Published: 15/12/2005 Volume 115 No. 5986 Page 30

Christmas is many things to many people, but to some areas of the health service it presents significant challenges. Emma Forrest has some advice

...you are a hospice

'The emphasis is on maintaining as much normality as is possible, ' says Association of Children's Hospices care development manager Sonja Ezergailis.

'We always involve the siblings and family members of our patients in preparing for Christmas, decorating and cooking like everyone does at this time of year. Those open on Christmas Day will have lunch and presents and try to ensure Christmas is celebrated.' When hospice patients are so ill that it is thought that they might not live to see Christmas, it is not unheard of for the day to be celebrated early.

'We do get patients desperate to see Christmas, and then it is a question of when they want it, ' says Jackie Leighton, fundraiser and publicity manager at Butterwick Hospice in Stockton on Tees.

'Their room would be decorated, things would be brought in from their home that they would associate with Christmas and the family would be invited in to open presents and have a Christmas dinner, so that in their room it is Christmas Day.'

...you are a mental health inpatient ward

Mental health adult inpatient units are quiet at Christmas, with as many people as possible discharged for the festivities, or given a few days or a few hours of leave.

'I used to quite enjoy working Christmas Day as there is not the usual hustle and bustle; the people who are working want to be and have quite a good time, ' explains Launa Rolf, assurance manager and former inpatient unit matron at East London and the City Mental Health trust.

On a psychiatric intensive care unit (PICU), where patients are likely to be too ill to leave, and on wards where patients have nowhere to go or are not allowed to leave, decorations - including a tree, a special cooked breakfast and presents for all the patients - are part of the ward's festive celebrations.

It might not sound much, 'but on a PICU this can be a significant effort, ' suggests a spokesman at West Kent NHS and Social Care trust.

In the run-up to Christmas, patients on older-age wards will help make cakes, have carols sung to them by local schools and take a trip to see Christmas lights. At West Kent, one of the older people's wards has a 'reminiscence room' made up in the style of a 1940s kitchen, with the sort of home-made decorations many would remember from the Second World War era.

...you are in a multi-cultural area

Hospitals with staff and patients from a variety of backgrounds could be faced with a delicate dilemma at Christmas. Do they go the whole hog with Christmas festivities, choose a politically correct celebration or aim to strike a balance?

Many seem to aim to offer something for everyone.

'Our spiritual care team's services are not exclusive to any faith groups and we usually find that many people from different religions attend, ' says a spokesperson at Homerton University Hospital foundation trust, where a sevenbranched candlestick holder will be placed in the main entrance because Christmas coincides with the Jewish festival of Chanukah.

At Barts and the London trust, the largest installation by trust arts organisation Vital Arts will celebrate light rather than a particular religious festival.

'I do not think people have a problem with different faiths celebrating their festivals, ' says lead trust chaplain Reverend Peter Cowell.

...you are a children's hospital

If it is Santa and stars you are after, children's hospitals are the place to be, with local football teams delivering sackfuls of presents in the days before Christmas, Santa's grotto in outpatients, and plenty of appearances from Mr Claus on the day itself.

'It is wonderful here at Christmas; we make it as magical as possible, ' says Birmingham Children's Hospital trust deputy head of marketing and head of fundraising David Shepherd. 'We have a 30-foot tree donated by the Forestry Commission, and after the lights are put on it in the first week of December we decorate all the main areas and corridors with other trees and decorations. Each ward has a sponsor to help with their decorations.' Local station Radio Lollipop tours the wards handing out presents on Christmas Day and a volunteer (checked out by the police) will play Santa, although as many patients as possible are discharged or allowed home for a few hours to have Christmas lunch.

The Christmas theme is even kept going in accident and emergency, where children will be given presents.