Ahead of World Palliative Care Day tomorrow, Health Reporter Emma Brady discovered what difference a day at a hospice can make for patients with terminal or long term conditions

Hospices are often perceived as being God's waiting room, filled mainly with frail, sick and prima-rily elderly people waiting for their final moments.

At St Mary's Hospice in Selly Park, Birmingham, the waiting room is empty.

Instead incessant chatter in the lounge can be heard down a corridor as 20 patients, many of them battling cancer, enjoy their elevenses, catch up on the gossip or take part in an art class. And they are not all pensioners.

As the largest independent hospice in the West Midlands, St Mary's receives more than 1,000 referrals a year, treats about 450 in-patients and sees more than 600 people on a day-release basis.

It provides a host of clinical and complementary therapies for patients and their families, and also has a community palliative care team which sees patients who remain at home for much of their illness.

However, an almighty black cloud hangs over St Mary's and other independent hospices across the country - funding.

Care provided by staff and volunteers costs #4.5 million a year or #12,300 per day.

The NHS meets 37 per cent of the costs, but the rest - nearly twothirds - comes from fund-raising and donations.

The palliative care provided by hospices aims to help patients and their families to cope with their condition and its treatment, and for many it as important as their clinical care.

Trisha Castanheira, director of nursing services at St Mary's, admitted hospices were massively under-funded although their care and attention to detail were greatly valued by the communities they serve.

She said: "We've had weddings here - one couple used the family flat for their honeymoon - arranged helicopter and plane rides for patients, taken them to the coast, we like to help make these things happen.

"In fact so much of what we do is about the little things, the attention to detail, as it is about their clinical care.

"But we are constantly living hand-to-mouth, as we have to find nearly #3 million a year to keep St Mary's going and that's getting harder as more charities compete for people's attention and generosity."

A national strategy for end-of-life care is being drawn up by the Department of Health, but Mrs Castanheira believes palliative care must feature more prominently in a new Cancer Plan.

In backing The Birmingham Post and Cancer Research UK's campaign urging the Government to commit to a second Cancer Plan, she said: "It goes without saying that a new cancer strategy should go some way to guarantee existing or, even better, improve funding for hospices.

"The role of palliative care is only going to get bigger as the population ages and incidence of cancer, heart disease and respiratory conditions increase."