Three-quarters of us want to die at home. The reality, however, is that almost that proportion die in hospital. The enormous advances in pain relief and our understanding of how to administer it effectively mean that people rarely need die in agony if technical skills and professional expertise are on hand. In busy hospitals, however, the primary duty is to provide life- saving and life-prolonging treatment rather than the conditions in which patients close to death can spend their last days peacefully and in close contact with their families.

Three-quarters of us want to die at home. The reality, however, is that almost that proportion die in hospital. The enormous advances in pain relief and our understanding of how to administer it effectively mean that people rarely need die in agony if technical skills and professional expertise are on hand. In busy hospitals, however, the primary duty is to provide life- saving and life-prolonging treatment rather than the conditions in which patients close to death can spend their last days peacefully and in close contact with their families.

Organisations such as Marie Curie Cancer Care and Scotland's hospices have brought about a sea-change in the care available to the terminally-ill and their families, but as charities, part-funded by the public purse, they all struggle financially and are able to provide only a fraction of the demand for their services.

Today The Herald reveals that the level of care for terminally-ill patients varies widely across the country, mainly because some health boards support the specialist services to a much greater extent than others. It can vary from an average of 140 hours to an average of 40 hours per patient. In real terms, that translates into only a few days for some patients, compared with weeks for others.

With a general move towards keeping people in their own homes for as long as possible, support for services, such as Marie Curie, is a vital component of fulfilling that aim. Under the present arrangement, costs are split on a 50-50 basis between the health boards and the charity, whether home nursing service or hospice, which provides care and vital respite for family carers. At the moment, NHS Scotland is paying £1.5m toward the home nursing service, but Marie Curie says it is providing a level of care "a good 20%" above the agreed service. While that is undertaken to avoid walking away from families in need, the inevitable consequence is that others not yet in the system will suffer.

Aileen Eland, nurse manager for the Marie Curie in Scotland, says it is a regular occurrence for her staff to tell health board managers they have not been able to see people because there is not adequate funding. Stretching scarce resources to cover ever-increasing demand is the perennial problem of the NHS.

In this case, the service could be extended at a relatively low cost. When it comes to caring for the terminally-ill, the problem is compounded by the fact that they come very low on the list of priorities. It should be part of the calculation that, however willing, families rarely have the expertise to care for a relative full-time at home without professional help, and that consequent hospitalisation will usually cost more.

Setting targets is never the only solution to a problem. However, a target to increase gradually the proportion who die at home could eventually reduce both the large discrepancy between the proportion who want to die at home and those who are able to do so and the wide variation in the levels of care across Scotland. Just as significantly, it would promote a greater recognition of the importance of services for the terminally-ill.