To supplant, supplement or support? Organisational issues for hospices.

This paper provides an analysis of organisational issues in palliative care. Palliative care services have spread to many parts of the world and in the process have adapted to the context in which they are situated. This analysis draws on data from a small study of 18 hospices in the North Island of New Zealand. Key informants were interviewed about the organisation of health care workers, the range and nature of services offered and use of volunteers. Data collection and analysis were guided by the methodological principles of qualitative evaluation. Four main types of hospice were identified; (1) in-patient units with medical staff, (2) nurse led services, (3) volunteer led services which employed no health professionals and (4) hospital based palliative care teams. This paper proposes a conceptual analysis of the role of hospices in health care around three major issues: to supplant, supplement or support. Comparisons are drawn between the development and organisation of British and New Zealand hospices.