In The Last Days Of Life The correspondence in The Times on the care of the dying is an indi- cation of the widespread concern at what is undoubtedly one of the gaps in the National Health Service. In a service where resources are limited there is a natural tendencv to concen- trate attention on those cases where there is a chance of recovery, but the outcome can be a quite unnecessary degree of suffering. There is no single solution, as Dr J. C. Cameron, chairman of the General Medical Ser- vices Cormittee of the British Miedical Association, emphasizes in a letter on this page today. The ideal for most people is to die in their own homes among their family and fami- liar surroundings. That is wbere they can receive most reassurance, and when there is no hope of recovery there is often less need of constant highly skilled medical attention and specialized facilities. The care of dying people in their own homes is not always so easy in these days of smaller families and more working wives who have less time to care for their parents. Thc embrace of the family is no longer so extensive as it was. But this trend can be exaggerated. We are not as a people so heartless towards our elderly relatives as popular myth- ology supposes, and family connex- tons and contacts remain closer and more frequent than is often imagined. In a great many cases it is not the will to care at home for the dying member of a family that is lacking. but the means to do so. The first piioritv. therefore, should be the pro- vision of more supporting services in the home. Mviore help is required both in services and in cash. The new con- stant attendance allowance for the disabled is a welcome innovation so far as assistance in cash is concerned, hut nobody could pretend that it pro- vides a complete answer. There is a need not only for more money but also for more phvsical assistance. This would be difficult eriough to supply in any circumstances, but it is made all the harder by the admin- istrative division between health and welfare services that will become wider still when the NHS is rc- organized-though that is a problem which affccts a great many patients apart from the dving. However much is done to improve the supporting services there will, of course. alwatys be a good many pat- ients for whom it is quite impractic- able to spcnd their last davs at home. Tbey mav live alone or thev may require constant specialized medical care. The problem lor them is to find an appropriate hospital place. or evcn in some areas a hospital place at all. It needs to be an appro- priate place in two senses. It needs to be a place with the necessary facilities and attmosphere for the dying. and it also needs to be in a hospital swhich is not geared to the rapid treatment and turnover of patients. On both these grounds a general hospital is usualiv not the answer. Part of the difficulty in finding beds for elderly patients comes about because consultants are reluctant to take in an old person who reallv ought to be in a geriatric hospital. but who might occupy for months or even years a bed that is required for acute cases. The placing of geriatric patients in general hospitals is usu- ally an inefficient use of medical resources. But there are too few geri- atric hospitals. and too many of their places are taken by those w ho could be looked after perfectiv well in old people's homes-if there Wcre enough of them. One reason why there are insuffi- cient geriatric hospital places and old people's homes is that the hospitals are provided by the health service and the homes bv local authoritics. As there are quite a number of old people who can be cared for in one kind of establishment or the other. there is a natural tendencv for both the NHS and the local authorities to leave the expenditure to the other. As in so many other branches of health and welfare provision, there can be no solution without closer cooperation between the two. IN THE LAST DAYS OF LIFE