End of life care is a measure of a compassionate society - Sarah Holmes
This year marks 25 years since joining Marie Curie and starting my career in palliative medicine. Over that time, I have had the privilege of meeting and caring for thousands of people living with terminal illness, their families and carers, as well as working alongside incredibly dedicated colleagues who support them every day.
What those years have taught me is that, while the priorities of health and care systems may change, what matters most to people remains consistent.
People want to be treated with dignity, care and respect. They want care that is tailored to their needs. And when the time comes, they want the opportunity not only to live well, but to die well too.
I was motivated to pursue a career in palliative medicine because I saw the difference good specialist palliative care could make for people at the end of their lives.
Sadly, I also saw, all too often, people missing out on the care they needed – so I wanted to try to make a difference. Frustratingly, 25 years later, almost one in three people still have to face the end of life without the care and support they need.
Those reflections have been very much on my mind as conversations continue about the future of social care, particularly through Andy Burnham's vision for neighbourhood-based care.
There is a real opportunity to build a system organised around people's lives, communities and relationships, rather than around services and institutions.
Discussions about reform regularly focus on helping people live well - and of course that matters enormously. But a truly compassionate and person-centred system should recognise that dying is a part of life and should support people to both live well and die well. These ambitions are inseparable.
In many ways, palliative care already demonstrates what good neighbourhood working looks like.
Good palliative care brings together, and is delivered by, GPs, district nurses, social workers, care providers, hospices, hospitals, specialists, voluntary organisations and family carers around the needs of an individual.
It's a common misconception that hospice care is something that happens in a specific place, but it is in fact, a style of care. It might be provided in a hospice building – to inpatients or outpatients – like at the Marie Curie Hospice in Bradford, but it can also be provided at home or in care homes, enabling people to be where they want to be, surrounded by the things and people they love.
At Marie Curie, we are already working with partners in Yorkshire and across the country to develop neighbourhood-based models of palliative and end of life care.
Our Early Identification and Advance Care Planning service in Bradford works with local GP surgeries to identify people that have life limiting or terminal conditions, ensuring they receive early intervention and get the support they need, when and where they need it.
We also have our Responsive Emergency Assessment and Community Team, known as REACT, in Bradford. In partnership with the Bradford Royal Infirmary, this service sees Marie Curie specialist teams working in the emergency department and the local community to identify people at the end of life earlier.
Instead of hospital admission, patients, where appropriate, are admitted to the care of REACT where they can access community or hospice-at-home services. Since launching in June 2022, it has reduced average hospital bed days in the last year of life from 38 to 17.
These examples show what can be achieved when services come together around people rather than expecting people to navigate fragmented systems.
At Marie Curie, our aim is to make sure people can plan their end of life, and that they receive the high-quality care and support they deserve at their most vulnerable time. However, a good death should not depend on where you live.
We know many people would prefer to die at home, surrounded by the people they love. The best way to make that choice a reality is by strengthening neighbourhood and community care. When the right support is available close to home, more people can receive care where they choose, while avoiding unnecessary hospital admissions, and experiencing greater comfort, dignity and control.
Marie Curie's mission is to fix end of life care. But achieving that will require strong partnerships, sustained investment and a shared recognition that palliative care should be woven into every neighbourhood care model.
The measure of a compassionate society is not only how well it helps people live, but how well it supports them to die, too. Nobody should die without the care and support they need.
Sarah Holmes is chief medical officer at end of life charity Marie Curie.