Opinion: A lifetime of giving - for a painless death

Nick Cater, a consultant and writer: catercharity@yahoo.co.uk

We all hope to die painlessly after enjoying our final days in enough comfort to settle the details of our lives. That's the cue for the underfunded but independent hospice and palliative care movement, which epitomises the often agonising tension between money and mission.

Failure of conventional healthcare meant it was born as an independent movement to ensure pain-free dignity for those at the end of their lives.

Yet hospices receive far less funding than they require to do their best work for all in need, which is due in part to pitiful support from the health service.

That is despite many dedicated donors, reflecting both the quality of the care and perhaps something about the peculiar aura of fear, faith, myth and loss that surrounds those who work at the point where life meets death.

The most recent figures for the charities engaged in palliative care will be out shortly through their umbrella body, Help the Hospices. That snapshot will once again offer more evidence that key services in health, education and welfare feed off a subsidy beyond tax of citizen cash and time. Of course, the state plans to gorge on it even more in future.

In England alone, the equivalent of £517m a year provides for thousands of people in hospices and, with extension services, in their own homes.

But barely a fifth of that money - £107m - comes from the NHS. That is nearly matched by the £89m value of hospice volunteering, and the endless effort of fundraising makes up the rest.

Should the state fully fund hospices, rather than absorbing a £410m subsidy?

It should do more, of course, but having once had the luck to meet Dame Cicely Saunders, the modern hospice movement's not-long-gone founder, when I helped promote her for the Conrad Hilton Foundation's $1m humanitarian prize, I doubt she wanted hospices to lose their freedom to become mere health contractors.

Hospices face a tough future as demographic trends produce a smaller proportion of the population from which to find working-age donors and taxpayers, while many more older people survive for longer and need long-term care, treatment for terminal illnesses and pain relief before they die.

Perhaps hospices are the best argument for lifetime giving, if only to ensure well-funded palliative care is there to ease your passing, and that of millions more. After all, you can't take it with you.

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