Sun Life Direct are to be congratulated on their annual Cost of Dying Report. It’s a comprehensive and helpful piece of research.
They have just published the ninth which shows that the basic cost of a funeral has risen by 6.2 per cent from £3091 in 2011 to £3284 in 2012; a 71 per cent increase since 2004.
Burial costs represent the largest increase (9.6 per cent) while cremation costs (6.6 per cent) and funeral directors’ costs (5.3 per cent) also rose significantly.
Eddie Harris, jazz sax player, wrote a song entitled I Need Some Money in which he said: ‘With the cost of living today, you can’t afford to die.’ The report bares this out: 17 per cent struggled with funeral costs and had to resort to serious measures to meet the shortfall with 20 per cent paying by credit card, 10 per cent borrowing the money, and nine per cent selling belongings.
Despite this, people are spending seven per cent more on memorials, flowers, and limousines.
The financial problems caused by the rising costs and growing inability to pay means the government’s Social Fund Funeral Payment Scheme, designed to contribute to the cost of funerals for the most vulnerable in society, is struggling to meet demand.
And yet, according to the report, 27 per cent have not thought about how they will pay for their funeral.
Little wonder then that Simon Cox of Sun Life Direct commented, “We must encourage people to look ahead and start planning in advance. There are suitable options for people to take financial responsibility for their own funerals.”
Those options, not surprisingly, are Sun Life financial products, and why not as Sun Life is a reputable company with a good reputation for services such as pre-paid funeral plans.  Cox’s foreword to the report should be read carefully as it is a most considered and well argued piece.
My Last Song has run a survey over the past few months asking visitors if they would consider planning their own funeral or leave it to loved ones. Out of the 500 or so who have replied, 84 per cent said they would consider it, not surprising as they were visitors to a site that encourages and assists them to plan their or their loved ones’ funerals.
If they looked at some of the advice we give, they could find significant ways of reducing the funeral costs.
These include buying the coffin direct from the manufacturer; reducing the amount of service and time provided by the funeral director; cutting back on flowers; refusing to be embalmed and planning more diligently things like transport and the catering at the gathering.
To help people be better informed and therefore more likely to save money, and indeed get a better funeral, we have provided a funeral planning checklist of decisions that need to be taken (or not) with the funeral director.
Costs will only come down if a radical new approach to funerals is adopted, starting with addressing one’s mortality and ending with a detailed plan for the send off that gives the best value for money and the best farewell ceremony.
There are signs that things are changing…the recent Joy Of Death weekend was well attended; the BBC2 programme Dead Good Job features the funeral industry and the Dying Matters coalition continues to grow and give excellent advice.
However, we are unlikely to see major changes for some time yet…a funeral is still a panic purchase for most people, and too many funeral directors know that such customers are unlikely to say no to the expensive options put before them.
There are honourable exceptions, those driven more by principle and tradition than bottom line targets. My Last Song would like to hear from them so we can bring them to the attention of our visitors.

The National Bereavement Survey, commissioned by the Department of Health, makes interesting reading.

Around 22,000 people responded to the first survey to measure care leading up to death – published by the Office for National Statistics.

The most striking, though not surprising, finding is that for those who expressed a preference, the majority (71 per cent) preferred to die at home, although most people died in hospital (53 per cent).

People’s reluctance to die in hospital, is reflected in the findings that hospitals, where most died, had the lowest ratings for caring for the dying with dignity and respect.

Only 30 per cent of people who died in hospital were given a choice about where they died, said relatives, compared to two-thirds of those who died in a hospice.

Sarah Wootton, Chief Executive of Dignity in Dying, made a key observation on the findings: “The end of life care which needs more work and investment is the involvement of patients in the decisions made about their care, and the recording of those decisions.”

She is absolutely right. Too often the end of life – dying and death – is ignored because it’s awkward, distressing or embarrassing to address. So the key decisions such as level of medical intervention, where the patient wants to die, who they want present and the type of funeral are left to medics, grieving loved ones and, in the case of the funeral, the chosen funeral director.

It’s going to take time to change this attitude of denying the inevitable, although the Dying Matters coalition is doing a great job, but change it will especially when baby boomers increasingly address their mortality. This is the ‘me, me, me’ generation, and they have been well informed and self centred about most decisions they’ve made and the same will be true for their end of life choices.

My Last Song has anticipated this by providing a death plan template which encourages the patient to be the centre of decision making, but involving their doctors, carers, close family members and, if appropriate, a minister of religion.

The issues covered are medical treatment, where to die, who you want present, and more holistic items such as any music you may want to hear, pictures you want to see, fragrances you wish to smell, how you may want to be dressed or made up. It also covers the pragmatic such as planning what happens to the pet and suggesting that the funeral wishes and will are up to date.

