INTRODUCTION

  The Church of England's Community and Public Affairs Unit assists the Church in making informed and constructive contributions to the issues facing society. It is answerable to the General Synod through the Archbishops' Council.

  We welcome the opportunity to respond to the Health Committee's consultation on palliative care. Our response is of necessity general rather than particular. We draw on our historical association with hospices, and on our involvement through chaplains, other members of staff, patients and their carers. We would also draw the Health Committee's attention to a separate but related response being provided by the Association of Hospice and Palliative Care Chaplains, which answers the terms of reference of the consultation in more detail. Here we wish to emphasise fundamental principles that must be retained if the considerable investment that hospice care demands is to continue to be provided.

RESPONSE

  It is salutary that the Health Committee is looking at equity of provision of palliative care, and of the NHS's role in it. There is certainly inequality of provision across the country because of the ad hoc way that hospice care has developed as a phenomenon of the voluntary sector. Ensuring that hospices conform to standards in line with the rest of the NHS is important.

However, there are dangers inherent in increasing NHS control of palliative care. The hospice movement began in a "charismatic" way as a result of the influence of inspirational leaders such as Dame Cecily Saunders. There is genuine concern in many quarters that a closer relationship with the NHS will lead to bureaucratisation that will be disadvantageous to patients. The very special ethos of hospices, which never fails to impress those who come into contact with it, should not be lost to the sometimes narrowly scientific and medical models which can pertain in other parts of the NHS. This special ethos was there in the original idea of the hospice, which sought to help people to "live until they die". It is worth noting that this initial impulse had its origins in a distinctively Christian perspective on life, health care and dying. It was a response to the lack of care of the dying that was vitally alternative to the more utilitarian euthanasia movement. The spiritual and psychological needs of patients are included in the holistic care that is offered as a matter of course. The majority of hospices have at least one whole time chaplain in acknowledgement of the very particular attention given to spiritual and religious needs in holistic care. The emphasis on offering whatever will help the patient experience a peaceful and happy journey to death, the focus entirely sensitive to what may be utterly individual needs, is crucial. Acute care, by contrast, can seem brutal and impersonal.

  It would be wonderful to think that integrating hospice care more with the NHS would have the beneficial effect of softening the impersonal ethos sometimes found in acute hospitals, but the contrast in size makes this unlikely. The ethos of hospices derives from their Christian origin but is maintained in part because of their modest size in terms of numbers of patients and the considerable number of staff who are able to give personal and attentive care. Hospice care looks extravagant when viewed from the perspective of an acute hospital, where recovery, cures and successful operations are so much part of the mindset. Hospice care is expensive and as a society we need to understand why care of the dying is worth such an investment.

  The ethos of hospices ensures that the reality and strangeness of death is faced by the dying patient, by his or her loved ones, and by the wider communities in which hospices function. Most people will come into contact with a hospice at some time in their lives and will for the most part be deeply affected, nourished and educated by the dignity and humanity learned from approaching death as an accomplishment rather than a dead end. Hospices are thus not only an investment in the dying, but also in the spiritual and moral health of the whole of society.

  Along with the other faith communities, we welcome continued partnership with the Government in ensuring that the world-class standard of hospice care available in this country continues in a more equitable way.

February 2004