NEWSMAKER: Dealing with death - David Praill, Chief executive. Help the Hospices

John Plummer

David Praill talks frequently of dying and encourages others to do the same. "To make the most of life, you have to think about death," he says. But for Praill, chief executive of Help the Hospices, life's transience is a professional and personal matter.

His organisation represents the 161 charity hospices in the UK that care for the terminally ill, or life-limited. "Call it what you like, they're for people who are dying," he says. According to Praill, 47, the fortunes of the hospice movement depend almost entirely on how much thought communities give to dying.

"A community doesn't have to be involved in mending someone's legs," he says. "But there is something about caring for people at the end of their lives that everybody should be involved in. The ability to deal with death is the ultimate barometer of society."

If Praill is correct, then recent developments suggest we must have been pondering the afterlife a great deal lately. It has been a stunning year for Help the Hospices. Tesco is set to name it as charity of the year in 2004 and Middlesex University has become the first institute of higher education to accredit a training course on child bereavement, to be run by the charity. Then last week the Government announced it will hand over the £50 million that it pledged in 2000 to palliative care.

For Help the Hospices, which employs 35 staff at the King's Cross headquarters that Praill picked up for less than £1 million three years ago, the repercussions are immense. The Tesco sponsorship alone could double its £3.5 million annual income. "We want it to be the most successful Tesco charity of the year ever, which will mean overtaking the £3.25 million raised for Macmillan," says Praill.

The Tesco nomination has added significance. "Winning it has confirmed the model that we have developed over the past five years as the national charity that supports local hospices in what I describe as a loose federal structure," says Praill.

Help the Hospices was founded in 1984, but during Praill's tenure its governance has changed to require that a majority of the board be either trustees or employees of local hospices. "We have a structure that empowers them to control our agenda," he says. "It's a sign of the maturity of hospices that they have looked more at what they can do together."

There are 61 NHS palliative care units but 80 per cent of hospice beds and day care centres are provided by the voluntary sector. They involve 90,000 volunteers and collectively require £300 million a year to survive, making them the biggest fundraising cause in the UK.

Praill, a mathematics graduate who served as a priest for two years, began working for hospices 12 years ago in Harrow. He calculates that in his previous job running short-term theological courses in Jerusalem he spent nine months sleeping under the stars in the Sinai desert on trips with students.

"Hospices and the desert are both environments in which you find it hard to hide from yourself," he says. "You are forced to confront profound things such as your own death and other people dying."

The realisation that confronted Praill was that he no longer wanted to work for the church. He joined St Luke's hospice in Harrow as an administrator and then as general manager.

He is convinced attitudes to hospices have changed. "Fifteen years ago, people thought 'hospice' meant 'hospital'. When I used to tell people what I did, they would either be so embarrassed they wouldn't know how to talk about it or they would tell me their worst death story. Now when I say I work in hospices people say 'that's fantastic'."

The UK's ageing population is likely to keep palliative care in the spotlight.

It also raises difficult associated issues such as euthanasia. Praill says modern medicine can be over-officious in keeping people alive. "It's not always appropriate to offer resuscitation to someone who has had a heart attack," he says. But he adds that ending the life of someone who wants to die is not something he supports.

Government funding of charity hospices has fallen from 35 per cent to 28 per cent in the past five years. Anyone who has followed the recent news agenda could be forgiven for thinking hospices themselves are in terminal decline. The three-year campaign to secure the £50 million promised by the Government was accompanied by claims that without the funding some hospices would close.

Praill describes the £50 million, not all of which will go to the voluntary sector, as "the first significant hike since the early 1990s", but is unwilling to kick the Government too hard. He acknowledges that "some hospices have had a tough time" and predicts more mergers, but says the main issue is mapping a cross-sector future for palliative care.

Praill does, however, criticise it for lumping palliative care in with cancer care. He also points out the potential threat to hospices from health professionals' rising salaries.

But he remains convinced that the need for hospices remains their salvation.

"As long as they continue to respond to their users and patients, their communities will continue to fund them."

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