Then why, as Marie Curie’s softly spoken chief executive, Matthew Reed, puts it to me, do we accept this funding model for the care we receive at the very end of our lives? What sort of societyallows a patient to take their last breath in a lift as they are rushed from A&E to a ward, “treated like a FedEx parcel as they as die because bed pressures are so great,” aspalliativecare doctor Rachel Clarke put it to me? Thousands do benefit from love, support and comfort in their final chapter: I watched my dad slip away without pain as Bob Dylan and Bruce Springsteen tracks played in a warm Marie Curie hospice, surrounded by doting nurses and his family. Not so for James Swinburne: “My partner’s grandmother had oesophageal cancer and was essentially dumped in a medical ward, full sickbowls left around all day, half-eaten meals that we saw in the morning still there in the evening.” She developed a bed sore, and a hospice place was only found when they threatened to go tothepress. With the government providing just a third of English hospices’ funding – in Wales it is scarcely overaquarter – these crucial services depend on the goodwill and charity of the public. There are gross inequalities,too:ethnicminority communities in particular struggle to get the care they need; and the poorest patients terminally ill with cancer are nearly a fifth more likely to die inhospital. “We’re all living with far more complexity at the end of life,” explains Reed, “and the whole system is not geared up for trying toservethatat themoment.” When palliative medicine works, it has a transformative impact. “The real profound thing you’re left with is: how can you help this person, maybe in their last days or weeks, whatmatters to them, how they spend their final moments on Earth.” That’s where imaginative ideas come in: bringing in pets, fresh fruit smoothies, a jacuzzi with a super-expensive bathbomb. The emphasis must be onproviding community-based services – like the gold standard of care my father was lucky to receive from Marie Curie – and getting terminally ill patients out of hospitals. Gallery: The fascinating history of the NHS in photos A sad truth too is that our medical professionals are not properly equipped to deal with dying. “It is a catastrophic failure in medical training to not deliver a proper end-of-life education,” explains the Association for Palliative Medicine’s Dr Amy Proffitt. And while the modern hospice movement emerged primarily from cancer treatment, this isnotthe biggest problem facing our ageing society: we need properly funded services for chronic heart failure, dementia and frailty.
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