Congratulations to the University of Nottingham, Dying Matters and the National End of Life Care Programme for producing the excellent Planning for your future care publication.

It is written in simple, positive prose and covers all aspects of Advance Care Planning including what is the most difficult aspect, ‘Opening the conversation’.  The tone for the leaflet is set in this telling phrase: ‘Not everyone will choose to engage in such a conversation and that is fine. However, talking and planning ahead means that your wishes are more likely to be known by others.’

I was particularly pleased that the leaflet covered wishes and preferences, and that these included some of the end of life experience defined in the My Last Song ‘death plan.’  Planning for your future care suggests where you want to be, who you want to be with, types of treatment, ‘how you like to do things,’ with examples such as sleeping with the light on or having a shower instead of a bath.

If you, or an ailing loved one,  want to have a ‘good death’ instead of a lonely, frightening end of life, then read Planning for your future care and act on its advice. To make the end of life experience as good as it can be,  fill in your own personal death plan, a template for which is available in the My Last Song Lifebox.

The wishes and preferences are more holistic, covering the music you want to hear; the smells you want surrounding you; the food and drink you wish to taste; the sensations you want your body to feel, such as caressing, massaging, stroking; what you want to see, such as a lovely view or your favourite photographs; how you want to look – clothes, make up, hair style; and ensuring the practical issues are resolved so you have no concerns.

By involving loved ones, doctors and if appropriate ministers of religion or spiritual advisers, having a death plan will go a considerable way to ensuring, if possible, the death is as comfortable and comforting as possible.

There’s a lot happening in the normally quiet death and dying space.  Much of this activity is due to the London Southbank Centre’s courageous decision to put on a week’s events centred on death, in an attempt to reduce society’s reluctance to face mortality.

Part of this will be Sandi Toksvig’s memorial lecture, which she trails with her trademark endearing and engaging wit here.

I’m also looking forward to Paul Gambaccini’s Desert Island Death Discs event, as it will look at the top funeral songs and what they tell us us about our attitudes to departing this world. Will he, I wonder, have gone through the 130 or so lists of farewell songs sent in by visitors to My Last Song?

The Natural Burial Ground’s funeral survey results have also been released, and have some interesting if rather partial findings. The survey has clearly and unsurprisingly been answered mainly by those in or close to the funeral business. What we liked about the results was the large percentages of people who go online to get information about funerals and who have written down or told relatives of their funeral wishes.

Sadly as these wishes are often misplaced or disregarded, such admirable intentions are a waste of time. Which is why people should store their funeral wishes and the vital information required by close loved ones immediately after the death in their own Lifebox.

High on the news agenda today was the story that data from the Office for National Statistics showed that dehydration or malnutrition was linked to 25 deaths every week last year. This is the shocking and depressing counterpoint to the admirable efforts others are making, often out of benevolent self interest, to encourage a change in how the British in particular look at death.

Depressingly it is still true that the vast majority of people don’t think about death and don’t talk about death until it is literally too late. And so the chances of having a good death are still remote as we pointed out earlier, with almost 70 per cent of people dying in hospitals or hospices even though over two thirds say they want to die at home.

My Last Song has supported the case for the terminally ill and the ailing elderly to have their own personal death plans, rather as mums-to-be have birth plans. This way the issues surrounding the end of life can be addressed in as calm a way as possible, with the involvement of loved ones, medical professionals and if appropriate, ministers of religion or other comforters.

After some research we created a holistic death plan template which covers emotional, physical, medical, practical and spiritual issues to make the end of life as comfortable and comforting as possible.

Funeral wishes, death plans and the raising of the public’s consciousness about death and dying are pointing in the right direction, but there’s still a long way to go.

When I started My Last Song four long years ago death, dying and bereavement were subjects rarely covered by media old or new. I had been to two funerals which were dreadfully inappropriate farewells and thought there must be a better way…from that My Last Song developed.

At one stage it had the strapline: Because a good life deserves a good ending, and that’s still our view.

Since then there has been an increasingly rapid change of attitude, highlighted by two or three events which, though small themselves, are significant because of what they signal.

But before that, mention should be made of organisations which have worked hard to change society’s view of how we end our lives. Dying Matters, set up in 2009 by the National Council for Palliative Care, works tirelessly to deliver its aim to change public knowledge, attitudes and behaviours towards death, dying and bereavement.

Dignity in Dying is hugely effective in educating the public in their rights to have a good death, including the option of an assisted death for the terminally ill.

The British Humanist Association has publicised the virtues of a humanist funeral for those who have no religious beliefs and the Institute of Civil Funerals have ensured that civil funerals, often a mix of religious and secular, are conducted to a high standard.

