More elderly people than ever are suffering from conditions such as cancer, heart disease and dementia, with many facing long, protracted deaths. High quality end-of-life care is essential if we are to give everyone the dignified end they deserve.
Happily, in a report issued by the Economist Intelligence Unit, Britain’s end-of-life care was voted best in the world. There was praise in the study for both the quality and availability of services, and (unsurprisingly for an NHS that is free at the point of need) it received top marks for affordability too.
Rankings in the survey were based on quality of environment, staffing numbers and skills, affordability and quality of care. Predictably, rich nations tended to perform best with Australia and New Zealand coming in second and third, but the report also praised progress made in some of the poorest countries.
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End-of-life care: The best and the worst |
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Top 10 |
Score out of 100 |
Bottom 10 |
Score out of 100 |
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UK |
93.9 |
Iraq |
12.5 |
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Australia |
91.6 |
Bangladesh |
14.1 |
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New Zealand |
87.6 |
Philippines |
15.3 |
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Ireland |
85.8 |
Nigeria |
16.9 |
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Belgium |
84.5 |
Myanmar |
17.1 |
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Taiwan |
83.1 |
Dominic Republic |
17.2 |
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Germany |
82 |
Guatemala |
20.9 |
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Netherlands |
80.9 |
Iran |
21.2 |
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US |
80.8 |
Botswana |
22.8 |
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France |
79.4 |
China |
23.3 |
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https://www.bbc.co.uk/news/health-34415362
Chief Executive of the National Council for Palliative Care, Claire Henry, said:
“At its best, how the UK cares for people who are dying is absolutely world-class with hospice care leading the way, but there can be no room for complacency, especially as the demand for palliative care is increasing.”
Of course the long-running argument underlining all these figures is how best to provide a dignified and comfortable death. Two years ago, the ‘Liverpool Care Pathway’ – a checklist system devised for those in the last stages of life – was scrapped amidst controversy. It was thought the tick-box culture had gone too far and the system had let people down. Cases of water being withheld from some terminally ill patients and sedatives being given when they were not required were reported.
New guidelines were drawn up last year but it is tricky territory to navigate, with some warning that the focus has shifted away from caring skills, as increasingly technical knowledge is required of nursing and care staff. Indeed, more consideration should perhaps be given to whether it is always right to attempt to extend life with modern drugs and technology, whatever the quality of life that the patient is left with.
The National Council of Palliative Care has welcomed the new guidelines, saying that they mirror a cultural shift towards a more caring society. But conversations, they argue, need to start much earlier so that loved ones can really make their wishes clear and ensure they are aware of all their options.
Palliative care is something that is well integrated into the NHS and the UK has a strong hospice movement. But these days, hospice care may not be what many expect. Although many patients may be frightened of entering a hospice, believing that they are all about the final stages of an illness, around half the patients who use the UK’s 200 plus hospices are discharged and given help to cope with their condition from home. They receive longer-term medical support while staff help to prepare their families for bereavement. About 30% of people with a terminal condition in the UK receive help from a hospice at some point, with 1 in 10 people dying in them.
Most hospice staff believe that it is simply a matter of taking more time with patients. Just spending that extra few minutes explaining something, or sending a concerned text message at the right moment, can make all the difference to someone. It’s all about quality of life and letting people know that, as they face their final years, months or days, they have options and they are not alone.
It’s good to know that UK tops the table for this type of care. And when dealing with end of life patients, a shift to a more personal approach can only be a good thing. After all, it doesn’t get much more personal than death, and it is something we all have to face at some point.
Sources: