My contribute to the debate on End of Life Care, 2 March

John Redwood (Wokingham) (Con): I will draw on conversations that I have had with people around the country who have experienced a relative dying relatively recently, as well as on my own observations. I will not mention a particular case, because if I did have a difficult case, I would take it up privately in the usual way.

The first conclusion that I have formed, which I think the Secretary of State has wisely come to, is that a patient undergoing the last stages of their life and their family need a named doctor who is in charge. The family and the patient, when the patient has capacity, need to have access at reasonable times to that doctor to find out where they have got to and what the next stage is likely to be.

I believe that Ministers have put in place a requirement for there to be a named general practitioner for every patient when they are at home or in a care home. That is very welcome and let us hope that it works, so that there is someone people can turn to, whom they trust and know. However, when, as so often happens, people enter hospital and may not come out again, because of the way in which rosters and rotas work, it means that every day or every other day, there is a different group of doctors and nurses in charge of them.

That can mean one of two things. Sometimes, the family and/or the patient are constantly retold very bad news because the new team feels that they have a duty to tell them. It may not be helpful for people to keep getting the same bad news. Alternatively, the family or the patient with capacity may want information at a particular time, but no one is up to speed because they have only recently taken over and have not had time to read the notes. Indeed, reading the notes is not necessarily as good as being continuously in charge of the patient and talking to them over the days or weeks in which the treatment is undertaken or as their last days draw near. I therefore urge Ministers to get behind the idea that it is best if there is a named senior doctor—perhaps a consultant or registrar.

Often, people in their last few weeks or months of life have complex and multiple medical conditions, so a series of different consultants are involved, but no one consultant feels as if they are ultimately in charge. I am told that in some hospitals, patients are moved from ward to ward at very short notice, with different specialties in mind. The family then turn up and do not even know where the patient is, because they think that they will be where they last saw them. That can be very disruptive for the family. More care and attention is needed in some cases to deal with that issue.

The second issue, which has been mentioned by other colleagues, is the interface between social care and hospitals. All of us who visit hospitals as Members of Parliament and sometimes as family members will have observed that a very large number of patients in a lot of our wards are extremely elderly and very frail, with lots of complex medical conditions. Some of them may not be easy to treat. Others might be better off in a care home or at home, but there has been a failure to put together the set of services that they need.

I do not really believe that that is a money issue, because in many cases one could buy an awful lot of social care for the cost of the hospital bed that the person is occupying. Social care might even be cheaper.

I am not recommending that we take people out of hospital because somewhere else is cheaper, but if they would be better off somewhere else, if they want to be somewhere else and if there are no longer any medical interventions that the hospital can make, it is sensible to take advantage of social care if it is also cheaper.

Kelvin Hopkins (Luton North) (Lab): I hear what the right hon. Gentleman says, but when local authorities know that they have to pay for care when somebody comes out of hospital, they will try to persuade them to stay in hospital for as long as possible. Different budgets put different pressures on different institutions.

John Redwood: The hon. Gentleman is right. Throughout the time he and I have been in the House, under Governments of different persuasions, we have all known about the problem, we have all said that we need to solve it and still we have not managed to do that. I hope that our current talented Ministers can do something that no previous groups of Ministers have been able to achieve. There is an experiment because, with the devolution models that Ministers are considering, if the health and social care budgets are put together under the same authority, the excuse that there is a budget row goes. One would hope that the best interests of the patient were dominant and that authorities would realise that, in some cases, the best interests of the patient also enabled them to save money through switching from an expensive hospital bed to a decent care package. That could be helpful, and I hope that Ministers will do that.

For the families of those who die, the need for care does not end at the moment of death. That is generally understood by the public sector, but there are serious problems with delivering the support and administrative back-up that families need when a loved one dies. Several people who have been through this recently told me that the first thing that happens is a delay in getting a death certificate. Without a death certificate, nothing can be done to settle things. People cannot even hold a funeral because they cannot instruct a funeral director until they have a death certificate.