And no summary of changes to funerals would be complete without mentioning The Good Funeral Guide who recommends those funeral directors who are moving with the times, and whose criticisms of the Cooperative Funeralcare and Dignity chains are founded on their sometimes appalling failings in customer care standards.

What of the smaller events which confirm the trend towards taking control of the end of life is gaining momentum?

First, the blog posted by ‘grief specialist’ Kristie West entitled Can A Funeral Be Beautiful? This highlights the film, Remembering Josh Edmonds, a poignant tribute video of a 22 year-old’s life and extraordinarily personal funeral. Making this film was his family’s way of celebrating Josh’s life, something that would have been unheard of a few years ago when the only acceptable way of treating a young death would have been to emphasise the tragic grief of a life taken too early.

At the other end of life’s passage, the Chicago Tribune highlighted what they call ‘Dignity Therapy’ which takes the form of interviewing the dying patient to record their messages to their loved ones, transcribing it and then producing a leather bound ‘legacy document.’

In this country, a similar service is provided by A Giving Tribute, an excellent start up which deserves great success.

The ever growing popularity of green funerals and the ‘natural death’ movement also shows that people are discussing the end of life event they want rather than leaving it to the local funeral director.

More radical still is the Death Café, currently only in London, but planning to expand to other parts of the UK, where, in the words of their website, ‘strangers come together to discuss death and eat delicious food.’ I plan to attend the next Death Café day, and will hopefully add to the favourable reports.

Note too that the photographers specialising in funeral photography, something that would have been frowned up a few years ago.  Farewell Photos and Funeography deserve a mention.

As for My Last Song, the growing use of the Lifebox where people store their funeral wishes, life stories, details to help their loved ones cope following their deaths shows the idea is increasingly appealing as is the number of people visiting the page describing the benefits of having individual death plans to ensure, as much as possible, you can have a comfortable and comforting death.

So at last we are changing our attitude to death, dying and bereavement, influenced for too long by Queen Victoria’s lifelong despair at the death of Prince Albert, into something we should discuss and be in control of.

Our deaths should be just as important as the rest of our lives, and thought of like this, a good life will indeed have a good ending.

I would like to draw your attention to interesting content put on the internet recently by Ken Murray, a Clinical Assistant Professor of Family Medicine at the University of Southern California.

Entitled How Doctors Die, it is puts the case for non-intervention once death is inevitable.

It argues that advances in medical science and equipment combined with the professional requirements of doctors  to keep people alive as long as possible has increased the likelihood of futile intervention and unnecessary suffering.

Tellingly, he states that doctors themselves are horrified of the prospect of ending their lives in such circumstances and are choosing in ever increasing numbers to insist that their fellow physicians do not intervene if death is inevitable.

“They want to be sure, when the time comes, that no heroic measures will happen – that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (cardiopulmonary resuscitation).

“Almost all medical professionals have seen what we call ‘futile care’ being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs.

“All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery…I cannot count the number of times fellow physicians have told me, in words that vary only slightly, ‘Promise me if you find me like this that you’ll kill me.’ They mean it.”

My Last Song believes a good life deserves a good death, and that futile intervention and prolonging suffering is not a good death.

We also believe that we should be in charge of how we want to die, not leave it to our loved ones – which is unfair, or medical professionals – which is too random.

We have argued many times in the past that society should face up to death and dying in a more positive, emotion-free way than is currently the case, and that this will be more likely if people are encouraged to discuss how their own death should be managed.

We have created a holistic death plan template which includes medical, emotional, physical and spiritual issues to be agreed, as well as advice on things that need to be sorted before death to prevent stressful worries. 

Used properly, and involving the patient, their close loved ones, their medical professionals – and if appropriate a minister of religion, it will be a major step in achieving a comfortable, comforting death.

It’s the death that doctors want for themselves and that should be the norm for the rest of us.

I was saddened to receive this contribution to the Gay and Lesbian Funeral Issues section of My Last Song by a contributor who asked not to have his identity revealed.

It is appalling that such cruel attitudes still prevail, and difficult to know how to counter them apart from being more honest and planning for the inevitable death of a partner in a same sex relationship and how the funeral will be handled.

I would like to hear the experiences of others in similar situations and any advice they have.

“My first, and only, partner died six months ago. We were together nine years, but we unwisely delayed getting a civil partnership and he was only ‘out’ to his close family and a few mutual friends.

As a result, I had no rights when it came to his funeral. All the major decisions were made by his grieving mother, who told me that it would break her heart to have someone stand up and talk about her son being gay.

I was allowed to attend the funeral, and as the only person able to use a computer properly I was tasked with composing the eulogy as it was dictated by her family. However, I was not allowed to be mentioned in it, and at the funeral the mourners were hustled out of the church quickly by his family to avoid me talking to them.

