While studying sociology as a medical student at Cambridge University, UK, Ros Taylor wrote her dissertation on the social status of the dying. In 1977, 10 years after the first modern hospice opened in the UK, “I was writing about institutionalisation of the dying…and the need for more open awareness of dying”, she recalls. This interest in care at the end of life stayed with her. Taylor is now Strategic Medical Lead at Harlington Hospice and Michael Sobell Hospice, London, UK, and Palliative Lead at Hillingdon Health and Care Partners, a partnership to provide joined-up care for people in west London. She is also a Commissioner for the Lancet Commission on the Value of Death, which sets out a new vision of death and dying and principles to achieve it. “The Commission is looking at changing the industrialisation of medicine that's happened”, says Taylor. “Medicine can do so much now. What we see in hospital is more and more interventions are done, but it's no longer as thoughtful as it could be, and the essential conversations of what matters to people are not taking place. It is the understanding that we are mortal and have a finite time on this planet that needs to be revisited in medicine.”
Taylor's engagement with how we die has defined her career. But she also has personal experience of the impact of a family death. Taylor faced devastating loss when her daughter Phoebe, aged 31 years, died by suicide in 2021. Taylor decided to share her grief on social media and posts thoughts and memories about Phoebe. “Not just to remember her, but also to encourage other people to share their stories. It's certainly helped me to capture the essence of Phoebe, and to challenge the stigma of suicide”, she says. The way Taylor shared this loss points to her openness in talking about death more generally, a feature of her work in palliative care.
After her medical degree at Cambridge and Westminster Medical School, Taylor's interest in palliative care grew when she worked as a general practitioner in Cambridgeshire and Cumbria. “I loved the holistic style of general practice” that existed then, she says. During her decade in general practice, she became drawn towards caring for patients with terminal illnesses and their families. But it was after hearing a lecture by Fiona Randall, a UK pioneer of palliative medicine, that Taylor realised she wanted to work in the specialty. After setting up a small palliative care unit in West Cumberland Hospital, Cumbria, Taylor decided to leave general practice and pursue a career in palliative and hospice medicine. She was appointed medical director of the Hospice of St Francis, Berkhamsted, in 1996 and realised early on that the hospice needed a different building. “I was having serious conversations with families in the bathroom because there was nowhere else to sit down and talk”, she recalls. She devoted the next few years to developing a multidisciplinary medical team and building a new hospice, which opened in 2007. In 2015, she became clinical director at the national charity Hospice UK, a role which included encouraging best practices to be shared and advocating for better funding for hospices. It “opened up a whole new perspective exploring the charitable role; why end-of-life care is funded predominately by charity in the UK and the problems that go with that. I used to rant in lectures about why care of people who are dying was funded by selling second-hand clothes and running marathons, which it still is”, she says. While in this role and missing clinical work, Taylor became an honorary consultant in palliative care at the Royal Marsden and Royal Brompton Hospitals, London.
In these leadership roles Taylor has been a change-maker and supported her colleagues, according to Max Watson, palliative medicine consultant at Western Trust, Enniskillen, UK. “Ros has made good things happen wherever she has worked and has been willing to put in the effort and deal with the organisational challenges to make it happen…As medical director of a hospice for many years she provided leadership by inspiration. She leads by encouraging people to be more than they could ever expect themselves to be and by affirming people's potential,” Watson comments.
Taylor has a special interest in a holistic approach to palliative medicine, first inspired by the 2000 International Congress on Palliative Care, Montreal, QC, Canada. This holistic approach, which she teaches to trainee doctors, “means understanding wherever somebody is in their life, even if they are only days away from death, they are a person with things that matter to them, that they have a past and a present and possibly a future, however short that might be, and we need to understand their priorities. So holistic care has always been about seeing palliative care as relational rather than transactional and seeing the patient as a part of a network within their family and their community”, she says.
To improve end-of-life care, Taylor believes palliative care should be a larger part of training for all health professionals. “Many medical school curricula still have just one day in 5 years focusing on palliative care issues, often with no placements in a hospice or palliative care team”, she notes. Taylor thinks it is a priority for palliative care to be reinstated into primary care in the UK. “I believe that palliative medicine is just good family medicine with more time”, she says. “Most of what we do is talking to people, discovering what and who matters, and seeing if we can facilitate those priorities, those goals of care”, she explains. In her hospice work, Taylor and her team recently helped a 93-year-old man reach his goal of care: playing the piano again. She reflects: “I now see our hospice as a fixer, trying to create memories for the people who are living on. We do an awful lot of that.”