Terminal cancer care services: Recent changes in regional inequalities in Great Britain

Hospice care has expanded rapidly in the last 20 years. A wide range of services now exist in Britain, North America and elsewhere, providing specialist care for terminally ill people (usually with cancer), and following practices based on hospice principles and philosophy. These services include hospices, continuing care units or palliative care units; hospital-based support teams or symptom control teams; and home care teams. This paper reviews the development of these services in Great Britain and presents the results of a survey showing recent changes in the scale and regional distribution of home care teams (HCTs) and hospital support teams (HSTs). A previous study in 1980 showed considerable regional inequalities in the provision of these services, with the south east generally much better off than the rest of the country. The survey presented here shows that this imbalance in provision of HCTs and HSTs between the south east and the rest of the country has been reduced. There are still large differences between NHS regions, but with no clear geographical trend. The total number of HCTs and HSTs has grown from 33 in 1980 to 87 in 1983. Of the new services, 78% have been funded by one charity--the National Society for Cancer Relief (NSCR). NSCR was almost solely responsible for the levelling out of the regional imbalance. New HCTs and HSTs funded by other sources were more common in the regions already better provided. The role played by the 1980 survey in this reversal of regional imbalance is discussed. It is suggested that this piece of health services research did have an effect by influencing the policy of NSCR. The concentration of financial control in the hands of a single charity makes this an atypical case. The impact of health services research on National Health Service development is usually more difficult to detect.