Some years ago I received a cheque for £1000, from a patient, to be shared; doctors, practice nurses, practice staff, district nurses, nursing care assistants and the local authority carers – in fact everyone who had been involved in his care at some point in his final years. The cheque arrived after his death, when his estate was settled.

He had been pretty fit all his life, well into his late eighties. But in the last two years his health really fell to bits. Surgery for prostate cancer had left him with urinary incontinence. Awful, advanced osteoarthritis in both hips and knees left him with poor mobility, unable to stand for long or get about, limiting him to living in a ground-floor room in his rambling, Victorian, former guest house. He was left increasingly unable to care for himself. But at least his mind was as sharp as a pin.

He lived alone, his wife having died a few years previously. His two daughters were very caring and tried to do as much as they could, but living 200 miles away, with young families and work, made this difficult. He was provided with regular daily social care, along with frequent district nurses and nursing assistant visits aided by regular GP input, enabling him to remain at home. A family home he and his wife had set up 60 years previously, with many happy memories, it seemed fitting that he was able to spend his last days there.

The problem was that the money came with conditions attached. He had been a real party animal in his younger days, so it was no surprise that he stipulated it was only to be spent on a memorable party for all of those involved in his care, along with their partners.  Furthermore he did not want it to be spent directly on health care, donated to health care charities or in any way be sucked into the NHS coffers.

Initially, this sparked some excitement and planning, until it became apparent that different rules applied to the people involved. The doctors, as independent contractors, whilst required to declare gifts in excess of £25 to their contracting authority, were able to keep personal gifts with no limits, so no problem there; the practice nurses and staff, as employees of the doctors, likewise were able to keep gifts on agreement with the doctors; but the district nursing staff employed by the local Heath Care Trust and the care assistants employed by the local authority were forbidden, by the rules operating at that time, from accepting any gifts, except for limited, inexpensive items such as chocolates or flowers.

How would you resolve the conundrum?

Dr Malcolm Hickey