DAME CICELY SAUNDERS,who has died aged 87, was regarded as the mother of the modern hospice movement; at St Christopher's Hospice, Sydenham, south London, founded in 1967, she charted new approaches in techniques for treatment of the terminally ill, based on her Christian belief that no human life, no matter how wretched, should be denied dignity and love.

Before St Christopher's opened its doors, there had been hospices, mostly run by nuns, which provided comfort for the dying; but they were backward in their understanding of medical techniques. Even on busy hospital wards where many people spent their final hours, very little was known about the management of pain. With a few exceptions, medical and surgical textbooks disregarded the problems of pain control; and chronic pain in the dying was usually either ignored or treated too late, by injection.

Cicely Saunders first had the idea of creating a modern hospice in 1948, when she was working as a lady almoner (medical social worker) at St Thomas's Hospital in London. There she met David Tasma, a young Polish waiter who, having escaped from the Warsaw ghetto, was dying of cancer, in great pain, on a ward she was visiting. Though he had little English, they spent their time together talking about death and the care of the dying: "He needed to make his peace with the God of his fathers, and the time to sort out who he was," she recalled. "We discussed the idea of somewhere that could have helped him to do this better than a busy hospital ward."

Cicely Saunders fell deeply in love and, when he died, he left her all he had - £500 - and told her: "I'll be a window in your home." "It was as though God was tapping me on the shoulder and telling me 'You've got to get on with it'," she recalled.

Carrying Tasma's memory with her, Cicely Saunders became a physician and went on to found St Christopher's Hospice, where she hoped to "help the dying to live until they die and their families to live on". She had no new drugs, but showed how, by using them earlier in anticipation of, rather than in response to, the onset of pain, terminally ill patients could be kept comfortable until the end.

She believed in the importance of allowing patients to control their own treatment, and recognised the need to work closely with families of the terminally ill. The wards of St Christopher's were light and airy and often teeming with children and pets.

In her campaign to establish a hospice, Cicely Saunders encountered apathy, even outright hostility, from the medical profession. Though she was widely revered as a sort of secular saint, it was only through being authoritative, and often downright difficult, that she forced the medical profession to acknowledge what medicine can do for the dying.

The movement changed the face of death for millions of people; not only the dying, but also those around them. By 1993 there were 173 hospices in Britain adhering to her philosophy, Cicely Mary Strode Saunders was born in 1918 at Barnet, north London, the eldest child of an estate agent.

She died at St Christopher's Hospice.

THE DEATH of Dame Cicely Saunders last week has served as a reminder of how recently the hospice movement was created. Driven by a desire to "help the dying to live until they die, and their families to live on", she opened the first hospice in 1967. The movement has since spread throughout Britain, and inspired imitations all over the world.

It appears incredible that, 40 years ago, there was no expertise in pain relief and the other comforts needed to allow for a peaceful death. It now seems like the hallmark of a civilised society to attach as much importance to palliative care as to the more glamorous aspects of curative medicine. And yet, the need for that same kind of care for children is only now becoming accepted.

While adults need somewhere for the last months of their life, sick children need somewhere to go year after year, places in which they can spend time with their families where there is not only expert care but opportunities for them to enjoy their brief lives. Again, Britain has shown a lead.

Since 1982, when Sister Frances Domenica opened Helen House in Oxford, 35 other children's hospices have opened throughout Britain, and seven more are planned.

Britain is in the lead because of our shameless culture of tin-rattling. Our decentralised health system may be clunking and patchy, but energetic individuals are used to making up for its shortcomings; we are happy to bungee jump and give balls for good causes, and also to give our own time.

No other country has those advantages. In America, hospice development has been stymied by health insurance that covers only the last six months of life - and who knows when that will be? The centralised and hospital-based health care systems of western Europe have been slow to invest in the more homely hospices. As for developing countries, caring for children who will not live into adulthood has been low on their list of priorities.

In the past few years, however, that has changed. Visitors are pouring in to learn from our children's hospices, from Japan to the Ukraine, from France to Korea and, most recently, Africa. "I have learnt so much, especially about pain and symptom management, from British hospices," says Joan Marston, who runs a hospice for children with AIDS in Bloemfontein, South Africa. "In 1998, when we started, we had very little idea of what a hospice should be. I have taken ideas and adapted them to our resources - our multi- sensory room, for example, is a simple wooden hut."

The learning is not all one-way. Via the internet, information is swapped internationally on the care of children with rare diseases and those running British hospices have been inspired by how problems are tackled elsewhere. Among recent ideas: training grandparents as carers (South Africa), paid leave for carers (Norway), and the need for spiritual as well as physical support (Poland).

Lack of state funding makes for constant anxiety. While adult hospices receive a third of their funding from statutory sources, children's hospices get only five per cent. Problems are compounded by the growing number of children with life-limiting diseases, some of whom can survive into young adulthood.