BBC2 Horizon ‘We need to talk about death’ missed the opportunity to talk about inequalities in palliative care

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On 23 January BBC 2 Horizon aired the documentary ‘We need to talk about death’. The focus of the program was on the wonderful hospice care, and the management of cancer diagnosis and treatment. It was good that the program showed a number of people with other diseases. The program was filmed largely at St Christopher’s Hospice in London. St Christopher is considered the first modern hospice, and to be at the foundation of the hospice movement worldwide. In England there are now 223 hospices.

National statistics say that each year some 50% of deaths occur in hospitals, 25% in care homes, 20% in people’s own homes, and 8% in hospices. You could argue that dying in hospice is rare, and this should have been made clear (in the program the 50% figure for hospitals was mentioned). It is true that the trend is towards an increase in the proportion of hospice deaths.

Cancer is not the most common cause of death. Heart and lung chronic illnesses, and dementia are the main killers combined. Most patients in hospices inpatient units have cancer, and people with dementia rarely make it to these units.

What it is not routinely mentioned, or measured, is that people from more deprived areas have 25% less chances to be admitted to a hospice, even if the hospice is built in the middle of that area. Twenty years ago the gap was 8%: a third of today’s 25%. As the proportion of hospice deaths increases, the relative gap between people of low socioeconomic status and people of high socioeconomic status increases (see the chart at the bottom of the article).

It is a fundamental principle of the NHS constitution that people have the right to choose their place of death, regardless of illness, socioeconomic status, or other characteristics. Though, the inequalities in place of death between people with different illnesses and people with different socioeconomic status are wide. People who live in deprived areas are at an increasing disadvantage when it comes to admission to hospice. The service is there, but access is not.

Sixty years ago, St Joseph’s Hospice, run by nuns in London, had the aim to provide dignified dying for the poorest. Fifty years ago St Christopher’s was founded. But hospice care at national level continues to favour the wealthier.

 Marco, 24 January 2019
 
Chart adapted from: Sleeman, K. E., Davies, J. M., Verne, J., Gao, W., & Higginson, I. J. (2016). The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993–2012. Palliative Medicine, 30(1), 45-53.

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