In search of a good death

Editor—Improving the care of the dying in the community is a crucial if neglected area of care, with a significant and far reaching impact. As the Audit Commission's report confirms,¹ too many people are staying too long in hospitals and better community palliative care could prevent inappropriate admissions, reducing hospital pressures and enabling more people to die at home. Ellershaw and Ward point to the improvements made in the recognition of dying and emphasise that a key aim of specialist palliative care is to disseminate this approach to generic healthcare workers in hospitals and in the community.²

Primary healthcare teams believe that palliative care is an important part of their work, and are keen to make improvements if enabled to do so. One means to optimise community palliative care, suggested in the draft supportive care guidelines, is the Gold Standards Framework, a seven point plan to improve the organisation of the care for dying people, beginning with cancer patients but extending later to all dying patients.³

With detailed descriptions of the key issues and suggested measures to address these, this simple framework is beginning to have an impact on patient care, improving communication and proactive planning, enabling more to die where they choose, and raising awareness of patients' needs while also improving the sense of teamwork and morale of healthcare staff. It is already being used by over 500 general practices, including, for example, a third of all practices in Northern Ireland with a successful bid to offer this to every practice in Scotland.

The Macmillan Gold Standards Framework programme, supported by the Cancer Services Collaborative of the NHS Modernisation Agency, provides resources and support for locally facilitated practice teams. As Neuberger points out,² superb care and a good death at home are possible, and are made more likely by such a framework.