Not only is there a delay in getting the death certificate from the medical staff at the hospital, but people cannot register the death because of the insistence on a face-to-face meeting with the registrar, which can mean a further delay of many days before a slot becomes available. Quite a lot of families therefore end up with one, two, three and four weeks of delay before they get the death certificate, which is necessary to trigger the funeral and any financial changes consequent on a person’s death.

The Government have introduced a sensible “Tell Us Once” system so that when a person dies, the family can fill in quite a complicated electronic form, which is meant to tell all Departments with which the dead person may have been involved what the Government need to know. There are two problems with that. First, families often do not have all the knowledge that they need. Unless they have that knowledge, the Government seem unable to cross-refer and discover that, for example, the person had a benefit as well as a pension. It would be helpful if Government computers talked to each other more adequately so that the Government could do more of the work and families just had to notify them of the death and did not have to know every detail of the dead person’s financial affairs.

Secondly, because the delays with the death certificate and registrar appointments often mean that registration of the death is delayed, the Government make payments to the deceased person, and the families, having used “Tell Us Once”, get a set of not terribly friendly letters—I appreciate that they have been dressed up a bit—saying, “Your dead relative owes us this much money”. The families cannot necessarily get their hands on that money, but they are none the less obliged to pay the Government back, at an unsettling time when they are mourning and grieving and were not expecting a tax or benefit bill.

In the interests of handling the families better, the Government should speed up their side of the administration so that the death can be registered promptly, the Government do not make wrong payments and the families are not faced with letters demanding money back when they have other things on their mind and are trying to deal with the hurt. It does not make it better when the Government say, “We’re very sorry you’ve had a loss” if they go on to say, “but you owe us this much money. The usual rules apply. See you in prison if you don’t pay”.

We need to improve greatly on dealing with the first few weeks for the poor grieving families, who do not necessarily know the process, are very lost because they have lost their loved one, and are not helped by delays and sometimes the incompetence of the regulatory authorities.


  1. The Active Citizen
    March 5, 2016

    Thank you JR for working on this whole question of end of life care. After my father’s terrible death from cancer and the care he received in the months prior to that, I don’t want to comment further as it’s still too upsetting.

    This whole area needs radical change in what is supposedly a civilised society.

  2. Lifelogic
    March 5, 2016

    All good points, the failure to read the notes or know the full facts about a patient is so often the cause or bad treatments and serious accidents. There is often a total lack of continuity and communication in treating patients.

    The other problem is that the way that the NHS and care sector are organised (and funded or often not funded) there is much pointless pushing from pillar to post, with much harm done to the patients and with no money overall saved – indeed usually the reverse.

    As Kelvin Hopkins says:-

    “When local authorities know that they have to pay for care when somebody comes out of hospital, they will try to persuade them to stay in hospital for as long as possible. Different budgets put different pressures on different institutions.

    It is the way the free at the point of rationing, delays and non treatment the NHS and social care system are organised and top down funded that causes so much of the problems.

    They are spending other peoples money on other people – so they rarely care what they spend nor what value they get for it and it usually shows. It only works at all because there are some very well meaning people working very hard within the NHS and social care. It is the system that is daft and needs addressing. But in in three letters priority NHS is clearly not a priority at all.

    1. Lifelogic
      March 5, 2016

      I cannot help thinking that the UK will certainly vote to leave now, the polls are so close and the leave voters more likely to vote as they fell more strongly. The remain side lacking any arguments.

      Hollande and Cameron choreographed farce over the migrant camp surely show for certain the man is unfit to remain in office, but it must have helped the leave cause significantly. Can we now have the true migrant figures from the active NI numbers please Cameron. Stop hiding them and let us have a fair and informed referendum.

      It is quite clear that most migrants come to work and with the daft increasing minimum wage by Osborne decree and further expansion of the EU even more will certainly come. Cameron’s benefit changes are largely irrelevant. Furthermore many are low paid and clearly a large net liability to the state, especially as they often send much of their earnings home.

