What prompted me to write this blog, after a blog free couple of weeks was this item about the role of the nurse in helping patients and their families at the end of life. http://www.syndicom.com/blog/nurses-and-their-forgotten-role-in-healthcare-collaboration

The events in Stafford over the last few weeks have made a lot of people think a lot about death. For anyone who does not know about this there has been a huge amount of upset caused by a very severe healthcare commission report on our hospital. There was a time on 2006-2007 when the hospital was allowed to become seriously understaffed, and care standards slipped pretty badly as a consequence.

A number of very elderly people, mostly at the end of their life, did not have the support that everyone would want in order to die an easy and dignified death, and their relatives did not have the satisfaction of complaining in a way that they believed to be effective.

Since then a lot of work has been done to bring things round, and now there is scrutiny and very real help from the highest level to make sure that the hospital will become one of the best in the country.

This process has been pretty traumatic for the town – and I suspect for hospitals all over the country who will have looked at what happened here and thanked their lucky stars that it wasn’t them in the frame.

The ripple effect is significant, there are new national procedures coming into place next month for handling complaints, people are starting to ask questions about the make up of hospital boards and the way in which they are informed, and there is more emphasis on trying to determine what quality of care means, and how you know if you have got it.

With end of life care I feel that is a difficult question, which different people will want to answer in different ways. The article I referred to at the start of this blog is perhaps looking at an ideal. It is certainly asking a great deal of wisdom and understanding from our nurses, and maybe if we are expecting that kind of service from them we have to give them very real support and recognition in exchange.

In my own dealings with different hospitals, what has worried me most with the four deaths that I have closely observed, is that we are getting increasingly good indeed at being able to keep people just about alive, and can sometimes prolong life for months or even years in a state that is undignified, and unpleasant.

In the case of my own mother, she was given life saving surgery at the age of 88, after having lived with dementia for four years. She then went on to live another five years in a state of total dependence. Emotionally this difficult for her, and also probably the most difficult time of my life. I did not like watching my mother completely forget her identity. The question which invariably came whilst she could still speak at all was “who am I?” The financial bill for this five years, split about equally between the family and the state, came to around £250,000.

Her death, when it came at the age of 92 was of course sad, but it is also what has always been described as “a happy release”. The doctors agreed with me that she should not be taken to hospital and she was spared all the invasive drips and transfusions and nasal gastric tubes that we so often see. She just faded quietly and easily into death over a five week period after her 5th stroke.

A nurse herself, she had never really expected to be cared for, but at the end she let this happen, and I think felt gratitude for it.

The main fuss about the report that has just been produced on Stafford Hospital is that the standardised death rate was high. Having read the report in detail, I have some personal doubts about this, doubts which the local press indicates are shared by the coroner. I think when all the investigations into case notes are carried out that there will be significantly smaller numbers involved than press headlines might have one believe.

Hospitals are likely to start worrying even more than they do already about their death rates. I hope that will not mean that they are even more reluctant than they already are to let people die a natural death. This article takes a look at what a natural death may mean, http://www.hospicepatients.org/and.html and advocates “Allow a natural death” If it comes to it I think I will want AND on my case notes.