'Love is stronger than death'

Dame Cicely Saunders has devoted herself to making life for the dying comfortable and dignified

When Adam Fagin's mother was diagnosed with terminal cancer, she began treatment at a hospice, the Marie Curie Cancer Care Centre in Liverpool. It was the first time Adam had seen the inside of a hospice. "My preconception about hospices was that they were for people who were at a much later stage of terminal illness. I was very surprised when I walked into this vibrant, hotel-like atmos-phere," he says.

"Everything that happened to my mum in there was about her, her life and who she was. My mum lost hair during chemotherapy treatment, and in a situation like that they are brilliant at restoring your dignity. My mum always said it felt like such a safe place for her, and that's how it felt for me, too. It was a haven."

At 83, Dame Cicely Saunders, the founder of the modern hospice movement, exudes life and vitality. She has spent much of her life caring for those who are dying, and like her, the hospices she has created are happy, peaceful and welcoming places.

Dame Cicely is feeling particularly buoyant at the moment: St Christopher's Hospice in south London, which she established in 1967 and where she still works, has just won the £700,000 Conrad N Hilton Humanitarian Prize. The annual award goes to non profit-making organisations that have made "exemplary and extraordinary contributions in alleviating human suffering". Previous recipients include Medicins Sans Frontières and the International Rescue Committee.

While she is delighted that St Christopher's has received this award, she laments the lack of public funding that it and the other 230 hospices nationwide receive. St Christopher's is 40 per cent NHS funded; the rest is raised from charitable donations. Some receive 30 per cent or less from the NHS, and survival can be a struggle.

Dame Cicely trained as a nurse after gaining a degree at Oxford University, but had to give up the job due to back problems. She trained as a medical social worker, and it was at St Thomas's Hospital in London that she met the man who was to inspire her lifelong passion. David Tasma, a survivor of the Warsaw Ghetto, was dying of cancer at the age of 40. She became his only visitor, and her time with him inspired her to dedicate her life to the dying. She believed that the needs of the whole person were not being met by existing pain control treatments for those who were dying, and she used the £500 that Tasma left her in his will to set up the first hospice.

While she is credited with founding the first modern hospice, different models of homes for the dying called hospices date back to the 19th century. They had their roots in philanthropy, religion and care for the poor, and attempted to cure the soul when the body was at the end of its life.

But Dame Cicely Saunders adopted a new approach.By the 1970s, the NHS and cancer charities had begun to take a keen interest in the work she was doing, and since then the hospice movement has developed and spread all over the world. The basic philosophy remains the same: to make death as peaceful and free of pain as possible, allowing people to be surrounded by those they love in a safe and comfortable environment.

For Joanna Traynor, the admission of her father to Eden Hall Marie Curie Centre in north London made his death more peaceful than her mother's had been the previous year. "My mother died at home. It was absolutely what she wanted, but the whole thing was truly dreadful. There was nothing peaceful about it. When my father became ill the following year, he deteriorated very quickly. To find himself helpless and dependent on his children for daily care must have seemed like the last straw. He was deeply depressed.

"When he was admitted it was a huge relief to everyone. For us, it was as if we had him back again. He was immediately made comfortable, he regained his sense of humour and could actually enjoy the visits from us and from friends."

One of the people who had an effect on the whole family at this time was a nurse called Paul. "I think they became quite close," Traynor recalls. "And I think it was crucial that he had someone he felt close to, whom he could open up to, but whose feelings he didn't feel he had to spare. Paul was such an amazing and charismatic person, and he got to know my dad really well. He laughed at his jokes, and when he said afterwards that he'd really miss him, you could see he meant it."

As the population ages, more and more people require hospice care. Each year, around 60,000 people are admitted to hospices, with nearly half returning home again – the average length of stay is 13 days. Around 120,000 patients living at home are supported by hospice care – this is well over half of those who are dying from cancer. Throughout the UK, there are about 370 community-based teams, and as needs increase, the model of hospice care at home is likely to expand.

Following his mother's death, Adam Fagin has become a keen fundraiser for her local hospice, and is concerned about the perpetual shortage of funds that hospices, which are free of charge to all comers, have to endure. "Most of those involved with fundraising are people like me who have had relatives cared for there. The message hasn't got out as well as it could to the wider community about how great the financial need is."

Dame Cicely believes that more needs to be done to address issues of "both the science and spirituality" of dying. "There have been huge developments in care at the end of people's lives, but we know that not everyone is getting equal access to that care. We did a survey in our own local area of south London, and found that while white people could be getting more care, black people were missing out on hospice care considerably more. We have links with hospices in many other countries, and there is a lot we can learn from developing countries about family values and care in the community.

"My own philosophy is that love is certainly as strong as death, if not stronger. People come to us looking for a meaning that is beyond themselves and that they can see is true. Troubled people come in day by day, but inside the hospice, it doesn't feel like that. It feels peaceful and safe, and because it feels so safe in here, families find their own strengths. You do see sorrow in people's eyes and you see them getting weaker, but you also see them at their most mature, making their own achievements."