      1. Hope
        March 5, 2016

        Part-time chancellor Osborne will need to spend more time in office than he has to date. Debt nearly doubled under him, deficit targets no where near being met- £79 billion, taxing the ordinary middle until their pips squeak, no serious spending cuts and no substantial changes to the finance sector as Mervin King recently pointed out, again. Yet, in the last parliament Cameron and Osborne gave twice the amount to the EU than they made spending cuts! £85 billion to the EU and £35 billion spending cuts. Does Osborne know how to add up? Or does he still allow the Treasury to follow Darling’s plan with as light adjustment?

        Cameron does not understand patriotism as we saw him with Hollande, therefore he ought to keep to the small things he knows about, chocolate guarantees, chocolate no ifs or buts. Now he makes ridiculous claims that it is patriotic to be in the EU, gives away billions of our taxes to the EU without good reason- after claiming he would not, makes threats to our nation because of his own incompetence then we read Junker boasting how he had to grovel yo him for help! Spineless individual that should crawl under a rock.

    2. Lifelogic
      March 5, 2016

      Osborne’s odds of leading the Tories decline by the day, I could never see it myself. He is quite rightly far too unpopular and certainly not a man of the people.

      So will it be Boris or even Gove perhaps?

      It seems Osborne has finally backed away for the main body of his idiotic proposed pension changes and further pension muggings. Let us hope so and that there is no sting in the tail.

      He now needs to also reverse his positions on his Landlord/Tenant muggings, the 3% extra SDLT and loss of interest relief, his ratting on the IHT promise, his pension cap and contribution limits, reduce CGT and index it, his job killing minimum wage nonsense, his dividend tax, his endless attacks on the wealthy, hard working and non doms.

      His approach is entirely counter productive to jobs and even to tax receipts and is totally misguided. He just needs to cut out some of the endless government waste for a change.

      Anyway at least they seem to have worked out what total lunacy the Swansea Barrage and some of the other expensive joke greencrap is.

      1. Lifelogic
        March 5, 2016

        There seem to be endless claims that there are huge government subsidies for energy from fossil fuels. More complete drivel yesterday on the subject on any questions where do they did up these people from. There is a huge net taxation (and no net subsidy at all) for fossil fuels. Also a massive subsidy for the expensive and intermittent (allegedly “green”) solutions. Why are people allowed to get away with this subsidy lie? Where there is a subsidy it is often only for them to provide the back up needed for the unreliables they green loons promote. So it is really yet more subsidy for the greencrap.

        When solar panels and wind work economically fine until then forget them. R&D yes subsidised roll out is bonkers.

      2. stred
        March 5, 2016

        Osbo has allowed, or perhaps guaranteed, that council can raise CT by 4%, as they are so strapped for cash. Yesterday the sun was out and I visited our country park which is about 1 mile by 1/2 a mile and is mostly swamp or lakes. It has taken a lot of voluntary work and landscaping, which could have been done by one landscape architect, part time over ten years. Yesterday, at the playground there were five council officers having a conference for an hour with a new Land Rover Freelander and a big Transit bus. Then in the cafe, two council park police came in for a coffee dressed like Mets and outside parked their new park police big 4WD.

      3. JoeSoap
        March 5, 2016

        re: pensions
        This government certainly seems to have turned the mess bequeathed them by Labour (NEST, reducing and ever changing lifetime limits and allowances) into the mother of all messes now. Really a numerate 10 year old could make more sense than is currently being shown by Osborne in this area. Is he now saying people not paying tax at 33% will still get relief at that rate? Is he completely disposing of pensions rules altogether and making ISA s more complicated too?
        Why not just leave the damn thing alone for 10 years, at least?
        All totally barmy.

      4. Lifelogic
        March 5, 2016

        Of course just by floating the proposed pension tax grab and then cancelling it Osborne has done a lot of damage and wasted a lot of people’s time. Even now they probably assume he will just do it later anyway.

