Let’s talk honestly about how we die

We often fail to ask what really matters most to someone in their final months, weeks, or days. The result of this is that around half of us end up dying in hospital, often after uncomfortable treatments. But we know that around 70% of people would prefer to spend their last days at home—or maybe in a hospice, or with a close family member or friend.

This is something we’re trying to change. But to get what we want, we need to have those important conversations in advance.

So, what is a good death? Doctor Cicely Saunders, who started the first modern hospice, put it perfectly: “How people die remains in the memory of those who live on. You matter because you are you, and you matter to the last moment of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”

Those words stick with me, and they guide how our health and care systems try to support families. If we want to help each person keep their dignity and independence near the end, we have to talk honestly and early.

That means creating a clear, realistic, and personalised care plan—one that’s written down, owned by the person themselves, and shared with everyone involved.

Let’s talk about choice. Too often, families are caught off-guard when a loved one suddenly has to go to hospital from home or a care home. Usually, they haven’t had those crucial conversations, and so they don’t know about all the help that’s available close to home.

General Practice teams and district nursing still provide the bulk of care when someone is at the end of their life. They are available during all hours and offer home visits. They are supported by:

• Hospice services provide holistic care and support for the person and those who care for them, including respite care, therapies and symptom control as outpatients or inpatients.
• Community palliative care specialist nurses, working with hospital-based hospice services and palliative care consultants.
• Hospice at home services provided by our independent hospices. There is a night support service providing quick access support for urgent care overnight.
• Urgent response and care co-ordination teams.

Our End of Life Toolkit acts as an information hub for staff and the public and includes information about local services and support.

The bottom line is that we need to get better at talking about what matters at the end of life—so more people can have the kind of death they truly want, surrounded by the people and comforts that mean most.

Dr Julie Barker, GP and End of Life Clinical Lead for Nottingham and Nottinghamshire