Pat Davis presides over one of Bristol's largest retail businesses. A sharply turned out executive with an alphabet soup of letters after her name, she has 27 shops under her management in the city, and oversees the financial arrangements for 220 paid staff and more than 700 volunteers, juggling investments and an annual turnover worth millions.
She works from an office in central Bristol, but we meet in her business's premises in the north of the city, an impressive modern building with beautiful, landscaped gardens, dotted with rose bowers, benches and water features. It is a lovely place to work. It is an even more enviable environment in which to die.
Those lucky enough not to have required the services of a hospice are likely to be surprised by St Peter's hospice, for which Ms Davis works as fundraising director. Nowhere to be seen are the cracked pipes and grubby paintwork of too many NHS wards. The decor is light and breezy; cheerful nurses sweep along corridors decked in fresh flowers. It feels calm, quiet, restful.
But this is not the hushed, stifling quiet of imminent death. The corridors are silent because almost half of the beds are empty. Demand for a place is unrelenting, says Ms Davis, but the hospice can't afford to staff them. Despite the 27 charity shops dedicated to raising funds for the hospice, she can't find the cash to care for any more than 10 in-patients at a time.
Most of us, doubtless, prefer not to think of it, but St Peter's is just the place where we would like to imagine ourselves dying: local, pleasant, lavishly staffed by NHS standards, and with a level of specialisation in pain management that is often missing in state-provided health care. The beauty of the place, says Chris Salt, 73, one of the patients, is in the detail: "Every tray comes with a vase of flowers, it makes such a difference."
Reflexology and aromatherapy are as much part of the care as that of the specialist palliative nurses who work there. Rooms are often ensuite, and the baths are fitted with jacuzzis. "If you weren't sick," said Ms Salt, "you would think you were in a five-star hotel".
They have even taken care in the decor, says Hazel Elliott, the nursing director, her voice dropping to a whisper. "I told them we weren't to have any of the bedrooms painted green or yellow. If you are a bit jaundiced, the last thing you want is your skin being reflected in the walls."
We may hope to end our days somewhere so humane, but the question is whether, after we have used up the remainder of our allotted four-score-and-whatever, there will be any hospices left. Of the 230 hospices dotted around the UK, a few are NHS-run, others are managed by specialist charities such as Marie Curie Cancer Care, but the vast majority (185) are independent, voluntary set-ups like St Peter's. They are local charities, locally managed - and almost entirely locally funded. And that, says Ms Davis, is the problem.
The sector's umbrella group, Help the Hospices, has just issued a bleak warning that more than half the hospices in the UK are in financial trouble. Beds are closing, nurses are being laid off, others are dipping into investments and reserves that are just about keeping the bailiffs at bay, but will not last for ever.
The St Peter's site in north Bristol was built three years ago to expand the services offered at another site; in total, it has 20 beds open in the city. But, says Ms Davis, the organisation's funding from the NHS has gone up "hardly at all", despite the fact that service provision has doubled.
As well as the in-patients, up to 120 patients attend St Peter's' two sites weekly through day sessions, where they can have their hair done, consult a doctor, or chat with other patients. The hospice also employs nurses who work in the community, helping patients in their homes and providing specialist training to GPs and district nurses. Within the space of a year, 1,200 patients come into direct contact with its services.
"Everybody is working flat out to keep the service at the level we currently have," said Ms Davis. "If we had more money there are other things we would like to do, but we are running to stand still. This year we start with a £200,000 shortfall. You obviously can't do that for long before you go bankrupt."
Hospice care has never formed part of core NHS provision. While homes for the dying were run by religious groups from the 19th century, the modern hospice movement can trace its origins to the late 1960s, when a small number of hospices were established. A decision was taken at that point to run them as voluntary charities, in order, said David Praill, chief executive of Help the Hospices, to ensure that the service remained of a higher quality than the statutory minimum inevitably provided by the state.
But they were also to remain free and open to anyone. Which meant an enormous commitment to fundraising. And an unrelenting round of tombolas, teddy bear raffles, and local paper photographs of smiling nurses clutching outsized cheques.
As other groups established their own hospices, funds from the NHS remained unforthcoming. But as the population has aged and palliative medicine - offered to those for whom a cure is no longer a possibility, but who need help managing pain - has become more sophisticated, governments have recognised that they have a moral responsibility to care for the dying. Many hospices got their first grant from their health authority in the early 1990s; this now averages just 30% of running costs nationally. At St Peter's, the figure is 20%. And falling.
"We have to match pay awards in the NHS," said Ms Elliott, "or we would never be able to recruit any nurses." Avon health authority, however, has told St Peter's it will get only an inflationary rise for next year. They hope not to close more beds. But they can't go on for ever.
The obvious solution is to remove the en suites, cut out the cut flowers, trim the nursing ratio (often at more than one nurse for two patients) and slash other non-essential services. It's a prospect Mr Praill considers with despair. "There is an intimacy around issues of dying that does not sit easily with the environment of a busy NHS ward," he said, "and we can't begin to resemble that. There is something about end of life care that is different from having a broken leg or getting your tonsils out."
In September, the government announced an extra £50m for palliative care - very welcome, all say, but it remains to be seen whether any of this money will filter down to funding those services under threat.
Ms Salt is packed up and ready to go home today, "feeling much better" after her short stay at St Peter's. In fact, more than half of its in-patients are able to return home after a period of crisis care, or a readjustment of the way they manage their pain.
"This is not a place where people come to die," said Ms Elliott. "These are patients for whom death is inevitable at some stage in the predictable future, whether it's in the next few months or the next couple of years. We tend not to talk about the terminally ill - they are living with their illness, and we try to deal with it in that way."
As we wander the sparkling corridors, I'm shown the family room, where partners can come and spend time with their loved one in the last stages ("We try to keep it like a honeymoon suite").
One of the staff takes me aside and tells me the reason she is proud to work at St Peter's. It is the memory, she says, of turning up at hospital just after her father had died, to collect her mother. She found her shooed out into the corridor, a cup of tea in one hand and a bag containing her father's possessions in the other. "He had the best possible care," she said. "But that is no way to die."
