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Bringing palliative care back home

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Patients should be able to die at home Patients should be able to die at home

I’ve long been interested in palliative care – specifically why we struggle to have an adult conversation about something the UK pioneered. Just under 50 years ago, the first ever hospice was opened in London through the efforts of the great Dame Cecily Saunders. Significantly she began her career as a nurse. When the curers run out of steam, the carers come into their own.

Last week a report revealed that hospitals still struggle to provide adequate palliative care. To me it misses the point. Surveys show that three quarters of cancer patients would rather die at home, but only 27% get there. Can’t we do better?

There’s a perception that palliative care is a kind way of letting nature take its course, an opiate-laced version of a cool flannel on the forehead. Rather it is a refocussing of priorities. Conventional medicine asks the patient to sacrifice quality of life now for a future benefit, palliative medicine lives in the present to help the mortally ill maximise their quality of life there and then. The hospital, with its emphasis on throughput and productivity, is not the optimal setting for it.

So maybe it’s time to look again, to build on the excellent work of folks like Macmillan, and join up primary care with social care with families and friends. Allowing a patient to fade away at their own pace by the bedside light, rather than under the strip light of a ward, is, in its own quiet way, as noble an aspiration as any we have in the NHS.

Mike Shallcross, acting editor, Independent Nurse

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I have been nursing for 40 years, and last year brought my mother home to die - as had been her wish. I was devastated to find, though, that GPs and district nurses do not communicate with each other any more, and the district nurses are so stretched that my mother was left in terminal agitation for 4 hours before the only 111 GP finally arrived from an hour away. He had been busy with a sick child. I bitterly regret bringing her home, as in hospital she would have waited a maximum of half an hour for a qualified nurse give the IM medication (she was unable to swallow oromorph). So before we start to increase the district nurse/GP workload by encouraging more people to die at home, we have to first address staffing levels and safe levels of care. As this involves extra finances, I doubt that safe care of the dying at home will ever be realised. I believe that instead we need our own Dignitas in this country, with an honest discussion about what the choices it offers, and the research which supports it. There is absolutely no evidence that in Switzerland or the USA that anyone feels "pressurised" to end their life, which is the current popular stumbling block in this country, based on fear not facts. I would love to hear from anyone with their comments.
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