Jeremy Hunt may have abandoned his ‘nuclear option’ of imposing a contract on junior doctors, but the issue still has a toxic afterlife
Health secretary retreats from claim he has right to impose contract – but threat may mean he has misled parliament
Whether you’re a junior doctor going on strike, or a nurse or consultant working in a hospital, we want to hear from you
Scott Murray in The BMJ reminds us that “cradle to grave” is simply not true. End of life care still not living up to public and doctors’ expectations (BMJ 2016;353:i2188 ). The quality of death and dying is being reduced, partly because of staff shortages, partly because of lack of teamwork and tribalism, partly because of unshared electronic notes, partly because of inadequate training, partly because of changes to the GP contract and partly because of funding insufficiency over many years. In general the public has accepted this covert rationing because the victims don’t vote, and they assume it cannot be changed… Dying people are a soft target, just like smokers, the obese and the mentally ill. Surely it is better to know what is excluded, and then we all can as groups, families or individuals plan for the deficit?
Royal College of Surgeons says financially challenged clinical groups are restricting access based on lifestyle factors
Thousands of people are dying hungry, thirsty or in pain, a survey of more than 20,000 grieving families claims.
One in eight people is not getting the food or water they need as they approach death, while more than half of those dying at home are in pain some of the time, the Office for National Statistics poll found.
The survey is the first since the abolition of a checklist that a review found led to dying patients being refused food or drink under harsh protocols. The report found that little progress had been made since the review.
Simon Chapman, of the National Council for Palliative Care, said: “Very little is changing. What’s good remains good and what’s poor remains poor. We need to see improvements in the areas that are lagging.”
The survey of families found widespread dissatisfaction with rushed hospital nurses, who in a fifth of cases were said not to have usually treated the dying with dignity and respect. Overall, 13 per cent of families disagreed or strongly disagreed that the patient’s need for food or nutrition was met in their last two days, while 12 per cent disagreed that their relative was helped to receive fluids. Ten per cent said that their relative’s pain was not relieved.
Fran Woodard, of Macmillan Cancer Support, said the latest findings showed that basic failings persisted. “Dying people and their families should never be left in such terrible distress in this day and age,” she said.
“It is disgraceful that almost one in four carers felt that someone dying of cancer did not get good care overall in their last three months of life.”
Each year in England about half a million people die, mostly in hospitals, which are rated once again as the worst places to die, with 31 per cent saying care was fair or poor. This compares with 18 per cent who said care was fair or poor in care homes and 21 per cent in hospices. Pain relief was best in hospices, where two thirds said their relatives never suffered, compared with 40 per cent in hospitals and 19 per cent at home. Hospice staff were also reported to be most respectful of the dying.
Ros Taylor, of Hospice UK, said: “We urge the NHS to harness the expertise of hospices, especially on pain relief, good communication and support for families, so that high-quality care is available to people at the end of life across all settings.”
The phasing out of the Liverpool care pathway for dying patients in 2014 was meant to usher in more individualised care. An audit by the Royal College of Physicians reported last month that staff were free to act with compassion.
Scott Sinclair, head of policy at the charity Marie Curie, said, however, that people’s experience of the care they received before death had not changed substantially. He said: “There are still areas of concern around pain relief for people at home.”