Last month's column concluded with the commonly understood assertion that there is nothing more certain in life than death and taxes. It is, perhaps, therefore, not unreasonable to expect that given the unavoidability and inevitability (of death, at least), the UK, as a well-developed, relatively rich and stable Western economy, with a historically established healthcare system, should be more assured of our resources, reserves, resilience and facility to respond to the health and social care needs of its citizens.
Nevertheless, the recent testimony of witnesses recounting their experiences at the continuing COVID-19 inquiry has highlighted how woefully and inadequately prepared the government was to deal with that particular health emergency. It is cause for a pause for reflection on future practice. In particularly emotionally elegiac evidence, consultant anaesthetist Kevin Fong, NHS England's former national clinical adviser in emergency preparedness, talked about how ‘overwhelmed’ services, such as intensive therapy unit, were and how traumatising the experience was for nurses, with them feeling they were ‘just throwing bodies away’ for the want of suitable equipment and time to maintain dignified and decorous end-of-life care practices. The inquiry has heard comparable evidence from the nursing care home and community care sectors.
Of course, the ‘scale of death’ of that ‘unprecedented’ pandemic is acknowledged, particularly for intensive therapy unit and care home staff. That notwithstanding, death, dying and loss are assuredly part of the human condition and each community and every family will ascribe a personal, private, particular or social significance and consideration of the experiences (Abel et al, 2021). As such, it is not an unreasonable expectation that individuals should have confidence in the care and every context of care that will be provided; yet access to high-quality palliative and end-of-life care is inadequate. While it may be a local service or political policy aspiration, the prioritisation of practicalities for achievement are more nebulous (Sleeman et al, 2021). Community services are facing increasing workloads owing to the ageing population and services for those living with multiple long-term and lifethreatening conditions are often fragmented. The resources are also limited or lacking and training, education and staff development opportunities are insufficient (Jones et al, 2023).
While the involvement and initiation of community and home-based palliative and end-of-life care are encouraged and entreated (Petrova et al, 2021), half of deaths occur in hospital because of the lack of in-home and community-based care provision (Peate, 2023). Approximately 100000 people in the UK, who could benefit from palliative care, die without access to such support (Dudley and Mutebi, 2022).
Similarly, while the provision of clinical palliative and end-of-life care is meaningful, worthy and rewarding for practitioners, the day-to-day working practices of such nursing are recognisably associated with a range of encounters and demands that can evoke physical, psychological and social causes of stress (May et al, 2022). The continual contact with suffering, bad news, uncertainty and death, for example, or the frustrations of the limitations of what can reasonably be accomplished or is acceptable given the scarcity of resource can be deeply affecting. It may also lead to many individuals experiencing stress, anxiety and burnout, which may manifest as physical or emotional exhaustion, irritability and agitation, insomnia, headaches, lack of concentration, anxiety and depression (Gómez-Urquiza et al, 2020; Clayton and Marczak, 2023). At its worst, such burnout can be associated with disengagement, degraded levels of care and safety, and degrading, impersonal or depersonalised care (Gómez-Urquiza et al, 2020).
Healthcare professionals should never again have to hear stories of nurses being ‘so overwhelmed that they were putting patients in body bags, lifting them from the bed, putting them on the floor, and putting another patient in that bed straight away because there was no time’, as Dr Fong so evocatively and expressively related (The Guardian, 2024). This will require the implementation of intervention that includes ways to improve staff numbers, working conditions, effective staff supervision and support (Clayton and Marczak, 2023). The writer and philosopher George Santayana suggested: ‘Those who cannot remember the past are condemned to repeat it’ (Santayana and Gouinlock, 2011). The recent histories we hear recounted, whether at a public inquiry or a private chat in the home or surgery would suggest that lessons need to be learned and acted upon.