        He is not suitable to be chancellor, he is heading the wrong way and is incompetent with it. Lower simpler taxes are what is needed. They raise more and mean that more people are productive and fewer employed in tax planning.

  3. The Active Citizen
    March 5, 2016

    JR, it seems callous to go off-topic after your article above, but you or your colleagues might be interviewed today regarding yesterday’s figures from the EU about migration. Overnight I went through the tables in detail and here’s my summary. Very little of these figures appear on the BBC or in the papers.

    EU Summaries For Normal People, No. 9 – The ‘Syrian’ Refugee Crisis

    1. The EU stated yesterday that over 1.25 million people claimed asylum in the EU in 2015. This does not include all the other migrants who entered, but haven’t claimed asylum.

    2. Migrant arrivals in Greece in January 2016 were 38 times higher than the number recorded in January 2015, according to Frontex, the EU’s border agency.

    3. During 2005, 73% of EU asylum-seekers were male. 81% were aged 14 years or over.

    4. Nearly three-quarters of asylum-seekers were not from Syria. In the UK alone, the highest numbers came from Eritrea (17%), Iran (17%), Pakistan (15%), and Sudan (14%).

    5. The country experiencing the highest number of asylum-seekers per head of population was not Germany or Sweden. This was Hungary, the country vilified in 2015 by the EU Commission and many EU country leaders. Some of these same countries are now adopting Hungary’s policies.

    The Failing EU Is Out Of Control – This Is Not a Safe Club To Be A Member Of.

    [Sources: EU Frontex report 22 Feb 2016. Eurostat Asylum Statistics 2015, published 02-04 March 2016.]

    As ever, a fuller version with links to tables is available to any Leave campaigns.

    Reply Yes, helpful numbers

    1. The Active Citizen
      March 5, 2016

      Correction to point 3 – it should read 2015 not 2005.

    2. stred
      March 5, 2016

      The new and much improved president of Nigeria came to the EU Councillast month and said that citizens from his country should not be accepted as refugees, as they could be safe at home. Many other African and ME countries where there are wars also have safe areas in neighbouring states. This is where foreign aid should be directed.

    3. Lifelogic
      March 5, 2016

      I see that the gender imbalance in Sweden, caused by predominantly male immigration, has recently been estimated at 123 boys for every 100 girls. Rather worse than in China, surely this alone is likely to give rise to problems.

    4. Pericles Xanthippou
      March 5, 2016

      I do like The Active Citizen’s executive summaries: undoubtedly material new to some, whilst a timely refresher to others.

      Reading No. 9, however, I was struck by the need of some standard terminology, not just in this forum but where ever this subject is under discussion. Here are some suggestions (perhaps not exhaustive):

      migrant: a person of any status, away from his home, village or country, with the intention of abandoning it, permanently or otherwise;
      asylum seeker: a person able or likely to be able to establish that he is fleeing a war zone or another place in which his life or those of his family members are threatened;
      irregular migrant: a person unable or unlikely to be able to establish credentials as an asylum seeker (which would compass economic migrants).


    5. Anonymous
      March 5, 2016

      Reply to reply: The PM, it seems, doesn’t want us to have these figures.

  4. stred
    March 5, 2016

    Some hospices have been hit by low returns on investment. Ours had halved its number of beds. This puts pressure on hospitals, which provide inferior care. It would be helpful if healthcare directed money in their direction.

    It would also relieve pressure on terminal care if the NHS did more to avoid killing people in the first place. A middle aged friend of ours died after 2 months from symptoms, after being fobbed off by GPs and denied a scan until it was too late. I read last week that hospitals are ‘bouncing back’ patients referred for scans who they consider do not have enough symptoms and ‘incentivising’ or perhaps bribing doctors to refer fewer. Our friend must have been one of their outcomes. In France and other countries the patient would have a choice of private diagnostic clinics, pay and reclaim the cost, then a relatively hpoeful chance of recovery.