A death plan won’t guarantee a good death, but its adoption will ensure that a far greater number of deaths are comfortable and comforting.  That’s the least we deserve, surely.

At the opposite ends of the buying spectrum are planned purchases and panic buys. Both hardly need definition, but my take on them is as follows.

Planned purchase. You know you need to make the purchase; you research the costs, value for money, quality and availability of the product or service. You get information online or from experts, friends and relatives whose knowledge and expertise you trust. Once planned, (or researched, possibly a better term) you make the purchase.

Panic buy. Something you didn’t plan or anticipate happens and to deal with the issue you have to purchase something at very short notice. You defer to other people’s expertise, don’t question the price, buy immediately…and often regret it afterwards because what you purchased wasn’t fit for purpose or value for money.

Now let’s look at the purchase of funeral services. In theory they should be planned purchases. (If you think you or your loved ones will live forever, stop reading here.) Once we reach a certain age, suffer from terminal or life threatening illnesses or feel for whatever reason the time is right, we have to address our – or our loved ones’ – mortality. And this, of course, includes thinking about the funeral.

And yet the vast majority of funerals are panic buys. Despite the best efforts of the excellent Dying Matters coalition, death and dying is still a taboo, ignored until a loved one has died at which time grieving relatives, in a state of shock, go to the funeral directors they have used before, or are nearest in the local high street, or whose marketing messages have been most successful.

There’s a good chance that the funeral director so chosen is part of the Co-operative Funeralcare group, whose venal, dishonest and disrespectful practices in exploiting panic buyers were exposed by Channel 4’s Dispatches programme on Monday 25 June.

While I’m fairly sure the programme highlighted practices that most Co-operative Funeralcare employees wouldn’t accept, the impersonal treatment of bodies and the desire to make the greatest profit is an inevitable result of a corporate mentality of money before service rather than the other way round.

Understandably, most people have no interest or desire to know much about funerals.  Which is why it is so reassuring that trustworthy sources of information, advice and expertise exist.

The Good Funeral Guide is a comprehensive guide. The Natural Death Centre is ideal for those wanting to plan a natural burial. You wouldn’t expect me to ignore the wide range of advice found in My Last Song.  (My apologies to those growing number of organisations not mentioned whose sympathetic advice on funeral planning also enables the customer to be better informed.)

As baby boomers – used to good service, questioning old fashioned rituals, less likely to be church going – increasingly address their mortality, a big change in attitudes towards funerals will take place. They will be informed purchasers, they will think about the environmental impact of their funerals, they will want to stamp their individual personalities on their final event.

The funeral industry, in the main rather conservative and distrustful of innovation, will have to deal with informed customers making planned purchases and demanding a very personalised service which will test the professionalism and business skills of many funeral directors.

The two conglomerates, Dignity and Co-operative Funeralcare, should anticipate this now and start providing a more imaginative and customer led approach because otherwise smaller, more creative companies will take growing amounts of business from them.  It will be interesting to see how they deal with what will be quite revolutionary changes.

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.

 The theme of this year’s Dying Matters Coalition Awareness Week (16 to 22 May) is ‘Why Dying Matters to me’ which is as good as any to get people to address the taboo surrounding death.

I fully support the aims of Dying Matters, a broad coalition headed by the National Council for Palliative Care, to raise awareness of death, dying and bereavement. This shouldn’t come as a huge surprise since My Last Song was established in the belief that more people would address their mortality on line, and use My Last Song to ‘Go out on a high note.’

I take heart in the increasing signs that society is more ready to address the subject of death in a positive way. This, I think, is because people are living longer and therefore most deaths don’t cause the terrible grieving such as Queen Victoria’s reaction to the early passing of her beloved Prince Albert.

So, does the ending of a long and fulfilled life mean that death is easier to address?  Is it also easier to accept given a medical diagnosis of a terminal illness that allows time to come to terms with a life that will end?

For many people the thought of discussing the end of life causes distress, anxiety and embarrassment, and they want to put it off. However, as Dying Matters understands, if you face the subject from a more informed and positive approach, the negatives are reduced.

My Last Song has produced an innovative and holistic ‘Death Plan’ template to encourage discussion about a person’s last days alive so that they have a ‘good death’.  The issues that are covered include medical treatment, physical comfort, emotional and spiritual needs and ways in which stress and fear can be reduced.

The questions are designed to involve the person’s doctor, close family and friends and even professional advisers so that the person whose life is ending has no concerns about issues, such as their will or who looks after their pets, that should have been resolved.

I hope that all those who support Dying Matters and who will use this week to raise awareness will also see the benefits of promoting personalised death plans as a way of reducing the fear of dying and increasing our control over how we end our lives.

The Quakers have been philanthropists since the commercial success of Quaker family businesses and individuals in the 18th century.

