End of life care needs communication and cooperation
The new patient charter on end of life care announced today by the Royal College of Nursing and the Royal College of GPs is a really important step in the right direction. This charter re-affirms the responsibility of GPs to help ensure that people who are reaching the end of their life receive the care and support that they want and, importantly, do not have medical interventions that they do not want. The charter makes seven pledges focused on helping people to articulate and record their choices about end of life care, ensuring that other professionals who provide care are also aware of these choices, and supporting the friends and relatives of the person who is dying.
Since the Mental Capacity Act was enacted in 2007, we have had legislation in place to allow people to record an ‘advance decision’ about the treatment they would wish to receive at the end of life, in case they should become unable to communicate or to decide at a future point in time. However, only about 3 per cent of people currently make use of these legal documents, and even where these documents exist, they are often ignored in emergency situations if paramedics, relatives or care home staff are unaware of their existence.
Demos’ recent report Dying for Change highlighted the urgent need to improve end of life care in the UK. While two-thirds of people (66 per cent) would like to die at home, at the moment only one fifth (19 per cent) are able to do so and if current trends continue, only 10 per cent of people will be able to die at home by 2030. The ageing of the large ‘baby boom’ generation also means that the existing infrastructure for providing end of life care will be put under increasing strain in future years: while around 500,000 people currently die in England each year, this number will have increased by 18 per cent to 590,000 by 2030.
However, improving end of life care is not only a matter of increasing resources. As the patient charter suggests, effective communication must be right at the centre of high quality end of life care. It is wholly appropriate that a person’s family GP - as opposed to specialists whom the patient may have just met, or relatives who may be emotionally overwhelmed - should be made responsible for ensuring that this communication about end of life care takes place. People die in many different locations, including at home, in a care home, in a hospice or in a hospital and end of life care it is inevitably a team effort with any number of different medical practitioners and carers involved. Encouraging GPs to communicate with patients about their end of life choices and record these decisions will be relatively straightforward; it is ensuring that all health and social care professionals who care for people at the end of life are aware of these choices and able to put them into practice that will present the most challenges.