Palliative care programmes have expanded enormously in recent years in Spain, with great success in terms of coverage of the target population and opioid consumption, but at the expense of deficiencies in the training of professionals and scarcity of fully comprehensive palliative care systems. A balance has developed with an almost even distribution of resources between home care and in-patient services, in spite of a strong tendency in recent years to prioritize domiciliary care in the wake of policies requiring limitation of health expenditure.