Councillor David Fothergill writes in his latest Blog about the concept of dying well. It encompasses the idea of living a life that leads to a peaceful and dignified death.
Dying well is a concept that has gained increasing attention in recent years. It encompasses the idea of living a life that leads to a peaceful and dignified death. The Marmot life course, developed by Sir Michael Marmot, provides a framework for understanding how social determinants of health impact our lives from birth to death. By examining the Marmot life course, we can gain insights into how to live well and, ultimately, die well.
The Marmot life course is a model that highlights the importance of social determinants of health throughout different stages of life. These determinants include factors such as socioeconomic status, education, employment, social support, and access to healthcare. Marmot's research has shown that these factors significantly influence health outcomes and quality of life. The foundation for a healthy life is laid in early childhood. Access to quality education, nutrition, and healthcare during this period is crucial. Children who grow up in supportive environments are more likely to develop the skills and resilience needed to navigate life's challenges.
During adolescence, social determinants such as education and social support continue to play a vital role. Positive relationships with peers and mentors can help adolescents develop a sense of identity and purpose. Access to education and extracurricular activities can also provide opportunities for personal growth and development. In adulthood, factors such as employment, income, and social support become increasingly important. A stable job and a supportive social network can contribute to a sense of well-being and security. Access to healthcare is also crucial for maintaining physical and mental health. As individuals age, social determinants such as income, social support, and access to healthcare continue to impact their quality of life. Older adults who have strong social connections and access to healthcare are more likely to experience a sense of well-being and fulfilment.
Dying well is about more than just the final moments of life. It involves living a life that is meaningful and fulfilling and being prepared for the end of life. Accepting the inevitability of death can help individuals live more fully in the present. This acceptance can lead to a greater appreciation for life and a focus on what truly matters. Preparing for death involves practical steps such as creating a will, discussing end-of-life wishes with loved ones, and making arrangements for care. It also involves emotional and spiritual preparation, such as reflecting on one's life and finding peace with the past. Ensuring a good quality of life in the final stages involves managing pain and symptoms, maintaining dignity, and receiving emotional and spiritual support.
End-of-life care statistics provide valuable insights into how we can improve the quality of care for those nearing the end of life. In England, 43.4 per cent of deaths occurred in hospitals, 28.7 per cent at home, 20.5 per cent in care homes, and 4.7 per cent in hospices. Additionally, 6.2 per cent of people who died had three or more emergency admissions to hospital in their last 90 days of life. This statistic underscores the need for better management of end-of-life care to reduce the burden on emergency services. Furthermore, 41.2 per cent of people who died in care homes were temporary residents. This highlights the importance of providing adequate support and care for temporary residents in care homes.
Councils play a crucial role in ensuring that people die well and with dignity. They are responsible for the provision of social care, commissioning services, providing information and advice, and working in partnership with other agencies. Councils can support end-of-life care by ensuring that services are accessible and tailored to the needs of individuals. They can also promote awareness and understanding of end-of-life care options among the public and healthcare professionals. By working closely with healthcare providers, councils can help to coordinate care and ensure that individuals receive the support they need in their preferred setting, whether at home, in a care home, or in a hospice. Additionally, councils can support families and carers by providing respite care, counselling, and other forms of assistance. This holistic approach helps to ensure that both the individual and their loved ones are supported throughout the end-of-life journey.
There are several examples of successful council initiatives in end-of-life care. For instance, the Compassionate Neighbours program, supported by various councils in London, trains volunteers to provide emotional and social support to people nearing the end of life. This initiative helps reduce loneliness and isolation, improving the quality of life for those in their final stages. Another example is the Dying Matters campaign, which encourages open conversations about death and dying. Supported by local councils, this campaign aims to change public attitudes and ensure that people are better prepared for the end of life. Additionally, the Gold Standards Framework (GSF) in End of Life Care, implemented by several councils, provides training for healthcare professionals to deliver high-quality care to patients nearing the end of life. This framework has been shown to improve the coordination and quality of care, ensuring that patients receive the support they need in their preferred setting.
The Marmot life course provides a valuable framework for understanding how social determinants of health impact our lives from birth to death. By addressing these determinants and focusing on living a meaningful and fulfilling life, we can improve our chances of dying well. Ultimately, dying well is about living well – embracing the journey of life with acceptance, preparation, and a focus on quality of life.
Councillor David Fothergill
Chairman
LGA Community Wellbeing Board
End of life care: guide for councils
Councils have a key role to play in helping people to die well and with dignity. This guide sets out how councils in England can play that role. The focus of this guide is adults during the final 12 months of their lives but the general principles also apply to children and young people.