The EIU’s recent Quality of Death report praised palliative care in the UK as the best in the world, citing the quality and availability of services provided by the NHS and hospice movement as “second to none”. Nonetheless, the report highlighted room for improvement, echoing findings of the Parliamentary and Health Service Ombudsman in England that criticised end-of-life care services.

As a clinician working on the front line of palliative care delivery there is no denying that being the best across 80 countries is a great achievement and testament to the dedicated work that goes on every day. While we should acknowledge our achievement, this is not a time to become complacent. We are good but could do better; there is a lot of work to be done to maintain that lead position.

We need to address the points that have been highlighted as areas for improvement, including better symptom control, better availability of out-of-hours cover, more flexible services and more responsive services. How do we do this when expectations are higher than ever, NHS resources are stretched and the “out of hours” period is two-thirds of the week?

In my mind there is only one solution: Advance Care Plans (ACP), and the communication and sharing of these plans digitally with the urgent care services that operate 24/7. Creating ACPs enables patients to take control and make choices with their usual doctor and nurse. Through the sharing of this information with the urgent care providers, the right care can be provided, at the right time, in the right place—24/7.  

Across London this work has already begun, with an innovative NHS service called Coordinate My Care (CMC). This coordinates the care of patients and provides them with choice and the assurance that all the healthcare professional teams involved in their care are connected and mindful of these choices, whenever they are treated.

A digital, personalised urgent care plan underpins the service. This documents a patient’s views and wishes, and can be seen by the entire multidisciplinary team involved in their care, 24/7.

The priority of CMC is to support and facilitate the provision of integrated health and social care by bridging the divide between community, acute and urgent care settings, with integration of the voluntary sector. CMC integrates care across London both in and out-of-hours, including GPs, community nurses, community palliative care teams, hospitals, hospices, social workers, the London Ambulance Service, NHS 111 and nursing/care homes. The service is clinician-led, with clinical governance embedded into its framework. 

To date, 24,676 CMC personalised urgent care plans have been created for patients. I strongly believe this model is the next phase in palliative and urgent care provision excellence. Online banking and the ATM and have given us 24/7 access to our finances.  Digital ACPs could be the answer to flexible, 24/7 patient care.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of The Economist Intelligence Unit Limited (EIU) or any other member of The Economist Group. The Economist Group (including the EIU) cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.

By Sarah Murray, writer on business, society and the environment

Across the world, the question of whether or not people should have the right to end their own lives is gaining attention. But while the debate is an important one, for me, an equally important question is how to extend the right kind of care to people living in pain and distress or with incurable conditions. And while progress is being made, we are still failing to meet this basic human need. 

This is the message that emerged during my research for a report that accompanies a new index assessing countries around the world on their provision of palliative care. The 2015 Quality of Death Index—commissioned by Singapore’s Lien Foundation and developed by the Economist Intelligence Unit—ranks 80 countries on how well they are doing on this. 

In the past five years, as the report reveals, advances have certainly been made. And on the policy front, one of the most important moments came last year when the World Health Assembly passed a resolution calling on member states to integrate palliative care into their national healthcare systems. 

But while international declarations are one thing, putting aspirations into practice is quite another. And when it comes to palliative care, the obstacles are not to be underestimated. 

For a start, modern healthcare systems are often built on a culture that prioritises cure rather than care. Too often, the focus is on prolonging life through expensive, painful and potentially fruitless medical interventions, rather than alleviating pain and emotional distress.

In many places, a shortage of trained doctors and nurses limits the availability of care. And reimbursement incentives—which in countries such as the US have followed a model in where payments are made for individual procedures rather than overall results—need to be shifted to accommodate the more holistic approach of palliative care. 

Moreover, as much of the evidence shows, palliative care is generally more cost effective than the alternatives. One review of the literature found that it was often cheaper than other forms of care and that in most cases the cost difference was statistically significant.

Economics aside, there is a moral agenda here. I found it interesting, for example, that when in 2009 the woefully poor access to painkillers in India was brought to the world’s attention, it was not by a medical journal or healthcare report. It was by Human Rights Watch. 

Since then, as the Quality of Death Index reveals, India has made progress in providing painkillers to its citizens, relaxing the outdated drugs laws that once made it hard for doctors to prescribe morphine. And a number of teaching programmes are appearing across the country. 

On the whole, income levels provide a strong indicator of the availability and quality of palliative care, as you can see from the countries in the upper echelons of the Quality of Death ranking (the UK comes first with Australia and New Zealand in second and third place). 

Yet beacons of hope are emerging in unexpected places. In Mongolia, for example, visionary doctor Odontuya Davaasuren has introduced the concept of palliative care to a country that was previously unaware of such services. Thanks to her tireless campaigning, Mongolia has a growing number of hospices, palliative care is part of social welfare legislation and morphine is available on prescription. 

Meanwhile, through an innovative programme developed by Hospice Africa Uganda, a pioneering institution founded by Anne Merriman, Uganda is making opioid painkillers available throughout the country. 

But even in places that do well in the Quality of Death Index much more work needs to be done before all those in need of care are accommodated. 

In New South Wales, for example, most palliative care in the state, which is home to one-third of Australia’s population, is still carried out by nurses and, outside the Sydney area, only a handful of specialist doctors practice palliative care. 

Meanwhile, despite evidence of its economic benefits and the fact that at some point most people will be in need of palliative care, a tiny proportion of healthcare research goes into this branch of healthcare. And while attitudes are changing, discussions about the end of life between patients and doctors are still not the norm. 

But the clock is ticking. As the world’s population ages rapidly, the number of people living longer but with a number of chronic conditions means demand for care is likely to increase dramatically in the coming years. This makes investing in developing better palliative care services an urgent task.

Of course, for some people, no amount of palliative care will alleviate the suffering. And in these cases, the argument for allowing people to end their lives is a strong one. However, the right-to-die campaign should not be allowed to eclipse what I believe is the other critically important debate—the discussion about the right to a peaceful, comfortable and pain-free end of life.

Original article published by Sarah Murray at https://www.linkedin.com/pulse/deaths-long-shadow-finding-better-way-out-sarah-murray?published=t

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of The Economist Intelligence Unit Limited (EIU) or any other member of The Economist Group. The Economist Group (including the EIU) cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.