There is no point trying to explain how psychologically mangled this has left me, I leave it to your imagination.

Suffice to say, those you think these attitudes are a thing of the past are horribly, horribly wrong.  It is no exaggeration to say that the two worst events in my life were, in order, his death and his funeral.”

Geraldine Beddel, editor of Gransnet, wrote a very thoughtful piece last week which argued that our society has unwittingly colluded in the mistreatment of old people by our widespread casual ageism.

Her thesis is that until we respect our elders, the pernicious cruelty towards old people will continue.

While I agree with her arguments I would like to make two observations.

The first is that these attitudes are far more prevalent in the indigenous, longer established population and much less in the families from Africa and Asia where the wisdom of age is much more valued and respected.

People from these continents are used to seeing their elders work hard, without the protection of a welfare state and pension schemes. In these cultures, a person is brought up and protected by the extended family, and as they get older they then look after those who’ve looked after them. 

There’s self interest and community interest at heart here, and it works well. Where this family/community protection is replaced by the state or other institutions, the appreciation of the human relationship is rapidly diluted. 

When transplanted into this country, such respect for older people remains for one or two generations. I know several African families very well, and respect for elders is a value that is instilled into the children. Any ageist remark or attitude is sometimes literally slapped down.

The second point is that we should value old people not just because they brought us up, but because they have so much to teach us. Again this is where communities from less developed countries can illuminate our failings.

Their idea of education was less through formal schooling and more from the passing down of wisdom, ideas, values and experience from generation to generation. The collective learning of old people was critical to the success or failure of a family, village or tribe.

In our more developed culture, old people may not play such an educational role, but their memories, life stories, achievements, attitudes make up micro social and family histories.

We should understand their worth and do all we can to keep them, because once lost they are lost forever.

This is why the Lifebox is such a useful service.  It’s an online secure area designed to enable personal histories to be uploaded and stored, then to be accessed by chosen younger family members.

It’s probable that many older people who will want a Lifebox will need the help of younger family members to populate it, and in doing so, the bonding between young and old will increase the mutual intergenerational respect.

This in turn will reduce our tendency, pointed out by Geraldine Bedell, to dismiss the value of our older family members.

Penelope Keith, now one of our ‘institutions’, has written in the Daily Telegraph that if younger people mixed more with older people they would be less inclined to break the law.

The star of The Good Life and To The Manor Born is president of a prisons charity which works to divert young people away from a life of crime.

She believes that teenagers and young adults would behave better if they spent more time with grandparents and other older people.

I hope she would like the idea of the Lifebox, the area in My Last Song where people can store and upload their digital memories so they are available for future generations. In effect it’s a digital time capsule.

The reason it should find favour with Ms Keith is that it is ideally suited to encourage younger members of the family to help older members use it. And in doing so, they will learn the lifestories and family history being imparted. This bonding might indeed make youngsters more law abiding. 

For in return, the young relatives will teach their grandparents and other older loved ones to use a computer with more confidence, the result being a unique and valued piece of family and social history which otherwise would be lost forever. The soft skills coaching of their elders will give youngsters a greater sense of purpose and self esteem.

If your family could benefit from all the features of the Lifebox, including drawing the generations closer together and older people being more computer literate, look no further than buying a Lifebox for the person whose memories should be safely stored, or for the youngster to show to his grandparents, ready to sit down and populate it every week or so.

During the past 40 years or so, a huge numbers of people in the poorer nations have been paid not much for doing a lot, while in the developed world many people have been paid a lot for doing not much.

And that, dear readers, is why there is now an irrevocable shift in the world’s economic order.

Those in the UK will be aware of the scores of thousands of jobs in the public sector, created by Labour and Conservative governments, which are not in the slightest bit productive. Many, but by no means all, are necessary to make our society run more smoothly, to help the disadvantaged, to regulate, to administer, to advise.

The private sector is also teeming with well paid overstaffed functions which produce little of value at one end of the scale, and hugely overpaid executives and directors at the other.

The service industries are particularly good at paying their staff a lot of money by providing services that might add value, but produce little that has a tangible long term worth.

In private and public sectors, the pay and conditions have been protected first by trade unions and later by the collective greed of workers and bosses scratching each others’ backs, unified by the shallow values of the baby boomers. Lots of people shouting ‘Me, Me, Me!’ soon becomes ‘Us, Us, Us!’.

Until only a short time ago, our pay increased every year, bonuses went up, pensions rose and our working life reduced.  As we live longer, our retirement extends and with it the time greater numbers of people are being paid for doing nothing.

We are now facing the consequences of an economy which has for decades been based on unproductive overpaid employment as our population grows increasingly old.

