ABSTRACT
The hospice in which I conducted fieldwork underwent some major changes both before and during the ten-month period of study. As described in earlier chapters, the hospice was originally a twenty-five bed unit. Six beds were cut about a year before I started fieldwork, and a further three two months into the study. In both cases, bed cutbacks resulted from the decision of the local Health Commission (the ‘purchasers’) to allocate a larger proportion of its palliative care budget to primary care services. This shift reflected broader trends in care for the terminally ill. As I indicated in Chapter 1, during the past decade or so there has been a noticeable transition away from hospitals and other institutions as the site for death and dying in the UK. A number of studies suggest that, if given a choice, the majority of terminally ill patients would prefer to be cared for and die in their own homes rather than in the sanitised and impersonal environment of the hospital (see, for example, Thorpe 1993; Townsend et al. 1990; Dunlop et al. 1989). Whilst a lot of contention and debate surrounds this issue (some scholars argue, for instance, that the desirability of a home death is a form of rhetoric congenial to policy makers and planners, promoted by them because it is a more cost-effective form of care1(Holmes 1995; Neale 1993; Parker 1990)), it remains the case that a progressive shift is occurring towards the care of patients with advanced and terminal illnesses in ‘the community’. Hence, as Lunt has observed in his overview of terminal cancer care services in Great Britain, a switch in emphasis is taking place at the policy and planning level from the establishment and support of hospice inpatient units to the financing
of home care services (1985: 753; see also Taylor 1983; Eve et al. 1997: 42).
