called Draper's Wing which is registered as a nursing home. When it was opened in 1967, it was designed not only to be a model of care for dying patients, but also a teaching and research centre. Subsequent purpose-built in-patient hospices in the UK tended to be much smaller, on average about 15 beds. These would have dedicated nursing staff and one or two full-time doctors, with possibly other part-time medical, nursing or paramedical staff. Other in-patient palliative care units start off as a few beds set aside in a small country hospital or nursing home, and may be as small as 2 to 6 beds. These may or may not have nursing staff dedicated for the hospice beds. Medical supervision may come from a local family physician with a special interest in palliative care. In-patient beds designated for palliative care may also be found in a few large teaching hospitals, notably the Supportive Care unit of the Royal Marsden Hospital, a post-graduate cancer hospital, and professorial units at St Thomas' Hospital, London and the Bristol Royal Infirmary. The latter two units are staffed by a professor in Palliative Medicine and his team.
Hospice Home Care
Soon after St Christopher's Hospice was opened in 1967, it was realised that patients did not necessarily need or want to spend all of their last days in the hospice. Many had physical or emotional problems when they came to the hospice, and as these came under control, they felt well enough and the family became confident enough to take care of them at home. The following year, 1968, St Christopher's started its hospice home care service. It was realised that in order for patients to remain at home, the hospice team needed to continue to provide care. At home, the day-to-day, hour-by-hour care of the patient was given by the family, while the hospice team of doctors, nurses and possibly the social worker and pastoral care givers, travels out to the patient's home to assess and control pain and symptoms, teach the family nursing care and give emotional and spiritual support. The concept of hospice home care will be covered in detail by Dr Rosalie Shaw in the next presentation. Here, I would just like to say that because of this need for continuity of care, many in-patient hospices which wish to provide a comprehensive service for their patients also began to run hospice home care services. Of the 408 hospice home care teams in the UK in 1997, about one-third are attached to a hospice in-patient unit.
