Over the past century, medical science has made extraordinary leaps in its ability to help us live long and live well. Progress on dying well, however, is less clear-cut.
A century years ago, 85 per cent of us died at home. Novels from the period detail the rituals and last rites that would precede the final hours. Afterwards, it was not uncommon for the body to be displayed in the house, for relatives and well-wishers to visit and pay their respects. This was a society in which death was still knitted closely into the fabric of ordinary life.
Today the picture is different. With half of all deaths in England now occurring in hospital, a damning report from the Royal College of Physicians and the Marie Curie Palliative Care Institute warns that too many patients are now “dying badly” in NHS wards around the country. That the report follows on the heels of the death of cancer-sufferer Stephen Sutton, a 19-year-old who raised £3.3m for charity from his sickbed, is a galling reminder that few pass with such grace as this inspiring young man seemed to.
We have the knowledge, the technology and the medicine to postpone death for a very long time (this is, ultimately, the core business of the NHS). Too often, though, the importance of specialised care when it finally comes is overlooked.
The central problem, according to the authors of today’s report, is in a lack of training of hospital staff to address the unique demands of end-of-life care, and in communication between those staff and the dying patients and their families.
In both we can see symptoms of the modern taboo around talking about death. In more than half of cases, dying patients capable of discussing it were not told when healthcare professionals had recognised they were entering their last days.
This is an uncomfortable revelation. But we must not be too quick to blame the staff themselves. Breaking such news is a task many in their position might seek to avoid.
There are, thankfully, professionals in palliative care who make it their duty to broach the subject of dying and deal with the lead up to it. Ideally, such professionals should always be on hand to assist patients and families – but the RCP’s report reveals that in three quarters of hospitals, they weren’t available at weekends. Mandatory training for staff in care of the dying occurs at only around a quarter of hospitals. Addressing these two simple oversights would go a long way to improving the way the NHS performs in this crucial department.
Improvements, of course, would not be without financial cost. The worry now is that, with the NHS facing unprecedented financial pressures, care for the dying continues to be seen as luxury when, in reality, it is among the more important services the NHS provides.
The Government says that all patients must receive “high quality and compassionate care in their last days of life – there can be no excuse for anything less”. To that end, hospitals and care commissioners must make it a priority, and if they cannot provide an excellent standard while also fulfilling the myriad other duties of the health service, they must ring the alarm and tell Westminster they need more support.
Broadly speaking, we live well in this country thanks to the NHS. Now it must do more to help us die well.