Wednesday, July 14, 2010

UK is the best place to die

I've just come across a fascinating article called "The Quality of Death: Ranking End-of-Life Care Across the World"

Dying is something not many of us really want to think about but it is surely reassuring to know the UK has come out on top when ranking 40 countries on the quality of death. It seems the UK is the ‘best’ place to die. Dying is one of those subjects that feels a bit taboo - even to write about but I suppose we all need to lobby for 'service excellence' in the delivery of care for people who are coming to the end of their lives.

I spent three years of my healthcare career based in a hospice. I found the front line folks who work directly with the patient and their family in end of life care to be totally inspirational.

Click here to read the report


Mark JF said...

I'm afraid I thought it was very misleading. I really don't want to talk us down (I'd prefer to die here than in many other places, although not for many years yet!) but there's a long way to go and we're kidding ourselves if we think we're top of the table.

The Index splits into 4 categories and we score 28th, 1st, 18th and 1st in the 4 categories.

One category where we come top gives a 25% weighting to the simple existence of a written government strategy. In other words: write it up, tick the box and score high. No measure is given as to whether the government is actually implementing, never mind achieving, that strategy.

The other category where we come top gives a 25% weighting to public awareness. In other words, talk about it and score high.

We come 28th on the measure that looks at the general healthcare: the number of nurses per 1000 population, number of doctors and healthcare spend etc.

We come 18th on the measure looking at public funding of palliative care.

So my take on it is this. In the UK, we talk about death and how to manage it in an open way. However, we don't spend a great deal on the healthcare system or palliative care that surrounds it. It's yet another sorry Labour legacy: lots of spin but lacking in substance.

Trevor Gay said...

Thanks Mark.

The worldwide hospice movement started here in the UK in 1967 and I am proud of that.

It is well known that the NHS has never spent enough money on end of life care in hospice care or in the community.

I would say to you in all seriousness more money has been spent on this important part of healthcare since 1997 than ever it was prior to the Labour Government being elected.

Mine is not a political point here it’s an emotional one. I'm pretty sure the current government will also increase spend on end of life services.

This report is from an independent organisation and has nothing to do with Labour Party spin.

A good yardstick of how a country's priorities might be measured is how it looks after people in the last days/weeks of a person’s life.

You are right that if we look at the figurers and weightings in detail there are areas where we need to improve. Looking at the overall scores of all 40 countries and adjusted by relevant weighting factors the UK does emerge on top.

Perhaps the best thing to emerge side that it will highlight the need for us all to think about the policy and the necessary investment we all have to make to ensure that people who die in a care setting do so in dignified, caring and respectful circumstances.

I am with you completely that we must not be complacent – there are huge areas where improvement is needed. That will mean more investment is needed from the tax payer – I hope we are prepared to pay the required amount.

Marilyn Jess said...

I'm so glad you posted this article. One thing you don't know about me is that I led a group who set up a palliative care suite in the nursing home I worked in. This was about ten years ago.

People are still thanking me for this--I now work there again as a consultant. Every week I see the value of the right care at end of life. We are changing attitudes about death, one family and one doctor at a time.

As a society there is still a long way to go. Less people are dying in hospitals in the US, and that's one step forward.The UK led the way in hospice care, and that's a huge achievement.

Trevor Gay said...

That's brilliant Marilyn - well done for setting up the palliative care suite. I was in awe f the folks who cared for patients in the hospice at which my office was based. I never got the hands on experience but it was inspirational to see the work close up.

I think I’m right in saying the overwhelming opinion from professionals and patients is that hospital is not the 'best' place to die.

I was recently moved to tears on hearing a widow describe the final hours of her late husband for whom she had cared for 15 years as his illness worsened. She had researched and spoken to professionals about the best way a patient can be supported in those final hours. In the case of her husband it was made a ‘whole family’ occasion including grandchildren whereby her husband was physically held closely and lovingly by various family members until he took his final breath. She described it so vividly that I felt the unmistakable dampness from my eyes.

JOHN O'LEARY said...

In the States you can't bring up this subject in the context of healthcare without dim-witted politicians raving about euthanasia or death panels. It makes us look like buffoons to the rest of the world. (No wonder I like Green Day's "American Idiot" so much.) But now that our healthcare reform bill has passed, I guess nothing matters anymore because—as several Republican politicians have said—this healthcare bill guarantees "Armageddon."

Trevor Gay said...

Oh dear John – those Republican politicians really need to get a life. They have a negative impact on the image of your great country as a caring, compassionate, society that I recognise so well through my discussions with so many of you.

I feel a judgement can be made about any nations priorities by looking at how it cares for the frailest among its population. It’s a no brainer as you folks say.

Who at the end of their life wants their value to be judged by their wealth? That is what those same Republican Capitalists would no doubt use as a yardstick of ‘success.’ – What rubbish!

Call me old fashioned my friend but socialism still resonates with me.

I would love to believe the ‘trickle down of wealth’ concept that your Republicans and our Conservatives peddle.

The reality is individual greed takes over – we only have to look at why the world is in financial meltdown.

VNicole said...

I honestly believe quality of death should be just as important as quality of life. Many people die alone and in pain in America, unlike other countries where people die with family. I know I have no intentions on dying alone. We really need to place more emphasis on making death a wonderful experience, although it is a sad moment. It may seem weird to plan a great death, but it is better to plan something wonderful then suffer through something horrible. Great Post!

Trevor Gay said...

One of my heroes in life Tony Benn -now 85 years young tells how his mother described death as "Gods last and greatest gift to the living"

That is just wonderful don't you think?

suniti said...

Where we die may not be much in our hands but - what we die as ,could be.
Always being in communion with the Ultimate may keep us in a peaceful frame of mind even then and enjoin Bliss

Trevor Gay said...

Many thanks Suniti - profound comments.