Meanwhile in countries such as India, China, Brazil, Vietnam, Korea, and increasingly in Africa and South America, vast and growing numbers of people have been working very hard from an early age until they expire making goods or harvesting food or extracting raw materials, all of which are sold for a profit. Their pay has been low, and kept low – talk of workers’ rights getting you imprisoned or laughed at.

In the UK, the increased income was used to borrow to buy property on the erroneous assumption that this would permanently gain in value. With our property as a safety net, we cheerfully got further in debt to buy more goods and foodstuffs, most of them made and grown by the millions upon millions of people in the by now fast developing world.

And so those countries grew richer as we got more in debt. That debt couldn’t be sustained once the property edifice started to shake and values dropped. Banks had huge books of toxic debt, interbank lending ceased and overstretched banks had to be bailed out by the government.

In many other developed states without a solid manufacturing base and without a well developed service sector, the situation is worse. In the southern European countries productivity per head is falling from a low figure, pensions are over generous, retirement age is in the 50s, working hours are low, unemployment high and tax payments a small proportion of what they should be.

Contradictions within the EU mean that a common currency is untenable; Germany will be able to make the financial rules, and enforce the austerity measures for a two tier Europe.

The electorates in these countries won’t like being told to accept reduced hand outs, pensions, to work longer and harder, but fundamental economic decisions won’t be influenced by the ballot box as much as by the markets and credit rating companies.

Funding the bail out of bankrupt economies are those countries in the developing world who have become very rich as money has flowed into their treasuries from the developed nations. China, India and the emerging economic countries will get us out of this mess, because it’s in their interest to do so, but the rules will be forever changed.

So the world is now one where in the west our lives are less influenced by democratic decisions than by the bond markets; Germany has gained economic and political hegemony in much of Europe, and countries such as China and India are more powerful than the UK, France, Italy, Spain and before long the US.

It was never supposed to be like this, but we had better realise that the old order, shaped by statesmen and industrialists after the second world war, has changed forever.

The 1st October is the International Day of Older People, and given My Last Song’s appeal, we are right there in that space.

The international element is the most important, in that it aims to campaign for pensions and greater provision for older people in the developing world. Alas, My Last Song can do nothing to support this goal.

But on a more individual level within the UK, US and other English speaking countries, I hope we can do something to ensure the wisdom, experience and values of each older person will remain after they die. 

This is not to assume that older people are about to die – thank heavens we are living longer and more healthy lives. But the older we get the more we must address our mortality.

And when doing, think about subscribing to a Lifebox into which you can put your memories, your wisdom, your achievements, your photographs…even your secrets. This will be secure so that only you, and after your death your chosen loved one(s), can open the Lifebox and access the information.

There is no such thing as eternal life, thank goodness. However, thanks to digital technology and perpetual storage on Cloud servers, your memories can live forever thanks to the Lifebox. And, as you are a member of the ‘Older’ community, these memories will include your nuggets of wisdom, experience and personal history that would otherwise be lost forever.

So Southern Cross, unsurprisingly, threw in the towel. The country’s largest care home operator couldn’t make ends meet.

Some of the landlords of their care homes will take over the running of them. As for the others, well there are few organisations lining up to take these over and so the Government has made the statement that nobody currently in these homes will be made homeless. Any further details conspicuous by their absence.

The Government must be aware of the ever growing problems being stored up in the provision of care for the increasing older population. It’s a double whammy…more people are joining the age group of 80 plus, and more within this group are living longer.

There is no sign of the reversal of the social trend of families, particularly those of the vast majority ‘traditional’ English families, losing their cohesion. An interesting aside here is that most of the immigrant communities bring with them strong family values, not all of them virtuous as can be seen by the increase in honour killings within the more tightly knit groups, whilst the strength of family unit of the indigenous population weakens.

So who will provide the care that an increasingly large proportion of this increasingly large group of elderly people will require?

There may be a huge market here, but I don’t think there’s a business in the market. Residential care requires a lot of costs: spacious properties and their maintenance; specialist equipment and medical supplies and a large labour force.

The income? Local authorities won’t have the money unless given increased ring fenced grants from central government. And the governing party (or coalition) will be loathe to increase taxation to pay these costs until this becomes the only socially acceptable answer.

My guess is that within ten years we’ll see a two tier system for the care of our elderly. A private sector catering for those (or their families) with the funds to pay for a high quality level of residential care and a state funded sector of homes run by a decentralised arms length agency for the rest.

It was with this sort of problem in mind that we put some advice on funding care options onto My Last Song.  It will be prudent to read it and to act on it before it’s too late.

The passage of time, like death, is impossible to deny but is often overlooked.