The future NHS will not cure death, but it can facilitate the transition

The future NHS will not cure death, but it can facilitate the transition

The future NHS will not cure death, but it can facilitate the transition

Infrastructure for specific palliative care research is scarce and academic posts in medicine are proportionately much fewer than in other medical specialties (Getty)

Infrastructure for specific palliative care research is scarce and academic posts in medicine are proportionately much fewer than in other medical specialties (Getty)

â € ‹â €‹ Health care “from cradle to grave” is the founding promise of the NHS. Yet what a sanitary contrast there is between those bookends of our lives.

The care that brings us to the cradle is proactive, research-based and commissioned according to the needs of the population. “Crib care” begins as care and advice for people seeking pregnancy (including the amazing medical and scientific developments that now allow previously infertile couples and individuals to conceive).

Then there is assistance during pregnancy, with careful development of birth plans that respect parents’ choices, giving priority to child safety and careful obstetrics during pregnancy and labor; and then the newly born human takes his place as the recipient of the NHS care from the cradle.

There is a demand for increased funding for maternity services to improve access and safety, to ensure that planning is sound, that all travails are carefully managed and, when needed, rapid and expert interventions. Reaching the crib safely is a priority.

But what about the passage to the tomb? The death rate in the UK stubbornly remains at 100 per cent; about 1% of the population dies each year. How carefully is caring for those who are dying, a process that will affect every citizen, being commissioned, planned and delivered? Is there the same focus on providing proactive, research-based care at the end of our life as at the beginning? What about planning ahead and respecting people’s choices about the place of care or treatments they want to avoid, or access to expert supervision of changing health needs as the end of life approaches?

Unfortunately, research on palliative care is underfunded. It is estimated that of the National Cancer Research Institute’s (a coalition of British research organizations) annual budget of over £ 600 million, less than 0.7% goes to palliative care research – that’s 70p for every £ 100 of healthcare spending. Research.

The National Institute for Health Research (funded by the Department of Health and Social Care) has an annual budget of over £ 1.2 billion and does not list end-of-life care research projects in its annual statement for 2021 -22. Infrastructure for specific research on palliative care is scarce and academic posts in medicine are proportionately much fewer than in other medical specialties.

Planning ahead is a little better. GPs have been tasked for decades with “finding their 1 percent” – to try to identify those people who are likely to be in the last few months or years of life and to invite conversations with them that they will begin defining personalized care plans for. when the end of life approaches. But with citizens’ reluctance to consider their own mortality and GP time reduced, these conversations don’t unfold systematically.

The future NHS will not cure death, but systematic consideration of our individual care plans remains possible. As with birth plans, end of life plans can describe our aspirations, but recognize that our care may need to be flexible to accommodate the circumstances we face. We may prefer home care while sitting reading our newspaper today, but closer to death the idea of ​​being assisted somewhere with competent staff to help us move, use the toilet, bathe or eat may seem more tempting.

Today we may think that any treatment that offers a few more days of life would be worthwhile, but closer to the end of our life we ​​may find ourselves clearly preferring treatments that prioritize our comfort and reduce our care burden.

In pregnancy, the path to see the doctor and start planning is clear: a positive pregnancy test triggers a series of actions for the pregnant person to seek contact with health services. However, in end of life care, with no test sticks to initiate planning initiation, the onus is currently on the NHS to seek out those of us who would be well advised to put our plans into action.

I wonder what would happen if we all took responsibility for our planning instead. Only mortals need trouble, of course. Just as we receive invitations to attend health screenings and choose whether to attend, why not send us advance planning information at regular intervals, perhaps from our 45th birthday onwards, at five-year intervals?

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An individual’s preferences and plans, of course, will evolve over the course of their life as lifestyle, commitments, health, and social circumstances change. Planning ahead cannot be a one-time event, it must become an “in my life” process with regular review points.

The process of death itself is as old as humanity. It is a recognizable process that we can anticipate, just as we can anticipate the usual process of labor and delivery. The future NHS requires staff to be trained and familiar with “ordinary dying”: able to recognize it and offer adequate supportive care without unnecessarily complicating the process by escalating costly medical interventions that will not prevent our death, but they could very well prolong our death.

Readers who would like to ponder some of the decisions that may arise for many of us are welcome to look at Hospice UK’s Planning Ahead tool. Full disclosure: This is a work in progress, feedback via an integrated feedback tool is encouraged and I am one of the working groups involved in its development.

Dr. Kathryn Mannix is ​​a retired doctor and palliative care writer. Her first book, “With The End In Mind”, was selected for the Wellcome Book Prize. Her latest book, “Listen: How to Find the Words for Tender Conversations”, is published by William Collins

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