One of the proudest chapters in British medical history was when Dame Cicely Saunders created the modern hospice movement.

This owed little to the NHS, drawing on an older tradition of charity and compassion, combined in Dame Cicely’s case by strong religious convictions.

It helped to create the specialty of palliative medicine and transformed the final hours of millions of people.

So the End of Life Care Strategy is welcome, but long overdue. Until now, it has been charities that have largely held the hand of the dying.

Marie Curie Cancer Care pioneered the Delivering Choice programme, to give the terminally ill a chance to die at home.

The efforts of its director, Tom Hughes-Hallett, to keep up pressure on ministers have been rewarded by a promise that the Government will honour its 2005 commitment to double funding for end-of-life care.

Caring for the dying involves a tricky balance between intervention and standing back. Health economists in the US have calculated that 30-50 per cent of lifetime healthcare costs occur in the last six months of life.

But American physicians are notorious for overtreatment. In Miami in 2006, the average six-month curtain call involved 46 doctor consultations; more than six days in an intensive care unit with a 27 per cent chance of dying in it; and a cost of $23,000.

The NHS tries not to surround the dying with the full apparatus of advanced healthcare; indeed, it may not try hard enough to save the old when their prognosis is good.

But even so, the money that Alan Johnson has promised is modest. When he pledged the funds in 2004-05, the NHS budget was £69 billion. By 2010-11 it will be £110 billion. Doubling the small slice of money spent on the dying - after a period in which the NHS budget itself has nearly doubled - is not as generous as it appears.

The sum to be doubled is that spent on palliative care, about £180 million. By 2010-11, this will rise by £198 million. As a department spokesman put it, this will “more than meet the manifesto commitment”. A harder question is whether it will meet the need.

The total cost of end-of-life care is measured in billions, the strategy admits; the promised funds are a small proportion of the total.

And ministers love making promises with our money; but they also promise an NHS “locally led”. If local leaders opt to spend the money on something else, nobody is going to stop them. And if such promises persuade people that they no longer need to support hospices and charities because the NHS is looking after the care of the dying, we could finish up no better off.

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