Terminally ill patients are to be given more choice over where they die and encouraged to make their wishes known, as part of measures to improve care for the dying.

There will be “rapid response” nursing teams to provide care to those who wish to die in the setting they choose – typically at home, surrounded by their loved ones. The ten-year plan also suggests that a cultural shift is needed for doctors and patients to be more comfortable talking about and planning for death. Medical staff are to be trained in how to broach the delicate subject of a patient’s prognosis.

Patients with terminal conditions should have a care plan setting out how they might be supported with pain relief, the Government’s End of Life Care Strategy for England suggests.

Mike Richards, the National Cancer Director, said that GPs, hospital doctors and experienced nurses should become used to asking themselves: “How surprised would I be if this person in front of me were to die in the next year?”

Times Archive, 1971: In the last days of life

In a great many cases it is not the will to care at home for the dying member of a family that is lacking but the means to do so

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• The last days of life

Depending on the answer, he said, “you have to ask, ‘Does the patient know this?’, and initiate the conversation from there. We need to develop doctors’ and nurses’ skills so that they can have these conversations.”

Just one in five of the deaths in England - most of which follow chronic illness such as heart disease, cancer or dementia - occur in the person’s home, despite two thirds of people saying that that is where they would prefer to die. By comparison, 58 per cent of people die in hospital. Families complain that a lack of support and pain management leaves them no alternative.

Announcing the measures yesterday, Alan Johnson, the Health Secretary, and Ivan Lewis, the Care Services Minister, said that they would help to ensure “high-quality, compassionate and dignified care” when lives ended.

The strategy, which promises that community nurses will be on-call around the clock in all areas, would be backed by an extra £286 million. This would honour Labour’s manifesto pledge at the last election to double investment in palliative care by 2011, the ministers said. The NHS budget will have risen by a similar proportion.

Mr Johnson added: “The most important objective is to ensure that people’s individual needs, their priorities, their preferences for end-of-life care are identified, they are documented, they are reviewed, they are respected and acted upon wherever possible.”

He wanted to start a national debate to get people talking more openly about death. The strategy suggested how this might be encouraged, such as getting undertakers to hold open days and schools to discuss the issue.

A century ago, Mr Johnson continued, “people were familiar with death - many people died at home, they died of diseases at a young age”. With today’s access to state-provided medical care, “people die in hospitals whether they want to or not, and sometimes there are issues about how they die in hospitals. The big issue for us is to give the choice to everyone.”

Campaigners have long argued that this is a neglected area of the NHS. Paul Cann, of Help the Aged, said: “There has been a presumption that death should be at the convenience of the system, as opposed to respecting the wishes of those approaching their final days.” The challenge now was to turn “fine words into action”, he said.

Ciarán Devane, of Macmillan Cancer Support, added that provision of community care would need to be improved in certain areas. Medical staff should be discussing the prospect of death with patients much earlier than they currently did, he said – where possible at least six months before a patient was expected to die.

Scotland is also working on its plans for end-of-life care. Wales has already produced guidance on the issue.

Niall Dickson, of the King’s Fund health think-tank, said that the system had not done nearly enough to provide good-quality care at the end of life. “Patients have been denied choice, pain has not be well controlled and relatives have been marginalised. “The extra resources are extremely welcome. [But] if this strategy is to make a difference it will need a change in attitudes and priorities - patients should feel comfortable talking openly.”

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