The NHS was set up to provide health care from the cradle to the grave.
But is this really happening in today’s NHS? If you read the latest report from the Royal College of Physicians you could be left wondering.
Doctors who carried out the audit said they found the standards of care provided to the dying “deeply worrying”.
This followed last year’s report by Baroness Julia Neuberger which was highly critical of the way the Liverpool Care Pathway – one aspect of end-of-life care – was being used.
But these concerns are not new. Back in 2000 the Department of Health’s cancer plan was lamenting the fact that too many patients experienced “distressing symptoms, poor care and inadequate communication”.
So what is going wrong? The reasons – as made clear by this latest report – are complex.
It is partly societal. Death still remains a taboo subject in England – and the rest of the UK for that matter.
A survey published earlier this month by the Dying Matters Coalition showed 83% of the public are uncomfortable discussing death.
That reluctance appears to have been transmitted to doctors. The survey showed a quarter of GPs did not initiate conversation with patients.
By comparison, in countries such as Spain there is much more openness about death and a natural acceptance that it is part of the cycle of life.
As a result, death is planned in advance, funerals are much more slanted more towards a celebration of life than an opportunity to grieve than they are here and, in terms of organ donation, the country is a world leader.
Even in the US, which has traditionally been much closer to the UK in approach, attitudes are changing thanks to initiatives such as The Conversation Project, which encourages people to start planning for death with their loved ones….
But – and this is a point made by the authors of the RCP report – there is also evidence it is not being prioritised properly by hospitals.
Between 5% and 10% of patients who come into hospital end up dying there.
Dr Kevin Stewart, who authored the report, says this shows it should be seen as part of their “core business”.
Yet it is quite clear it isn’t. Specialist palliative care services are all too often only available Monday to Friday – something that is virtually unheard of in other areas, such as cardiac care.
While, at the top of trusts, there seems to be little appetite to tackle it head on. Less than half of trust boards had even discussed palliative care in the previous 12 months.
Death, it seems, is too much of a taboo subject everywhere.
Its a taboo to discuss the philosophy of health care, the break up of the NHS, rationing, co-payments and whether we should encourage “everything for everyone for ever”…. Commissioning for death is uncommitted and only partial.. and relatives of non-voting dead are ignored, whilst staff live in fear and are gagged…