In 1867, Quaker Social Action (now known as QSA) was set up in the East End of London as a result of the appalling poverty affecting the working class in that area.

Some 144 years later, the levels of poverty have, thank goodness, declined, but poverty still exists in the East End as it does in many parts of the country. And the recent recession, increasing unemployment and public sector cuts are making the situation worse for a lot of families.

Last year, to meet a growing concern, QSA launched Down To Earth, a project that addresses what I’ll call for shorthand, ‘funeral poverty.’ The project helps people living on low incomes to have the funeral they want at a price they can afford.

As their website explains, “when someone close to us dies, money is often the last thing on our minds.” In 2008 the average cost of a funeral was £7,000, and for families facing financial disadvantage and low income, finding that amount of money can be the first step in a downward spiral of financial difficulty and debt.

It can also cause a great deal of family strife and individual anxiety, at a time when people face extreme distress and anguish.

The Down To Earth project deserves much credit and support for addressing a very real issue that’s all too often ignored, along with everything else to do with our demise.

It may not be a particularly popular or attractive good cause, but consider its main purpose…’to help bereaved people to plan a funeral that honours and celebrates the life of the person who has died, but which will not have a negative effect on their own financial future.’

Hopefully Dying Matters will use its increasingly high profile to support Down To Earth, and also visitors to My Last Song, which has chosen QSA as its April Charity of the Month, will see the benefits of leaving a legacy so that their deaths will mean that the funerals of others need not cause distress and hardship but can be a fitting end of life event for those less fortunate.

In an attempt to get publicity for its worthwhile Great Daffodil Appeal, Marie Curie Cancer Care published the findings of a survey of where people would like to die.

These findings were picked up by the Dying Matters Coalition which, knowing the interests of the tabloid news desks (and probably its members also), headlined the piece they wrote on their website: ‘Most men would like to die having sex’.

Why let the facts get in the way of a good story…only one in five men said they would like to spend their final moments engaging in a spot of hanky panky.

More important than the imprecise description of research statistics is the good work the Dying Matters Coalition is doing in getting death talked about.  In this case, the vital issue of where people want to die instead of hospitals which is where most people will experience a possibly lonely and frightening end.

Dying Matters put this item on their Facebook page which resulted in some interesting comments. One woman said she could understand why ‘some blokes would want to go while they’re coming’.

Another reminded us of Peter Sellers’ comment on having a heart attack while making love to Britt Ekland: ‘I didn’t know whether I was coming or going.’

So well done Marie Curie and Dying Matters. Your efforts have resulted in a witty discussion about sex and death…the final taboos are gradually being defeated, and that can only be a good thing.

Marie Curie, the cancer care charity, this week published the findings of a survey that showed that almost two-thirds (63 per cent) wanted to die at home and 71 per cent would like to be surrounded by friends, family or loved ones. In stark contrast, just three per cent wanted to spend their final hours in hospital.

Yet according to the Office For National Statistics 69 per cent of people in England and Wales died in hospitals and hospices in 2009. And think tank Demos believes that by 2030, just one in ten people will die at home, the rest dying in hospitals and care homes.

I believes that personalised death plans will enable people to be more likely to have the death they want rather than the frightening and lonely end of life experienced in many hospitals. The sort of treatment old and dying people can expect in NHS hospitals was graphically shown on Dispatches earlier this week, confirmation of the Health Service Ombudsman’s criticism of how the NHS deals with the elderly.

The main cause of this often appalling standard of treatment of the dyings is that they don’t have a voice because death is so rarely discussed. Despite the best endeavours of Dying Matters, death is still a taboo subject and therefore the dying haven’t been consulted on how they wish their final days to be spent.

Yet if ailing elderly people and those with terminal illness were encouraged to fill in a death plan, it would mean the involvement of family members and family doctors who would then know what end of life experience the dying person wanted.

Dr Chris Browne, contributing editor of the health section of My Last Song, agrees: “As a GP I believe that death plans should be encouraged as they can empower the patient and their families to take greater control of the end of life experience.  This won’t happen without people’s wishes being discussed, evaluated, written down and then acted upon by family members and medical professionals.”

The death plan template within the Lifebox section of My Last Song covers much more than medical decisions. The headings enable the dying person to be as comfortable in mind and body as possible when their final moments arrive.

These headings allows people to state where they want to die, the level of medical intervention they want, who they want to visit them when they are dying, who should be there, what they want to hear, (music, poetry, prayers), what they want to smell (incense, scented candles, oils, flowers), how they want to be touched (hands held, caressed, gently massaged), and importantly and often overlooked, being clear of worries (knowing their loved ones and pets are cared for, their estate is in order, their will is up to date).

After all, pregnant mothers-to-be are encouraged to create a birth plan so that they are confident that giving birth will be as positive an experience as possible. The same should be achieved if death plans were more widely used.

