Finding a Place within the Health Care System? A Comparative History of Palliative Care Services and National Policies in England and the Netherlands

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Abstract

A comparative history of the development of palliative care services and policies in England and the Netherlands during the post-war period is presented in this thesis. These countries were chosen as England is the country where the modern hospice movement started, whereas a different set of services developed in the Netherlands. Examples of questions addressed are why the service developments in these two countries differed substantially and how specialist services for the dying related to the health care system. Given the choice to study England and the Netherlands, attention had to be paid to the impact of the acceptance or rejection of euthanasia on the development of palliative care as well. Chapter 1 provides an overview of the thesis and its aims. It also includes a literature review and elaborates on the comparative research approach chosen. Chapter 2 discusses the development of palliative care services and policies in England. The main topics addressed are the establishment, expansion, and diversification of palliative care services by the voluntary sector and the governmental policies that led to an increasingly close connection between these voluntary organisations and the National Health Service. Chapter 3 is an intermezzo that discusses the main characteristics and developments of the health care system in the Netherlands. Chapter 4 considers the role of nursing homes in the development of palliative care in the Netherlands. It is concluded that these institutions cannot be considered the equivalent of the English hospices. Moreover, two projects to improve care for the dying and their attempts to obtain public funding are discussed. Chapter 5 focuses on various models for specialised services for the dying that were developed in the Netherlands during the 1980s and early 1990s. Major differences with the English hospice based model of palliative care existed as volunteers had a central role in providing palliative care in the Netherlands. Moreover, the Dutch government aimed to develop palliative care as a generalism rather than the specialism that it became in England. Chapter 6 covers the period from the mid 1990s to the present. The policy programme that the Dutch government initiated because of the imminent legalisation of euthanasia, and its impact on palliative care are the main topics. Conclusions, illustrations of the policy relevance of these histories, and suggestions for further research are presented in the final chapter.

Layman's Abstract

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Keyword(s)

England; History of health policy; Palliative care; The Netherlands

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