Mary Baines, who has died aged 87 from Parkinson’s disease, was the doctor responsible for setting up the UK’s first home care team for the dying, based at St Christopher’s hospice, Sydenham, south-east London, in the 1960s. Its pioneering model of palliative care at home, involving a group of healthcare workers supporting patients and their families, has since been replicated and adapted around the world. In the UK more than three-quarters of palliative care is now provided in the community and there are nearly 300 similar care teams.
Baines had been working in general practice for seven years when in 1964 she heard Dame Cicely Saunders, who founded St Christopher’s, on the radio, appealing for money for her new hospice. Baines had trained in medicine at St Thomas’ hospital with Saunders.
“At this time, doctors had no interest in people who were dying – they were only interested in people who could be cured,” she later said. “I thought it was very odd, this idea of caring for the dying.” Nonetheless, she made a donation of £3 to the radio appeal and did not anticipate further involvement.
When Saunders then got in touch and invited her to join the hospice, Baines’s medical friends advised against it for the sake of her career. But inspired by her Christian faith, she went ahead, and spent the next four decades involved in research, teaching and mentoring junior doctors in the new field of palliative care.
Born in Wallington, then in Surrey, Baines was the daughter of John Silver, a teacher, and his wife, Marjorie (nee Tripe). From Croydon high school she went to Newnham College, Cambridge, where she gained a first in natural sciences. She completed her medical training at St Thomas’, qualifying in 1957, and went to work in the hospital’s casualty department. From there she became a general practitioner in Norwood, south London.
Not long after she joined the medical staff at St Christopher’s in 1968, the need for home care became apparent to Baines and Saunders. A woman in her 50s with advanced breast cancer asked to go home after being treated at St Christopher’s, but had to be readmitted to the hospice 10 days later because her GP had reduced and then stopped her pain-relieving drugs, believing as many did at the time, that she might become addicted.
Baines later explained: “It was this incident that prompted Cicely Saunders to say ‘We must start hospice care at home now.’”
The textbook that Baines wrote with Saunders in 1983, Living With Dying: The Management of Terminal Disease, criticised the practice of giving pain relief only when patients asked for it as “indefensible” and said oral morphine should be given regularly every four hours.
The first team of palliative home care started work in 1969, combining the skills of local GPs, district nurses and cancer nurses, who went into patients’ homes, advising on and administering pain relief and supporting families, on a 24-hour basis.
“Mary was a meticulous researcher and this helped in the early days when medical colleagues tended to see hospice care as tea and sympathy with the odd drug thrown in,” said Gillian Ford, former deputy chief medical officer at the Department of Health, who was seconded to St Christopher’s from 1985 to 1999 to help develop palliative medicine as a speciality.
Gifted with empathy and a gentle manner, Baines was determined that hospice practice should be evidence-based. Taught by Saunders that patients preferred doctors to sit on the bed, rather than stand over them, she was gratified when a study proved this to be the case. “It is necessary for everyone to review their clinical practice and ask whether the things they do are based on hunch or proof,” she said.
Baines travelled widely promoting the development of hospice care in India, South America and Eastern Europe. She also gave talks to schools. She once described herself as the “doctor with the longest experience of a hospice in the world”. In autumn 2019, at the age of 86, she travelled to a conference in Buenos Aires. She was appointed OBE in 1991.
After retiring from St Christopher’s in 1997, Baines became part-time medical director at the Ellenor hospice, Gravesend, Kent. But she returned regularly to Sydenham to greet groups of professional visitors, explain the history and give them a tour of the hospice, where she also died.
Her husband, Ted Baines, an Anglican clergyman whom she married in 1958, died in 2017. She is survived by their children, Rachel, Tim and Simon, and eight grandchildren.
• Mary Jean Baines, palliative care physician, born 29 October 1932; died 21 August 2020