    1. Lifelogic
      March 5, 2016

      It is the way they are funded that incentivises them to delay and fob off the “customers”, not something you find at a normal business where paying customers are driving the business.

      Free at the point of rationing, delays, incompetence, death and non delivery. Cameron’s “in three letter” priority.

      Worse still they often will not say you need a scan (or something) but we cannot give you one for months so please go privately. This alone kills people who could easily afford to pay anyway. This is an outrage and surely a form of medical negligence.

    2. Iain gill
      March 5, 2016

      Yes even when diagnosed early many people are effectively left to die, as my father was of prostate cancer. Frankly evil system and uncaring staff are what the patients face.

    3. JoeSoap
      March 5, 2016

      Yes, perhaps the French system is one of the consequences we will be able to afford when we leave the EU?

    4. Lifelogic
      March 5, 2016

      The money need to follow the patient, better still have the patients or relatives themselves pay for what they need where they can. Then the quality would improve and there would be some incentive for the good places to expand and the poor ones close down. A pressure totally lacking in the NHS in fact it is better to be bad then you deter patients. If a casualty (or GP) is quick and efficient they create a rod for their own backs by attracting more patients from other hospitals or GPs. So they do not get efficient.

      Why indeed?

      1. hefner
        March 6, 2016

        Oh yes, with cancer treatment costing anything from £10000 to £60000/year, this obviously is affordable by everybody!
        Try to take a medical insurance plan after you are 50, see how much screening and testing it will require, and if one test value looks just out of accepted normal boundaries see whether you’ll get that insurance, and if you are lucky to be accepted, see at what price.
        Very nice of you, LL., to carry the flag of privatisation at all costs, maybe not everybody can afford it.

    5. Anonymous
      March 5, 2016

      My own father is terminally ill with prostate cancer having visited his GP complaining of it three times before a proper blood test was taken – too late.

      Death comes after a long struggle with excruciatingly painful paralyses and then organ failure.

      It does seem that female conditions are taken more seriously in this country. It wasn’t because my father didn’t take the issue seriously but that the medical system clearly doesn’t.

      1. Iain Gill
        March 5, 2016

        I agree. My father was diagnosed nice and early but the bastards left him to a long slow death that the hospice doctors openly said would not have been allowed in any other Western country where he would have been actively treated at the beginning, and probably lived many more years. NHS gives you nothing after a lifetime of paying in but morphine. Scum.

  5. Margaret
    March 5, 2016

    What you seem to be confusing is ‘End of life’ and a bad prognosis. End of life care is usually confined to the last few weeks when the patient simply needs peace and comfort plus ongoing pain control in the form of continuous opiates etc.
    Doctors are needed primarily to prescribe these opiates , although there are specialist nurses who can take over this job and provide one to one care more effectively and this will increasingly become more helpful. The District Nurses provide 24 hour care . These professionals are more specialised and qualified to do this . The General Practitioner ( and my first role is Nurse Practitioner in General Practice) have so many different aspects of care to attend to. End of Life Care is not feasible except in prescription of drugs. The concept of a Dr is based upon an old fashioned social stratification and their role is only linked to a future of private care and money making. A specialist Nurse is helpful. It is simply a case of not throwing out the word ‘Dr’ for every aspect of human life. You must have heard it ” Dr’s recommend this type or another of disinfectant’ It is an obsession with an outmoded type of care . People need care at their end of life not a Dr . I have been caring for the dying and living for 45 years. Dignify people , make them comfortable but don’t keep throwing out that supposed one role of a general practitioner who have the most wide spectrum of problems to deal with as it is. The myth that Dr is needed should not be perpetuated . An informed caring person is required.Time is not on our side in general practice.

  6. Antisthenes
    March 5, 2016

    You have identified the problems some of which also effect other patients in NHS hospitals and having named doctors and combined budgets will go some way in solving those problems. Those solutions though only address the symptoms not the real cause of these problems and so many more that the NHS face. What we are seeing here is dysfunction and confusion which is something that assails all public sector bodies and always will because of the bureaucratic and monopolistic nature of them.

