Home help: The government wants you to have a comfortable (and cheap) death

Home help: The government wants you to have a comfortable (and cheap) death

Jan 18th 2014 | From the print edition

DEATH comes to all, but some are more sure of its timing, and can make plans. Kate Granger, a 32-year-old doctor suffering from an incurable form of sarcoma, has “very strong ambitions” for her last hours. She plans to avoid hospital emergency departments and die at her parents’ house—music playing, candles glowing, family by her side.Surveys show that over two-thirds of Britons would like to die at home. Like Dr Granger, they want to be with family and free of pain. Yet hospital remains the most common place of death. For some this is unavoidable—not every disease has as clear a turning point as cancer—but for others a lack of planning is to blame. The government, motivated by both compassion and thrift, wants to help.

In death, at least, public wishes align neatly with the state’s desire to save money. The NHS has calculated that if roughly one more patient per general practitioner died outside hospital each year, it would save £180m ($295m). In 2008 it introduced a broad end-of-life care strategy, which sought to increase awareness of how people die while improving care. Since then the proportion of people dying at home or in care homes (the split is about half-and-half between them) has increased, from 38% to 44%.

To steer patients away from hospitals, general practitioners have been encouraged to find their 1%—those patients likely to die in the next year—and start talking about end-of-life care. This can be difficult for doctors. “As a profession we view death as failure,” says Dr Granger. Yet when there is no cure to be had, planning for death can be therapeutic for patients.

Those who do plan ahead are much more likely to have their wishes met. A growing number of patients have electronic “palliative-care co-ordination systems”, which allow doctors to register personal preferences so that other care providers can follow them. A paramedic called to a patient’s home would know of a do-not-resuscitate order, for example. One study showed that such systems increase the number of people dying in their homes.

But savings for the government may mean costs for charities and ordinary folk. At the end of life it is not always clear who should pay for what. Although Britons can get ordinary health care without paying out of pocket, social care is means-tested. People must often shell out for carers or care homes—or look after the terminally ill themselves. Disputes crop up over trivial things, like responsibility for the cost of a patient’s bath.

A bill now trundling through Parliament would cap the cost of an individual’s social care. Still, some want it to be free for those on end-of-life registries. That would cut into the government’s savings—but allow more people to die as they want.