MOST people with a life-threatening illness say that they want to die at home, but 60 per cent still die in hospital.

The Prospect Hospice's plans to set up an expert and flexible service, delivered when and where people need it, could make all the difference and swing that statistic around, by providing the home-based specialist care which will prevent unwanted admission to hospital or hospice.

Palliative care - caring for those who cannot be cured - needs the right environment and expertise.

A large hospital such as the Great Western is not always the most appropriate place as it focuses largely on emergency admissions and can have a busy atmosphere, unlike the more calming environment of a hospice or family home.

But GWH does have specialist expertise in the form of clinical nurse specialist Vanessa Davey, whose role centres on getting the most appropriate care in the most appropriate place for her patients.

Vanessa has many patients to care for and she believes a quarter of them are admissions that would not have gone ahead had a 24-hour system been in operation.

In others words, people who have gone into hospital to be cared for could have remained at home, surrounded by their family, if Prospect@Home had already existed.

"There are a variety of reasons for such admissions," said Vanessa.

"For example, an on-call doctor might have admitted them because they need symptom control, or because a family can't cope any more.

"But if we have a home service that is available up to 24 hours a day, with nurses and carers staying with a person, they would be able to remain at home and need not go into hospital or hospice at all - unless that is what they want."

She is convinced that Prospect@Home will reduce these kinds of admissions and give the patients proper choice in where or how they will be treated.

"I know that such a system can work, because the edge of Great Western Hospital's catchment touches on North Wiltshire, where the Dorothy House Hospice runs a home care service," she said.

"It is wonderful when I have a patient in, living in that area, and I can tell them that they can go home because comprehensive, 24-hour support is available."

Prospect@Home would also ease the pressure on Vanessa and her colleagues, who would then have more time to devote to those who truly need to be admitted.

"I not only get referrals from the community but also from ward doctors and nurses within the hospital," she said.

"Equally, some people have to come into hospital for certain medical procedures which cannot be carried out at home.

"My role is to organise their care and what symptom control is needed.

"It is very rewarding to be able to help people and if Prospect@Home is in place then I will have much more time to devote to people.

"Home is where most patients want to die and I want to be able to give people what they want.

"People should be able to die with dignity and if that means dying at home, then that's what should be allowed to happen."

Public took hospice to their hearts

THE Prospect Hospice began from humble beginnings in May 1980, but didn't really take off until October 1981 when a team of Home Care Nurses had been assembled.

These specialist nurses worked alongside the patients' own district nurses and GPs to support those with a life limiting illness.

Leading the hospice during those early days was Methodist minister the Rev Derryck Evans.

He, along with other fundraisers, had big ideas for what a future hospice might look like, using the hospice's motto: "Live until the very moment you die."

Fundraising allowed the organisation to open a small daycare centre in converted flats in Church Place in 1982.

In May 1985, the Prospect Foundation launched a £1m campaign spearheaded by Lord Stoddard of Swindon, and the people of the town took the appeal to their hearts.

Within just six months of the launch it had raised £300,000, and by May 30 of the following year they had reached the seven-figure target.

By October 1986, the foundation had a 10-bed ward at the Victoria Hospital, which was officially opened by the Countess of Westmorland - the president of the National Society For Cancer Relief.

But the Victoria Hospital was a stepping stone towards the Prospect Foundation having its own purpose-built unit for patient care.

Many years of fundraising followed and in 1995, a purpose-built Prospect Hospice HQ opened its doors in Wroughton.

The new facilities cost £2.5m, which included the purchase of the land the hospice stands on, construction and equipping the building and providing enough cash to get it up and running.

The new building was opened by Princess Anne, pictured right with the then chairman of Prospect Eric Walker, who was so impressed with the hospice that she refused to be hurried and spent a long time speaking to patients and their families.

It now costs almost £4m a year to run the hospice and about a third comes from the National Health Service which still leaves £2m to be found from the community on an annual basis.