    So the real problem is how healthcare is provided and funded and how that is structured is the key to making real improvements and make the NHS more accountable, efficient, less wasteful, more productive and financially sustainable. That can be achieved by simply handing over some of the provision and funding to the private sector.

    Of course my last sentence will bring everyone’s wrath down upon my head as how dare I attack the holy cow the NHS and even think such a thing let alone suggest it. The answer to that is because I have seen what I suggest work in practice and it works very well indeed. Before you say it no it is not a system that is totally free at the point of delivery but nobody is disadvantaged by that fact. There are safeguards to ensure that it is affordable for all. It also has the considerable advantage that far more money is used in patient care than the NHS uses as it is so bloated by non front line staff and bureaucratic methods at wasted cost. There are many more advantages to this type of system far too numerous to list here. I have listed some of them in previous posts.

  7. agricola
    March 5, 2016

    My suggestion is that hospitals are not the best places for the terminally ill. There are two better options. Home, where at the end of ones life many of us might prefer to be. Hospices which are dedicated to the terminally ill.

    I can accept that there could be cases where hospital is the only option. Highly infectious disease for instance, but it should a place of last resort.

    If the money was redirected to GPs to deliver a one on one service and hospices for enlargement to cover home nursing or in hospice care. At present I believe they are all charities so increasing their workload would require funding. With a bit of thought it might not need new money just redirected money from the hospital service. The hospital service would get a reduced workload and gain bed spaces.

    Many friends have taken this route at the end of their lives and it would appear to be infinitely more humane and personal way of accepting the inevitable. It is also much easier on relatives. Give it some serious thought. Hospitals should be places where the expectation is recovery.

  8. Iain gill
    March 5, 2016

    A big improvement would be to allow hospice doctors to anonymously feedback on the care of local general hospitals and consultants. In many cases they know of systematic poor care leading to much earlier deaths than should be the case but are reluctant to do anything with that information.

  9. alan jutson
    March 5, 2016

    I can only speak from personal experience of 10 years ago, when my mother suffered a series of massive strokes, but survived in a terrible state for a further 5 years.

    Firstly her symptoms (pre stroke) were not taken seriously by her Doctors practice, a Locum Doctor finally sealed her fate with refusing her a repeat prescription.
    The local Hospital to where she was taken had a designated Stroke ward but it was full, so she did not get a scan or treatment for 3 days, (you stand a chance of recovery if treated within 3 hours) indeed it took 12 hours to find her a ward bed.

    After our family being told she would not survive, she did.

    She remained in Hospital for 10 months, because they wanted to put her in a Nursing Home in their area, not in mine, where I could visit her on a regular basis. (I was the only living relative).
    After 10 months of contesting four medical assessments, and lobbying for her care to be here in my home Town, I finally succeeded, but only after a face to face meeting with the Chairman who was in charge of the care of elderly people, who agreed my Mother was entitled to Continuing Care, fully funded under the NHS.

    Her last 5 years were spent in a wonderful care private home here in Wokingham (I visited 12 before I made a short list), although she herself was in an absolutely desperate state.

    The problem all the way through, seemed to be the lack of real care for the patient, the lack of urgency and provision of known resources, the lack of people with any real knowledge about the next stage of care or what was available, the complete lack of flexibility in the system, the lack of any real personal responsibility.

    Once she was finally settled in a local nursing home her care was as good as one could ask for, the Social Services team (from her own area) were then sympathetic and personable.

    The irony of it all, the cost of the Nursing home in Wokingham, was the same as the one they wanted to send her to in the first place, within their own health area.

    During the 10 months she was in hospital I travelled 70 miles per day to visit her, and paid over £1,000 in car parking charges to the hospital car park operator, when I could get a space.

    I only hope things are better now.

    1. Iain Gill
      March 6, 2016

      They are not.

      The car parks are ridiculous.

      Not just the charges, but the way they were managed.

