Letters Care of the dying in the community

Hospice ethos is the heart of caring for dying people in the community

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f4891 (Published 14 August 2013) Cite this as: BMJ 2013;347:f4891
  1. David Jolley, psychiatrist1,
  2. Michael Tapley, medical director2
  1. 1Personal Social Services Research Unit, University of Manchester, Manchester M13 9PL, UK
  2. 2Willow Wood Hospice, Ashton under Lyne OL6 6SL, UK
  1. david.jolley{at}manchester.ac.uk

The articles by Collis and Al-Qurainy1 and Sleeman and Collis2 stand well alongside the recent review of the Liverpool care pathway.3 The key directive from this review is that: “Use of the Liverpool care pathway should be replaced over the next six to 12 months by an end of life plan for each patient.”

The clarity of this is weakened by the qualifying clause, “backed up by condition specific good practice guidance.” The point is that we must care for patients and ameliorate their symptoms whatever the underlying condition or combination of conditions may be.

Hospices receive less mention than perhaps they deserve. Collis and Al-Qurainy’s review shows an increasing preference for hospice care with advancing age but that the likelihood of dying in a hospice decreases in old age. Patients trust hospices because they see them as sharing their values and their wish for honest, calm, and competent care. The well intentioned and well prepared attempt to translate what hospices do into a formula (Liverpool care pathway) that could be applied elsewhere has foundered. What healthcare needs now is the hospice ethos spread thick and wide. Hospice is the heart of the community.


Cite this as: BMJ 2013;347:f4891


  • Competing interests: Both authors provide clinical sessions at Willow Wood Hospice, Ashton under Lyne. MT is medical director of Willow Wood.


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