Dr Alf makes interesting points but the truth is that because of NHS inefficiencies, local authority duplication, and pensioners making unnecessary demands on the NHS for minor problems that they ought to resolve themselves, no amount of money would ever be enough to fund end of life care as it should be.

The “Liverpool Care Pathway” was supposedly abolished along with “do not resuscitate ” signs on patient notes. In reality, it was airbrushed out of the medical lexicon of the NHS but never went away. Under it, allegedly 450,000 people are hastened to an early grave by drugs (pain management), plus the progressive denial of food, water and treatments, other than those designed to make patients “more comfortable”.

My own brother and my late stepfather died at home in familiar surroundings and were looked after by ourselves and in the case of my brother, his wife and teams of nurses and carers during his last days. Too many people do not want to shoulder this responsibility and outsource it to the NHS and to care homes because the prospect of impending death and the physical aspects of looking after someone at home are beyond them.

In the UK, there are too many squeamish people who find death, dying and the practical issues “too difficult to talk about”, something that they find “hard to comprehend” and other euphemisms that are mechanisms for avoiding and not confronting reality. They argue :

We would not be able to cope

We lack the space

We lack the time, or

We live too far away and they would not want to move.

Merging Adult Social Care into the NHS and stripping away layers of management would be a start, and addressing the problem of 32% local authority worker productivity would be a good second step.  Also if Kenya, a country which inherited our system of local authorities under colonial rule, can reduce the number of devolved county governments to 47 (the world first), why can we not do the same?

Much of the problem with the end-of-life care and cuts in service provision has to do with the obduracy of local authority chief executives, middle managers and trades unions who want people to believe their narratives on “austerity”. They are aided in this by dissembling Chief Constables, mendacious Fire Chiefs and the assorted bunch of unelected throwbacks, plunderers of expenses in the outmoded “House of Lords”, who temporarily derailed the necessary cuts to Child Tax Credits. Recipients of this benefit have, in the majority of cases, up to 5 children for whom they expect others to pay, even though they cannot pay for any of them. The benefit has grown sixfold since its introduction to £30 billion GBP a year and is riddled with actual plus the potential for fraud, plus the propensity for employers to deliberately underpay people knowing that the taxpayer would make up the difference. The benefit should be abolished entirely, then employers would be compelled to make up wages to what they should have been or lay off unnecessary workers. Employers and benefits recipients had more than enough notice via George Osborne in his July budget and for them to demand more time is frankly an outrage that the House of Lords needs to be made to pay for dearly.

Some of the savings should be put into end-of-life care and hard-hitting education to encourage people to do the right thing by their elderly relatives.

John Gelmini