The report from 'Dying without dignity: Investigations by the Parliamentary and Health Service Ombudsman into complaints about end of life care' came out last week. Seven case accounts are given of people who met their death in ways that are not what they wanted. It is heart-breaking. But this is an important report: and the NHS needs to face the challenges it sets. There is only one chance to get it right. And it is more heart-breaking when it is communication – between professionals, patients and family, that is the fault-line.
To take one example – Mrs G was 82 and seen regularly by a MacMillan nurse. She had asked to die at home surrounded by her loved ones. Abdominal pain, vomiting and shortness of breath forced her to hospital and she was discharged home with a note for her GP to review her, The GP failed to respond, and 12 days later further pain forced her to call paramedics. Again the paramedics asked for the GP to review her. At the oncology clinic where she had an appointment she admitted she was not coping at home and was taken to hospital to wait for a hospice place. She dies a few days later, shortly after moving to the hospice.
The verdict of the report is that “Both Mrs G and her partner had to cope with her symptoms and pain alone because there was no review of her needs. They experienced the distress of her worsening health with little support. We concluded that Mrs G would have been able to die at home as she had wished, if her GP Practice had made proper plans to support her though the end of her life.
Communication around end of life issues are burdened with emotional intensity. It is so understandable. How do we keep talking, listening and acting when we want to avoid the subject altogether? This is one of the questions we will address with our palliative care partners in Hospice Care Week 2015.