      At a large general hospital which I visited daily as I had a sick relative inside, the security guards watched me go in every day and they decided I must be staff (who apparently are not allowed to use the public car parks but only their own, where there is obviously not enough parking for the numbers of staff), anyways the security guards came out screaming abuse at me accusing me of being staff breaking the rules and parking in a public space. Not only that they took pictures of me and the car. As if having a sick relative isn’t enough, having the stress of nonsense like this is beyond a joke.

      Basildon hospital, should be shut down its that bad. Just give the patients a cheque to take anywhere they like.

  10. Ex-expat Colin
    March 5, 2016

    Didn’t have a problem with “Tell Us Once” just the dumb solicitors who my mother instructed to conduct probate. Thats a warning that needs to be put out about probate incompetence. I charged them £600 for that stupidity and which took 2 years.

    I could only communicate with the DWP satisfactorily via my Tory MPs assistant.

    Its a bigger mess than folk might currently think..Solicitors, forget it!

  11. Bert Young
    March 5, 2016

    It was right of John to feature the problem concerning the plight of families following death . It is bad enough to bear the emotional consequences of a near and dear loved one let alone the follow up requirements necessary ; this has not been highlighted before to my knowledge . Several years ago I was the executor to an old lady who died without children and who was a widow ; the consequences involved were extremely time consuming and complicated ; I would not wish this responsibility on anyone . There is a lot of cleaning up necessary to ease this sort of burden ; it will save time and expense .

  12. Pericles Xanthippou
    March 5, 2016

    In my hazy recollection there used to be, at the change of watch, a briefing session, in which the relieved watch told the relieving one all about each patient. Everything was still in the notes but this session gave the relieved watch the opportunity to bring to the attention of its relief matters of particular importance.

    I wonder to what extent that often vital step is now missing owing to the use of computers and, possibly, an assumption that, as all the data are ‘on the computer’, every-one ‘must already know everything needs to’.


    1. Pericles Xanthippou
      March 5, 2016

      Correction: … every-one ‘must already know everything he needs to’. ΠΞ

  13. hefner
    March 5, 2016

    Thank you for this very sensible contribution.
    The death certificate question is indeed very important: how comes that other countries have a doctor at time of death delivering a primary certificate, which has to be registered with the town/regional/state authorities within 24 or 48 hours, which in turn then provide an official paper acceptable by any other authorities (banks, health and pension schemes, solicitors, …). How comes that the UK cannot do something along the same lines?

    And here the EU has nothing to do with it!

  14. Ex-expat Colin
    March 5, 2016

    “the Government seem unable to cross-refer and discover that, for example, the person had a benefit as well as a pension”

    The DWP you meant? And don’t I know it!

    My mother died and DWP overpaid pension stuff for about 2 months. So I paid the DWP demand of about £650 on demand. Ten months later while dealing with DWP via my MP (Tory) the DWP inform him the estate owes £650 pension over payment. I provided the bank transfer references…oh says the DWP, it has been paid..we didn’t see it. Idiots abound!

    Its along string of mess..

  15. Anonymous
    March 5, 2016

    Prior to the internet I recall getting a death certificate was very quick and very simple.

    As for palliative care towards end of life – Atul Gawande’s Being Mortal is a good read.

    Some surgery (for increased comfort) is worth it and others (for extending life) only cause waste and prolonged suffering.

    Continuity of staff is essential but continuity of expectations of the patients and their families is even more vital.

    Family being key here. We need to do more to strengthen families and incentivise them sticking together.

  16. Lindsay McDougall
    March 6, 2016

    There are some issues that you need to face up to:

    Whereas health care is for the most part financed nationally, care at home is financed by local government. Therefore, if we want to increase care at home in order to reduce hospital costs, we have to accept that council tax will have to rise, and there may have to be a transfer of monies from richer areas to poorer areas.

