Written evidence submitted by Dr. Kate Woodthorpe (COR0111)
1. I am an academic based at the University of Bath who specialises in death, dying and bereavement. I am submitting evidence as I am very concerned that there has been little Government/local Government advice about dealing with deaths in the community. These may be deaths as a result of Coronavirus, or (just as likely) deaths that occur because the individual is regarded as vulnerable and cannot be admitted to hospital.
2. It is unclear to me how Local Resilience Forums, working with the NHS and local authorities, are preparing to provide advice and guidance about supporting people to die at home, and specific information about supporting very unwell/dying vulnerable people who live alone.
3. In terms of my suggestions for a way forward, I would create very practical advice based on public health models of end of life care, often termed Compassionate Communities. I give just a few examples of how this could be done and communicated to lay people:
- A local/national system for individuals who live alone to alert their neighbours to their being unwell and needing help. This is particularly important for those who do not have access to the internet. The NHS Volunteer system is commendable but it is unclear how it can support those who do not have a smartphone or are not internet-savvy. Is something as simple as (for example) putting a purple colour item on/by your front door/in your window enough to alert others? Clearly the issue with this is that that household would be easily identifiable as vulnerable/elderly, the person being unwell and potentially living alone, and therefore become a target for criminal activity. This would need to be mitigated.
- If there was a way to alert others living locally, are they prepared to support those who are unwell and/or dying in their homes –potentially who they do not know? How well equipped are people to support others in their neighbourhood, for this type of care? What are people prepared to do – especially if it means going into other’s homes where there is a high risk of infection. What could that care look like and how could suggestions be communicated? I suggest that guidance needs to be very simple and not overwhelming as it will dissuade individuals from acting.
- As above with alerting others, with newspaper and milk deliveries in the past, there was a system whereby it could be noted in (eg) milk bottles were not brought in, newspapers piling up by the front door, curtains not being drawn. This was a way to learn that someone in the household had died. Are there equivalent services now that have frequent contact with homes and could they have a role in altering others now – eg. postal services?
- Finally, it needs to be clear within Local Resilience Forums what the role is of GPs in supporting people to die in the community if they cannot enter their houses in a timely manner. Continuity of care may be critical to ensure that those who live alone and cannot be admitted to hospital, who are reaching the ends of their lives, are identified, supported, and their bodies dealt with after their deaths in a time-sensitive way. Are there other healthcare or local authority professionals/practitioners who could be redeployed or act in an auxiliary role to support those who cannot be admitted into hospital?
4. In sum, much more needs to be done within Local Resilience Forums to enable dying at home and in the community, when NHS and social care staff cannot be called/relied upon to do so – either because their resources are focused elsewhere, or because they are understaffed owing to illness.