Transforming the delivery of health and social care: the case for fundamental change

The majority of my workload at the minute as a GP trainee in a busy maternity unit is the diametric opposite to the care we give people at the end of their lives. Babies are planned for meticulously, their birth plans are discussed with their parents, and the mother is meticulously screened to ensure that the pregnancy has every chance of succeeding. People decide how and when they are to attend hospital, in what circumstances they will deliver, the type of pain relief, and often the position in which they choose to deliver. Babies are given the best possible welcome to a cold, frenetic start in life.

Compare this to 70 years later, on average, and you will find a different picture. People languish in symptoms of their progressive disease states, remember that diabetes mellitus, chronic heart failure, and dementia are all incurable diseases. On reflection most current medicine is palliative; there are few curable disease states within medicine. Death is a certainty, no one has escaped and no one will escape. Some of us will develop end-stage chronic lung disease, end-stage heart failure, or dementia and we should plan for how the end of our lives is spent.

The reality is, demonstrated by the King’s Fund report,¹ that we are getting older and that the years added are not necessarily healthy years. We do not realise that as time passes we are less likely to tolerate an acute deterioration in our already faltering chronic disease. Hospitals and further medicines can buy time; further unhealthy months or years to our lives, but as patients and doctors we should be realising that there are finite limits to what can be done.

Let us recognise that death comes to us all, some of us can plan for the end and let us embrace the end of our lives as we celebrate birth. Plan for how or where you would like to be cared for, what symptoms of dying concern you the most, what spiritual needs you should have honoured at the end of your life, and importantly how you should be remembered. Death is inevitable, but empower yourself, make a plan for how you see the end of your life, and allow friends and family to support you as you leave this world, just as the friends and family of your parents supported you into it.