The NHS and ‘cradle to the grave’

Nick Triggle for the BBC reports 14th May 2014: The NHS and ‘cradle to the grave’

The NHS was set up to provide health care from the cradle to the grave.

22.08.2012: Martin Rowson on Andrew Lansley and the NHS

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…

Everything for everyone forever? (Philosophy, honesty and accuracy)

Why do all the forbidden words in the NHS begin with R: “Rationing”, “Reorganisation” and Rationalisation?

Palliative and Terminal Care should be fully funded.

Death discussions ‘taboo’ for many in UK, survey finds

Ann Clwyd’s husband ‘spent 27 hours on A&E trolley’: “My husband died like a battery hen”

The cover up and denial. “Help us, doctor. We’re frightened of being ill in Cover-up General”

Dead people don’t vote… End-of-life care ‘deeply concerning’

Gagging and Whistleblowing – Raj Mattu to speak directly to Simon Stevens.

Gagging clauses used to protect NHS reputation at expense of safety





This entry was posted in A Personal View, Commissioning, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

4 thoughts on “The NHS and ‘cradle to the grave’

  1. Pingback: ‘Do not resuscitate’ is doctors’ own choice for end-of-life care – but perish the thought to educate patients! | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  2. Pingback: GPs back the right to die for terminally ill | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  3. Pingback: Cradle to grave? Why the cost of dying is rising. | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  4. Pingback: Things are going nuclear over the NHS – cartoon. This is the era for “soft targets”. Quality of dying reflects this.. | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s