Despite significant improvements in recent years, care of the dying is too often a lower priority than saving lives.
Death and taxes are famously the only certainties in life. And it is pretty certain that we’re going to see a lot more of both in coming years.
We need to face the fact that for the foreseeable future, most people are dying in hospital
I’m happy to leave taxation to the politicians and economists. But I do know a bit about death - Marie Curie Cancer Care directly cares for 29,000 of the more than 570,000 people who die in the UK each year. And one thing we can be confident of is that the death rate will rise steeply in coming years. It is estimated that between 2012 and 2030, annual death rates will rise by almost 17 per cent to nearly 590,000 deaths every year in England and Wales alone.
That is a significant change for any health system to cope with. However, the challenge is not just to cope with an increasing number of deaths. With better medicine, improved nutrition and less smoking, people are living longer, meaning that many of us are going to be significantly older when we die.
By 2030, those of us aged 65 and over will account for almost 87 per cent of all deaths and almost 44 per cent will be 85 or older. While there will continue to be many cancer deaths, most of us will die of other conditions and have far more of the complications of old age and long term illness.
There’s a big difference between caring for a 66-year-old ex-steelworker with lung cancer, and the same gentleman aged 90, when he also has mild dementia, severe arthritis and a terminal heart condition. While it certainly is possible to nurse someone who is very frail, with multiple conditions, in their own bed, it is more difficult. Home deaths are already far less common in the over-85s, and for patients with non-cancer conditions. This is going to be a huge challenge for health and social services, and for the charities that aim to make it possible for people to choose to die in their own homes.
Home deaths have already fallen, and if we allow things to drift, demographics will lead to even fewer people dying at home and more in hospital. It’s expensive to look after someone with complex multiple needs in hospital and the hospital model of care is based around getting better. Despite significant improvements in recent years, care of the dying is too often a lower priority than saving lives.
There is a real risk that hospitals could become warehouses for dying elderly people. Data from the Healthcare Commission shows that a significant number of complaints about hospital care are related to care of the dying. This is not acceptable in a modern society.
Unless we start to plan now, this will be a major issue for whoever is running our health and social care services during the next 10 years - and a huge problem in 20 years.
Evidence from Marie Curie’s delivering choice programme shows that with the right kind of care a lot of inappropriate admissions to hospitals can be prevented. In other cases, people can be admitted for short periods, and discharged after care.
There is much we can do to make sure that more people get the right care in the right place at the right time. Offering more home nursing, backed up with the ability to respond quickly in a crisis, with hospices acting as hubs across the community will enable us to respond to people’s needs and preferences far more effectively. Communities will much more effectively be able to support people to stay at home until the end of their lives, if that is their wish.
Marie Curie is working to provide patients with greater choice over their care, and place of death, rather than to specifically reduce the costs of palliative care. But, even during a time of significant economic challenge, it should still be possible for people to get the high quality care they want, where they want it and at no more cost to the taxpayer. A King’s Fund evaluation of the delivering choice programme in Lincolnshire showed that it is possible to significantly increase the proportion of deaths at home and decrease the proportion in hospital at no additional overall cost while freeing up invaluable hospital beds.
At the same time, we need to face the fact that for the foreseeable future, most people are dying in hospital. That means we must continue to make hospitals a better place to die.
As the election approaches, we are going to hear a great many pledges and aspirations. Here’s one of very few commitments that really would make a difference to every single voter. Let’s free up urgently needed hospital beds by giving more people the choice to die in the community. Let’s make Britain a better place to die.