I don’t have a television…when, on those rare occasions there is something I want to watch, I ask various friends and ex-partners if I can pop round. The answer is normally yes, and the added bonus is I get snacks and a decent glass of wine at the very least.

I felt unable to call on this resort last night as the programme I wanted to watch was Dispatches on Channel 4 which featured three people close to death who filmed the treatment they were given by the NHS.

I tried to watch it on my PC, but the broadband connection was playing up, so I only watched a little but what I saw was shocking, and this has been confirmed by comments, particularly those on the Dying Matters facebook page.

NHS end of life treatment is appalling, but this is to a large extent due to the client base having such low expectations and failing to demand better service.

Contrast it to the facilities and level of treatment provided to expectant mothers.

Mothers-to-be are given lots of advice, midwives and pre-natal specialists encourage questions, maternity wards are colourful, pleasant, uplifting places and individual birth plans are discussed. There’s a sense of well-being and an openness in facing the forthcoming event.

Death is as inevitable as the birth, but it’s treated very differently. Of course, one doesn’t expect medical staff to approach the end of a life with cheerful smiles. There needs to be a much more sympathetic and careful approach.

But as the Dispatches programme proved, sympathy and understanding are often sadly lacking when NHS staff deal with the dying, and it’s mainly due to the fact that families of the very elderly don’t address the forthcoming death.

Until people are able to look a doctor or nurse in the eye and say ‘I want to discuss how you will treat my loved one at the end of their life’ things will change hardly at all. While we continue to ignore death, find it uncomfortable to address, postpone the distress or just hand the consequences to others, we shouldn’t complain too much if the quality of its medical care management falls below our expectations.

I’ve gone on about it before, but a major step to improve this situation will be the acceptance of personal death plans which will involve the ailing patient, close loved ones and the appropriate medical professionals.

The My Last Song death plan is a holistic model, covering more than medical treatment but also the mental, emotional and spiritual needs of the patient so that at the end of life the dying person is in a state of comfort, peace, contentment and happiness.

There may or may not be a journey then embarked on, but if there is, it’s a good place from where to start.

A ‘good death’ is becoming more discussed as more people get older. The increasing numbers of people aged 70 and over coincides with other societal changes including the breakdown of the family support system, fewer people with strong religious beliefs and reduced resources for a health service that will have to deliver more end of life care.

The previous Government, aware of the growing need to address the issues, launched an End of Life Care strategy in July 2008. The strategy is supported by National End of Life Care Programme and £286 million of Government money.

It’s informative to visit the website and look at the vast amount of work that is being done as part of the programme. The work, the goodwill, the case studies, the references to publications would be commendable if there was a clear focus on what the programme wants to achieve: high quality, person-centred care for all adults at the end of life and enabling more people nearing end of life to choose where they die.

However, the Programme has grown like topsy and the more it grows, the further it is from achieving these aims.

It is a good example of the wasteful cost and confusion of trying to find a top down solution to what is the most individual of any health care situation – caring for a dying person.

So far the mixture of academics, care workers, medical professionals, think tank researchers and other well meaning individuals have not found the solution and they never will.

The present government recognises that inflexible, bureaucratic, centrally imposed and expensive solutions to society’s complex problems are doomed to failure. It is redefining the state’s relationship with civil society by reducing the role and cost of the state and hoping to increase personal and community responsibility and participation.

The success or failure of this experiment will define society’s progress for the first half of the 21st century.

As far as the end of life care is concerned, delivering a good death requires more emotional capital to be invested than currently the case and less money than currently anticipated.

Planning a ‘good death’ must involve family, friends and appropriate medical professionals. Coming together to address the subject of death and dying will necessarily overcome the still common fear of discussing the subject until it is literally too late.

There is not a great deal of point spending large amounts of money on end of life care as death can’t be defeated only delayed. Of course, the pain, suffering and fear can be managed and reduced but this shouldn’t be expensive.

If GPs and palliative care specialists insisted that patients completed a personal death plan, and if family members felt comfortable in encouraging older loved ones to fill in their plans, a good death would be a far more likely outcome than anything that will emerge from the current hotchpotch of case studies and models coming out of the National End of Life Care Programme.

Important players in changing attitudes will be the excellent hospice movement and the Dying Matters Coalition which, if properly funded, could lead the move to rid our society of the taboo surrounding death and dying. If people talk about death and plan for it – their own or that of an ailing loved one, or in the case of the medical profession a patient – the more likely will be a ‘good death’ instead of a lonely and impersonal passing.

Currently just a small dot on the radar is the ‘soul midwives‘ movement which is a voluntary group of women who want to give spiritual, physical and existential comfort to the dying.  It will be interesting to see if this becomes a growing movement or whether friends and family will be able to administer the same kind of holistic end of life care.