Care of the dying 'society's litmus test'

The coalition wants more people to be able to have the death they want

Every minute someone in the UK dies - and most deaths still occur in hospital.

But in this week's Scrubbing Up Prof Mayur Lakhani, chair of the Dying Matters Coalition which aims to change public attitudes towards death, dying and bereavement, says most people would prefer to die at home - and that major changes are needed to allow people the death they want.

It has been estimated that in England alone around 92,000 people do not receive the palliative care that they need when they are dying.

Many complaints about hospitals are to do with end of life care.

Meanwhile, the number of people dying each year in England and Wales is set to rise over the next 20 years.

How prepared are we as a nation to deal with this demographic time bomb? And what does the NHS in particular need to do?

'Home is best'

The NHS is not currently geared up to help people die at home.

As a practising GP, I know this only too well. Current services are inconsistent and fragmented and nowhere near strong enough in the community. Services are part time and not 24/7, which is what dying patients need.

The default is hospital admission.

But this is not what people want.

In a survey by British Social Attitudes, launched to mark Dying Matters Awareness Week, one of the strongest messages from the general public is that hospital is not the place where they want to die.

Only 7% of us say it's the place we want to end our days, while two thirds say that home is the best place to die.

And here is the profound mismatch between our wishes and our reality.

Currently only one in five of us will die in our own home while over 50% of us will die in hospital.

A new deal is therefore needed for a 24/7 community service for patients at the end of life.

Wake-up call

What are the prospects for this happening?

Several things need to change.

We need much stronger leadership and planning.

The advent of GP led commissioning (clinical commissioning groups or CCGs) is an exciting, and unique opportunity to do something very special.

The reforms have been controversial, but for the sake of the patients everyone must rally round for better quality.

Most people do not want to die in hospital - but the majority do

How we care for the dying is a litmus test for our society.

The attention paid to this area by this government should be applauded.

But it can go even further to deliver a stronger, caring and compassionate nation to deal with the predicted demographic change.

Earlier this spring, the House of Lords published a report which contained an urgent wake-up call to all of us by warning the UK is woefully unprepared for an ageing population.

The government should prioritise action by publishing draft proposals on how we should support older people in the last years of life.

As the number of people over the age of 85 is set to double over the next 20 years, the UK needs a new focus on health, wellbeing, housing, care and support for this emerging cohort.

Dignity and compassion

The case for change remains very strong and urgent, especially with the huge public concern in the light of the Francis report.

Practically, NHS England and must accelerate improvement now and transfer resources from hospitals into communities and to develop stronger strategies for services working together.

The medical professions must play their part. They need to bring back dying into people's homes by adopting a different approach to care.

They should recognise that death is inevitable and not a failure, and make sure dying people get the dignified and compassionate care they need, for example by encouraging the use of more advance care plans.

But we mustn't just leave dying just to the professionals.

We all have a role to play with our families and friends to face up to death, to be better informed and more confidently plan for the end of life.

The Dying Matters Coalition is asking everyone to consider five things: write a will, record funeral wishes, plan for future care and support, register as an organ donor and tell loved ones their wishes.

We should be optimistic.

Things are improving and the number of people dying in their preferred place of care is increasing.

More and more people are talking about dying and death. But we need to go even further.

The way we care for dying people is a measure of our values, there are no dress rehearsals and only one chance to get it right.