Reflection (Part 2)

Hospital will remain the most common place of death in the foreseeable future. It is important to plan for substantial changes in infrastructure to improve the environment for dying patients. The quality of communication and the hospitality staff extend to families is critical to the experience of dying in hospital.

The circumstances of the death, rather than the place, and particularly the ability of family carers to accompany the patient through the process of dying seem to be the critical feature of a good death.

Making substantial changes to the environment and layout of existing wards will be a difficult, lengthy and expensive process. It is an enormous challenge, especially in the current cash-strapped circumstances of the NHS, and a continuing policy to reduce the total number of hospital beds. On the face of it, more sensitive and effective communication between staff and families should not be difficult to achieve. However, despite several decades of policy directives and educational effort to improve this, there is little evidence of substantial or enduring change.

Despite the challenges, there is a pressing need to find ways of developing the hospital as a supportive environment for staff to provide excellent end of life care for dying patients and their families.

The RLO ‘Dying in Hospital’ has more information about these issues.