Editorial Comment: We must face up to death

Death and dying is the great taboo. It makes us uncomfortable, so we fail to discuss the issues until it is too late.

This is why the £286m NHS End of Life Care Strategy is so important. It sets out to provide choice and information on end-of-life care options while there is still time to make decisions.

Investment in staff, community-based palliative care services and structures to help people plan ahead are very welcome, but the crux of the issue is making the strategy work in practice. And that is a matter of joined-up government – something that tends to work better at policy than frontline level.

More people choosing to die at home will inevitably increase the need for both more social care and health resources and more co-operation between primary care trusts and local authorities. Strict guidance will be required to address what is deemed nursing care and what is deemed personal care to ensure we do not face an endless game of pass the budget responsibility.

There are also implications for the personalisation agenda. Will those choosing to end their days at home have personal budgets? What will these apply to and, to be blunt, what happens if an individual outlives their budget? These may be difficult, possibly taboo, questions but they require discussion if this strategy is to work.

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