The vital questions of life and death at the end of our journey

Unfortunately, some of us don't get to choose how and where we will slip this mortal coil but unlike centuries ago, when most people died at home, these days more than half of us die in hospital. Yet new research shows that 70 per cent of people in England would prefer to die in the familiar surroundings of our own home. In Yorkshire and the Humber, only 19 per cent of people die at home.

Wealth seems to influence the equation: 62 per cent of the poorest people die in hospital, but only 55 per cent of the wealthiest do, according to a report by the National End of Life Intelligence Network. While certain serious medical conditions require the patient to be in hospital, others do not, and patients are almost certainly dying in hospital who may not require such a clinical environment and might prefer to die at home, if asked.

Hilary Fisher of the Dying Matters Coalition (DMC) – which has 10,000 members from organisations including the NHS, voluntary and independent sectors, faith groups, community and education establishments and the legal profession and funeral sector – says the survey shows where we die but whether we experience what we might call a "good death" is another matter, because too many of us do not discuss dying, either at the point where it's happening or well in advance of becoming seriously ill.

A case in point is that of the Peaches from Hull. Two years after the death of her 59-year-old husband Colin from stomach cancer, 56-year-old Susan wishes they had grasped the nettle and spoken about their feelings and how he would have liked to spend his final days. A large part of the problem was that they were not fully aware that Colin was actually dying, as medical staff did not warn them.

"We just didn't realise he was dying," says Susan. "The doctors kept telling us he needed to keep fighting, so we lived day to day, assuming if we fought, he'd get better. We never even discussed whether he would prefer to be cremated or buried and that was very hard once he'd passed away. I just went on to auto pilot after he died but now I wish we'd spoken about it. If we'd known we had such little time left, we could have gone to some of his favourite places and he could have spent his last days as he wished."

Dying well is part of living well, says Hilary Fisher. "DMC works to break the taboo of not talking about dying. Unfortunately,

most people seem to feel that talking about it will make it happen.

"To understand how people would like to die, they need to talk not only to their loved ones about how they want to prepare for death but also talk to their doctor and other health professionals. Doctors, including GPs, can be very reticent about raising the word 'death', yet a majority of complaints to hospitals are about care of the dying and many of those are about how little information is given to patients and families.

"Talking about death and care of the dying is of increasing importance because we have an ageing population, and in five years' time significantly more people will be dying each year than the 500,000 who do so now. We prepare for childbirth, we prepare for sending our children to school, and we should also look at the options around how we might want to die. But we don't talk, so although we know it is going to happen, death is still in the closet."

Heart failure and stroke are the biggest killers in the UK. One in four people will die of cancer. With an increasingly ageing population, the majority of older people will be living with a number of conditions. For example, around 30 per cent of people over the age of 85 with cancer will also have dementia. How hard-pressed NHS and other resources are spent on coping with these complex needs and more end of life care is taxing some of the top brains inside and outside government.

Returning to the survey on where people die versus where they would like to die, Sam Turner, of the National Council for Palliative Care, says the impediments to dying at home – if you want to – include lack of communication between loved ones, and the fact that, depending on the medical condition involved, specialist equipment, drugs and nursing may be needed.

"Dying at home can take a lot of co-ordination. Hospices are the gold standard but in-patient beds are few and far between, but they are now working with people who are dying at home. There are only 5,500 specialist palliative care staff across the country, so health professionals and social care staff need training in end of life care.

And staff in care homes need training and confidence to deal with care which they could give rather than calling 999.

"The current Palliative Care Funding Review is looking at where we're spending money and where it could be better spent. It's not necessarily going to lead to more money, but about using what there is more wisely.

More co-ordination in end of life care is something that's vitally needed, along with the conversations we should all be having with our families."