Eleven years ago a good friend died of lung cancer in the palliative ward of a London hospital. Since the operation(s) had gone wrong and he was only 62, it wasn't ideal.

But he was being looked after and he died in the night.

I thought of his case when reading the Department of Health's end of life care strategy which seeks to remedy so much of what sometimes goes wrong. "How people die remains in the memory of those who live on," said Dame Cicely Saunders, the hospice pioneer. It's quoted on the front cover.

Indeed. Another chum, also felled by Big C after his symptoms were missed by busy GPs, died suddenly in hospital at a time when his wife was excluded for having a cold. The thought that I last saw him after she did still embarrasses me.

Death, which was so common among children and young adults in the age of infections a century ago, is now largely a matter of old age and chronic illness. Familiarity has decreased.

So we can do better managing death at home and probably will. Alan Johnson and his social care minister Ivan Lewis have doubled the palliative care budget - to£380m by 2010-11 - despite ever-tightening economic constraints.

But unlike the US, where they throw high-tech dollars at staving off the inevitable, it isn't primarily about money. It's about "attitude and priorities," as the King's Fund's Niall Dickson noted. On a practical note it's about pain management at home.

Here is an activity where the state, voluntary and even private sectors should be able to do more together than apart. That's the future in all healthcare models, as a useful - and provocative - document from Charles Clarke also reminded us all this week.

Yes, that Charles Clarke, the former home and education secretary. What does that burly wannabe heart-attack know about health, I hear you murmur?

Not a great deal perhaps, though as a Norwich MP he witnessed the downside of an early PFI hospital.

But he's also a very bright chap with time to kill since flouncing out of the Blair cabinet rather than accept demotion, a self-indulgence that still rankles with me. Gordon Brown could do with more colleagues willing to stand up to him.

Anyway, Mr Clarke has produced a paper designed to stimulate debate on "user charges" as a means of promoting both efficiency (the better use of taxpayer resources) and fairness in public services.

As you will have spotted "user charges" is a euphemism. It covers everything from NHS prescription (and parking) charges to London's congestion charge, the cost of your passport or TV licence, the M6 toll, pre-school nursery fees and that capped tooth. Oh, and Mr Clarke's own baby, student tuition fees.

As Nye Bevan demonstrated by resigning over prescription charges in 1951, they are often emotive and "politically poisonous". Yet, as Mr Clarke points out, many progressive social democratic states use them widely. Emotion is the enemy of rational debate, something he should have told himself before resigning in 2006.

He's aware charges drive away the poor, but says they can be protected. Transparency, which reveals real costs (vital to green taxes) and cuts out waste (a classic is the small charge for GP visits), can also generate more money for more services: charges for nurseries is a good example.

Mr Clarke actually opposes Swedish-style fees for the GP because its purpose is to curb demand by cutting no-show waste. He does favour co-operation with non-NHS sectors, for instance via better insurance and co-payments (state and patient both contribute) for old age social care - and much else.

A core of free NHS treatments based on medical/health need could be augmented by a more flexible non-core group for which people might pay for within the NHS because they are essentially cosmetic or "clinically ineffective".

Occupational health systems should be better tied into the NHS, especially over work injury; scans and foreign-trip jabs might be paid for; patients and their families could pay for a wider non-medical "menu" of hospital services. All would extend choice and generate funds.

Mr Clarke warns the left not to denounce this as "privatisation" and the right not to shout "stealth taxes." Let's talk as adults.