its services with Dover Park, admitting most of its patients who need in-patient care to Dover, and even sharing its staff, notably Dr Shaw, who is now Medical Director of both services. A fully integrated home care and in-patient service is envisaged in the future.
Hospice Day Care Services have been started at both the Hospice Care Association and at Assisi Home and Hospice. These are still at a relatively early stage of their development, as we have not yet worked out the local conditions which affect our hospice day care services. We have run into problems principally over the provision of transport for the patients. Also, culturally, many of our patients are not keen to leave home unless they have to. We may see our hospice day care service become a largely custodial service for those patients who do not have enough support to enable them to stay at home without the service.
So far, I have mentioned in-patient hospice care as provided largely in free-standing hospices. In some countries, in-patient palliative care units may be a free-standing unit within hospitals or they may be a ward within a hospital. Such is the case in Sabah where beds have been set aside in a government district hospital for palliative care. These units may also run hospice home care services and day care services.
Hospital palliative care teams also exist in some countries. These have no in-patient beds, but are purely consultative services. There are currently 139 such Support Teams in UK hospitals.
Coverage of cancer patients
The second challenge for in-patient hospice care is that of coverage. In Singapore, as in most parts of the world, palliative care has confined its services largely to cancer patients, cancer being a disease that carries a fairly clear-cut prognosis and follows a relatively well-defined progressively downhill course. In just over ten years since the first hospice beds were set aside in St Joseph's Home in 1985, 40% of patients dying of cancer received some form of hospice care, either home care or in-patient care or both by 1995. This is a considerable achievement, possible partly because Singapore has a population located within easy driving distance from centrally located hospice home care and in-patient services. This coverage will not be so easily achieved in a country with a rural population scattered over wide or inaccessible areas.
