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J R Soc Med. 2005 January; 98(1): 45–46.
PMCID: PMC1079252

Palliative care in community hospitals

Professor Payne and her colleagues (September 2004 JRSM1) conclude that community hospitals represent an under-used resource for palliative care. I surveyed the use of an urban community hospital for each of the years 1987–2004 when I worked in my previous practice of 8000 patients in Haydock, St Helens. During these 17 years we cared for 249 patients who died of malignant disease when at least part of the terminal phase was spent in the community.

The place of death, and numbers (percentage) of these patients was:was:

Table 1
The place of death, and numbers (percentage) of these patients was:

Although on average only 3 patients died in the community hospital each year, this was a particularly useful option for those without a family able to care for them at home. It also made an important contribution to our aim of keeping as many patients as possible, when this was desired and appropriate, under our care at death. We achieved this for 74% of patients—a percentage that remained constant. This was probably helped by the out-of-hours service being asked to pass any calls for such patients back to a general practitioner from the practice.

One relative has stated his definition of good palliative care: 'the essential concept is that the doctor (or at least the practice) will stay firmly with the patient and relative at their time of need and not desert them'.2 Community hospitals have an essential role in the provision of this and other aspects of primary palliative care, which should be developed further.3


1. Payne S, Kerr C, Hawker S, et al. Community hospitals: an under-recognized resource for palliative care. J R Soc Med 2004;97: 428-31 [PMC free article] [PubMed]
2. Brewin T. Personal view—deserted. BMJ 2001;322: 117
3. Murray SA, Boyd K, Sheikh A, Thomas K, Higginson I. Developing primary palliative care. BMJ 2004;329: 1056-7 [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press