Hospice and palliative care in hospital – then and now …

Europe’s first hospital palliative care team was founded by Dr Thelma Bates in 1977 at St Thomas’ Hospital in south-east London, UK. Earlier this year, the key members of the team reunited in London to celebrate the 40thanniversary. Dr Thelma Bates OBE FRCR MRCPRetired Consultant Clinical Oncologist, St Thomas’ Hospital, explains the background to a longer article published in the June edition of the European Journal of Palliative Care.

Founding members of the team with two members of the current staff.
Left to right. Dr Shaheen Khan (lead clinician of Guy’s and St Thomas’ palliative care team), Dr Andrew Hoy, Dr Mary Baines, Dr Thelma Bates, Barbara Saunders and Rachel Hill (head of nursing for palliative care).
Photograph courtesy of Guy’s and St Thomas’ NHS Foundation Trust press office.

This is my first ever blog post and heralds the publication of Bates et al. ‘The first hospital palliative care team in Europe celebrates 40 years’ in the European Journal of Palliative Care.

As I see it, palliative care has grown along three distinct paths, the Hospice, the Home Care Team and the Hospital Palliative Care Team. The hospital side has flourished quietly and is today rapidly becoming an integral part of the National Health Service. It is, after all, here in the hospital where most European patients still die despite a stated preference by many to die at home. The paper above describes the ‘then and now’ of our hospital team but does not tell all.

In 1977, as a Consultant Clinical Oncologist at St Thomas’ Hospital in London I led this small pioneer Hospice Team.1At the beginning, I was advised by kindly friends and colleagues not to go ahead as it would be bad for my image and reputation! Palliation was the soft option in oncology where the emphasis was on cure. I took no notice. My oncology practice continued in parallel with no less emphasis on cure and prolongation of life where appropriate, but with an added interest in developing gentle palliative radiotherapy or chemotherapy to relieve distressing symptoms in patients with a very limited life expectancy. 2,3

Sister Barbara Saunders (left) and Dr Thelma Bates on the ward at St Thomas’ Hospital in 1978.

Then, our hospice work style of not taking over care completely had many advantages, but it could bring difficulties. Occasionally, we met a situation where a dying patient clearly needed facts but his doctor had lied to him and only told the family the truth … not uncommon in those early days. Is it always right to speak honestly to the patient if it upsets the family and risks harming his relationship with his own doctor? Or, in this situation, is it better to pause, speak to his doctor and family urgently and get agreement to speak frankly? This would sometimes be my preferred way but many, I know, do not agree with me and always put the patient first. Shared hospital care can be different from care in a hospice.

I left the team on the appointment of Geoff Hanks as the first Professor of Palliative Medicine in 1991 and had no further contact until this year. So it was pure happiness for me to see the size, scope and maturity of the present-day team’s many activities.

One obvious big difference today is the subtle emphasis of the firm hand of management on their shoulder. It is different now but what remains is the central core of care, compassion and sheer clinical competence that underlies it all.

References and links

  1. Bates T D, Hoy A M, Clarke D G & Laird P, The St Thomas’ Hospital Terminal Care Support Team – A new concept of Hospice Care. Lancet, 1981; 1: 1201-1203.
  1. Bates T D, Radiotherapy in Terminal Care. In: The Management of Terminal Disease. C. M. Saunders (Ed.) London: Edward Arnold, 1978; 119-124.
  1. Bates Thelma and Vanier Therese, Palliation by cytotoxic chemotherapy and hormone therapy. In: The Management of Terminal Disease. C M Saunders (Ed.) London: Edward Arnold, 1978; 125-133.

Celebrating 40 years of palliative care’ (a short article on the website of Guy’s and St Thomas’ NHS Foundation Trust).

Read the full article in the European Journal of Palliative Care
This post relates to the longer article, ‘The first hospital palliative care team in Europe celebrates 40 years’ by Thelma Bates, Shaheen A. Khan, Mary Baines, Andrew M. Hoy and Barbara Saunders, published in the June edition of the European Journal of Palliative Care (EJPC) 2018; 25 (3).

 

 


A note from the EAPC concerning the European Journal of Palliative Care

We regret to announce that Hayward Medical Communications, the publisher of the European Journal of Palliative Care (EJPC), is closing the journal after 24 years.

Since the launch of the journal in 1994, the EAPC and the EJPC have forged a strong and mutually effective bond. Together, we have provided our members and readers with a wide range of papers, including several seminal EAPC White papers and the book of abstracts for many EAPC congresses.  Our successful collaboration has also led to the publication of numerous posts on this blog contributed by many of the EJPC’s authors, providing a background to their longer articles. The diversity and high quality of the content have enriched our blog and we are deeply grateful to past and present authors, and to our colleagues at the EJPC. A tribute from the EAPC is published in the current issue of the journal.

You can view and download more than 120 posts based on EJPC articles in the special category on the blog for the European Journal of Palliative Care.

Please address any enquiries about EJPC editorial or subscription matters to the publisher at: ejpc@hayward.co.uk (editorial) or ejpc_subscriptions@hayward.co.uk (subscriptions).

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