    The second issue is that the House of Commons has not got itself, the God squad and the medical profession under control. A Bill to allow assisted suicide a la Switzerland was voted down by 3 to 1 in the House of Commons, the sentiments of the God squad being to the fore. Why cannot I be allowed, when I judge that my time has come, to pack my family off for the weekend and consume three large bottles of aspirin? Because all of these busybodies don’t believe that I have the right or competence to make my own decisions.

    Then there is the extent and direction of health spending. The NHS cannot afford to vaccinate all young children against meningitis but it can afford afford to spend billions extending life way beyond its natural term. In the 1960s, conditional life expectancy on reaching retirement was 10 years for men (i.e. if you reached 65, you could expect to live to 75) and 18 years for women (if you reached 60, you could expect to reach 78). Now the ages at death are 84 for men and 86 for women, with a unified retirement age of 66, which will be increased to 67. Sorry, but the working population cannot afford to finance retirement holidays of getting on for 20 years.

    Just to take one practical example – if a person has had two cancer operations and reaches the age of 80, should that person be given a third operation funded by taxpayers? Another example – a person has had therapy to delay the onset of dementia, and both medication and therapy to slow its progress. However, the dementia has now reached the severe stage and is blighting the lives of not only the person but his/her family? Is it not best that people write living wills in advance so as to deal with this situation? The late American president Richard Nixon left strict instructions that on no account was he to be kept alive if he suffered severe mental impairment. Why can’t we all do that?

    Somehow or other, care for the elderly will have to be rationed; in 10 years time there will be many more of us. Meanwhile, the medical profession has been increasing life expectancy by 2.5 years with every 10 years that passes. Whom the Gods wish to destroy, ……………………………………

    1. Jonathan Sidaway
      March 6, 2016

      1) I think one can do what Tricky Nicky did, and write a living will.
      2) What is ‘natural span’? People live as long as the NHS’s latest technology lets them.
      3) I don’t think anyone is questioning the legality of suicide – it was the legalized involvement (in assisted death) of not necessarily willing doctors that was at issue in the minds of MPs voting against the Falconer Bill. I speak as one of the God Squad, but the vote struck me as hinging on a consideration of secular fairness rather than religious bigotry.

  17. Jonathan Sidaway
    March 6, 2016

    Since dealing with my parents’ decline and death three years ago, I have thought that the missing link in the NHS is a combined geriatric hospital and (unspoken) hospice to which older people could go after, for instance, radical surgery in a conventional hospital; the well will go home from this halfway house. Neither the recoverable nor the terminal will be subjected to the mess of social services intervention. Perhaps this extra layer in the NHS cake could be funded by a compulsory insurance impost on the employee … details details, I don’t know. Unforeseeably massive costs immediately present themselves to the imagination. Knowing absolutely nothing about the details, I would ‘ contend’ that such a solution would be cheaper for the govt., the current pragmatism being based on people having enough money to finance a private arrangement (some will – the American experience seem to tell us that a lot of people won’t), or on social services – the latter is the local council: given current local admin funding, is it really a good destination for dying poor people? Mutatis mutandis, or mebbe not (this being all just a hunch I have), similar comments apply to the care of mentally ill people. It is plain to many of us that the current arrangements are no good for them – the recent Panorama programme seemed hardly hysterical on the subject. The basic question is: would proposals for, say, state geriatric hospitals, funded as mentioned, and mental health care – say, low security units with a few beds going spare 3 days a week – be more expensive than the current mix of private- state provision?
    The bed business seems an important issue from all this – given the costs of keeping people in A an E, or on the streets, how much do bed economies cost cf supposed savings?

    1. Iain Gill
      March 6, 2016

      Certainly the hospice docs are often the most expert docs in town at pain relief. Many non terminally ill people could use this skill, sadly this rarely happens unless docs break the system and do whats needed as opposed to what the silly flowcharts say.

      I think on the whole we should move away from state designed top down service design, and move over to giving patients real buying power and decision making ability. Let the providers be forced to adapt to the patients buying decisions instead of the other way around. Empowered consumers will always produce a better more efficient set of dynamics for change.

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