Dr Jurgen Abela's article about new Hospice services to cater for non-cancer patients was welcome and interesting. There is a lot of activity in the field and the public also needs to be informed what services are being offered in the public service which ultimately bears the brunt of the work load.

Palliative care is aimed at relief of symptoms once a disease is felt to be beyond cure. This can involve the use of drugs, psychological and social support, nursing care, physiotherapy etc. etc. but also the judicious use of radiotherapy, chemotherapy and surgery. Many of these patients suffering from advanced cancer can live for several months, not uncommonly a few years and it requires expertise and experience to know when and how to intervene to maintain the best possible quality of life. It also requires professional interaction between many health care workers.

When it comes to the care of advanced cancer patients this has always been a large part of the Oncology department's remit and we have registered a steady progress over the years with the introduction of new services. We have been running a palliative care and pain clinic at Boffa Hospital for several years. The last year has seen the appointments of the first consultant in palliative care, Dr Doreen Pace, an Oncology and Palliative care specialty development nurse Christine Grima and a full time clinical psychologist Benna Chase.

All have many years of experience in the field. The palliative care service is being projected to patients at Mater Dei and Gozo General Hospital.

Within a year we hope to open a ward at Boffa Hospital dedicated to inpatient palliative care rather than have these patients on the general oncology wards. This ward will then move to the new premises at Mater Dei.

Much of this work by its nature needs to be done in a hospital environment but there is a lot of work that needs to be done in the community which after all is where people live and where they usually prefer to stay. For this we rely on the work of and co-ordination with community nurses, general practitioners and Hospice movement staff. The idea of holistic care applies not only to an individual being seen as a totality but also to a service. For this reason the oncology department has been more than happy to take on board GP trainees and expose them to several weeks of palliative care and oncology training, an experience which will no doubt help them in their management of cancer patients in the community.

What we cannot afford to do is duplicate some services while leaving large gaps in other areas. Deficiencies in the community will lead to an increase of admissions to hospital, admissions that could otherwise be prevented by crisis prevention rather than crisis control. Likewise, patients discharged from hospital that fail to find adequate support in the community will end up back in hospital sooner rather than later. To provide the best possible service, our human resources need to be focused rather than dissipated. For this we need a clear integrated and common policy in palliative care for the sake of our patients and their families.