There are many issues in there. We sometimes get very good discharges from hospital, in which people are discharged home with the expectation that they are now facing death with some sort of immediacy that matters to everyone. Death might take hours, days, weeks, months or longer, but that sort of thing is extremely helpful. Nothing makes my life easier as a generalist, which is what I am, than when one of my more knowledgeable specialist colleagues in whatever discipline says, “That’s that.” I can then do my stuff, and everything is okay.
Does being on the register make a difference to what people get? I suppose the answer is yes. I am unlikely to refer somebody for specialist palliative care input if I do not think that they are dying. Should being on the register make much difference? If people buy into the model that I am suggesting, which involves the provision of good care for people who happen to be dying, I am not sure that it matters so much.
Where do the resources need to go? Lifting the structure from Maslow’s pyramid of human needs, I would start at the bottom. There are a few core things that people need; I am being dead serious in that respect. They need a bed, aids and appliances and things like that. One level above that, however, they need care. They need people who are there around them, whether it is their family—if that is possible and if they have family—or their social carers, before we even think about healthcare and nursing staff.
We are not in a situation—certainly where I work—in which we can guarantee care for somebody who is dying. My last patient died of MND; I have permission to use his details. We could not guarantee that he, as a single man whose nearest relations were two brothers, one in Skye and one in York, would have a night carer every night of the week. I am talking about somebody who was so paralysed that he could not move. Until we get that right, we will struggle with the rest of the stuff, because that is a pretty core need.
There are a lot of issues, which brings us back to what Ranald Mair said. The people who supply that sort of work, such as the staff of Cordia, who provided the care for the man with MND, are fantastic, and we need to celebrate what they do. However, we need a lot more of them, and that is a macroeconomic issue. I believe that they should be paid a lot more. They are working with the most vulnerable and needy people in society, and we pay them less than they would get if they were stacking shelves in Tesco. That does not work for me.
On top of paying those people a decent wage and giving them a decent career structure, we should look at their personal attributes. This is a dodgy area to go into, but we need to find people who are genuinely caring, compassionate and empathetic. There are big differences between people in that respect, and there is research on palliative care that looks at the variations in personality between those who work in palliative care and other people. They are very different.
I think that I am quite a caring and compassionate individual, but I would be a disastrous surgeon. I would be full of anxiety and worry, asking, “Should I cut that artery?” and stuff like that. It would be terrible. We need to look for the right people and give them a career and a way forward.
Sorry—I was sitting in the public gallery behind Ranald Mair earlier, and I would very much get behind what he said.