develop models of care.

Another common but inaccurate perception is that hospice services are only available to people from certain backgrounds.

Patients referred to hospices will be accepted on the basis of need, as outlined by their GP, irrespective of diagnosis, background, class or religion.

Myth: hospices are only available to patients from certain backgrounds
Indeed, patients of all faiths and none will be cared for, and most hospices' core services are provided completely free of charge to patients and their families.

The charity Help the Hospices states: 'We strongly believe that palliative care should be routinely available to all who need it.

Governments across the UK should make sure that public funding is made available to increase the availability of palliative care, whether provided by the NHS, by social care services, by national organisations or by local hospices.'

There are myriad opinions about what services a hospice should or should not provide. But there is no single referral process for GPs to follow, and development of services and referral criteria are often influenced by local factors.

North Devon Hospice has recently reviewed its services and there is now much greater clarity, internally and externally, about what it offers.

Referral criteria may sometimes confuse and individual hospices try to make the referral process straightforward.

As more cancer, neurological and heart failure patients live longer with their life-limiting conditions, all hospices must consider their vital role in supporting these patients.

Will hospices evolve and adapt to include services providing long-term support? If so, what service models are required to meet these needs?

To evolve hospices must target their finite resources to greatest effect. Perhaps in future some GP referrals will be declined if they do not meet updated referral criteria.

Myth: hospices only care for patients with cancer
Discharge processes may need to be developed to enable increasing numbers of patients to be discharged temporarily and re-admitted later, on the basis of clearly defined need.

For us, with parts of north Devon being in the fifth percentile of the UK's most deprived regions, the need to move the debate forward is becoming urgent as the focus on patient choice and community care grows.

We need to engage with you - our GP colleagues - to develop relevant, effective and sustainable new service models.

  • Jo Bellinger is marketing manager at the North Devon Hospice, a registered charity


  • End-of-life care as in-patient or at home.
  • Support for patients' children, other relatives and carers.
  • Holistic approach with an aim to 'put life into days' by helping patients achieve maximum quality of life.
  • Patients referred by GPs are accepted on the basis of need.
  • Most referrals are currently cancer patients.
  • Hospices want to develop care models for other life-threatening conditions.


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