Whilst I welcome the general recommendations of the report to improve care to people at the end of their lives and the attempt to ensure a more equitable funding system as there is undoubted need for increased support for more people to help them have a dignified death in their place of choice.
I am concerned about the concept of a register. The report recommends that to receive fully funded care, people would have to be on an end of life register. To get on the register they would need to have an assessment by a healthcare professional and agree to be on the register. For some people this might be a relief mitigating the need to undergo a means test and possibly ensure swifter discharges from hospital. However would everyone want to be on a end of life register?
People already find talking about dying difficult and many professionals have had limited training or experience having those conversations. This raises many questions - would there be increased demand on hospice staff to be involved in those conversations? Could patients unwilling to have such conversations receive a lesser service? Would some providers only accept people if they were on the register? Would people ask to go on the register to get the free funding?
The proposed system is also very medically orientated and might put some people at a disadvantage if they wanted a more natural uncomplicated death - there are real similarities with birth which has also been taken over by the medical world.
The new system of funding for hospice also looks rather bureaucratic with hospices needing to collect activity data about patients and their level of need and function. Hospices already face the bureaucracy of ensuring they are compliant with the Care Quality Commission, Charity Commission, Companies House, Cancer Peer Review and the End of Life Care Measures.
Although the report clarifies what the NHS will fund and what they will not, many services still need to be funded by charitable donations.
I would be interested in hearing what other people think please post your comments.
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