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.

Today’s damning review by the Health Service Ombudsman of the medical treatment of elderly patients will make frightening reading for hundreds of thousands of older people and their loved ones.

The ombudsman, Ann Abraham, said the patients whose cases she reviewed suffered unnecessary pain, neglect and distress.

Her review is even more chilling when one bears in mind the huge increase in the number of older people the NHS will be treating in the years ahead. Those who are 70 and older are the fastest growing section of the population and in 2015 will measure well over seven million in England alone.

It is a sad fact that many old people who are admitted to hospital then die there, against their wishes and those of their loved ones.

This desire not to end one’s life in hospital will be made stronger by the growing belief that the standard of medical care will not be of the expected level, highlighted by today’s findings.

So it is even more essential then to address the uncomfortable issues about end of life treatment, care levels and, yes, death.

People are entitled to a ‘good death’, not a lonely, frightening and sad ending.

Which is why I’m such a strong advocate of the introduction of personalised death plans. These will encourage the ailing, their close family members and their doctors to address issues such as the level of medical intervention and where they wish to die.

The death plan provided by My Last Song also includes decisions such as who the dying patient wants to be present, the spiritual needs of the patient and the issues that will, as much as possible, ensure a ‘good death’, such as the music or readings they want to hear, the aromas they want to smell, the way they want to be touched and the comforting mental state of knowing their affairs are in order, their loved ones, pets, possessions etc have been properly dealt with and their funeral wishes will be carried out.

Until our society takes a much more proactive and responsible attitude to dying, death and the way in which our elderly are treated when in hospital or indeed other places in which they receive care, we will continue to read reports of unacceptable yet avoidable cases of their poor medical treatment and unnecessary suffering.

Death plans must become more commonly accepted ways in which we take control of our ‘end of life’ experience, for the benefit of the old, their families and those whose task it is to provide treatment, care and comfort.

It may seem unlikely but the best two funeral websites in the world are run by UK companies.

A top ten list was compiled earlier this month by US funeral guru Brian Burkhardt. And heading the chart was London based My Last Song followed by The Good Funeral Guide, run out of Birmingham.

The other places were taken by US websites.

I was surprised that My Last Song had been awarded the number one slot.

In the past two years there’s been a big increase in the number of funeral websites. They are particularly popular in the US, so for My Last Song to be chosen as the best in the world by an American funeral expert is quite an honour.

Charles Cowling, who started his website in 2009 to promote his book The Good Funeral Guide, is equally pleased. “There’s a lot of global ideas-swapping around the topic of funeral customs and how they are evolving, especially in the English speaking world. This is a flattering accolade.”

What is it about funeral information that makes it so web-friendly?

First is that while people are reluctant to talk to their friends and family about their mortality and the funeral they want, a website is emotionally neutral and gives positive advice. It’s not going to cry or ask to be left money.

Second, the huge increase in ‘silver surfers’ means that more older people are accessing the internet to find relevant information.

Third is type of information being offered by websites that appeal to the ageing baby boomers.  Fifty years ago this group redefined youth culture. Now they are challenging funeral traditions. They want funerals that match their lifestyles, their beliefs, their achievements and their interests and websites like My Last Song give them the information, for instance music choices, they like.

As Charles Cowling emphasises, “This demographic is simply not going to accept a dreary traditional ‘cut and paste’ farewell event to mark their lives. They will want colourful, celebratory and upbeat funerals.” And funeral websites are meeting their needs.

Funeral planning and advice might be a niche market, but the demographics suggest it will be very big in a few years time.

I was convinced My Last Song would be a success when I analysed the population figures. “According to the Office of National Statistics, there will be almost 7 million people aged 70 and over in 2015 in England alone.  In 2020 this rises to 8 million.

The other interesting statistic is that there were less than half a million deaths registered in the UK in 2009 and that between 1999 and 2009, death rates fell by more than a quarter. So people are living longer which means they will be our customers for longer, visiting the websites more often, buying funeral plans, writing and editing their wills, wanting more information about age related illnesses, care options, and how to enjoy a longer and more active older age.

My Last Song has in-depth advice on all these issues, and expects to monetise the website within two or three years with affiliate agreements, sponsored pages and click throughs to companies wanting to reach this demographic.

I’m also planning to launch a US version of the site in 2012 and now looking for collaborators across the Atlantic.

There are more people in the US, they spend more per head on their funerals and they love music, which is an important driver for visitors to My Last Song.

Cowling’s business model is more simple. He uses his website as a first port of call for anyone needing to plan a funeral and find a good funeral director. It also carries updates to his book.

He has a listing of outstanding funeral directors UK-wide to which he is constantly adding.  “People increasingly want unique funerals for unique

The Good Funeral Guide website also carries a lively and provocative blog which enjoys a world-wide readership.

There are lots of jokes about the funeral business being a dying industry, but for these two UK companies, there’s a lot to look forward to.

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.

AND stands for Allow Natural Death, and it’s a phrase that American researchers believe will catch on more than the current phrase, Do Not Resuscitate.

The issue about end of life medical treatment is as topical in the US as it is in this country.

In both societies, neither ailing older people nor their younger family members are comfortable talking about death. It’s therefore surrounded by fear of the unknown, and as nobody likes to talk of what they are afraid about, so the taboo about addressing death continues.

Usually late in the patient’s life, he or she will say that ‘I don’t want to be hooked up to lots of machines,’ or ‘I want it to happen quickly.’

How this view is communicated to the health professionals providing end of life treatment is again the subject of confusion and reluctance to address the issue. The patient’s life is therefore often unnecessarily prolonged, the family’s anguish stretches out and the medical staff are not certain how to proceed.

A simple form of words can change this, and the acronym AND is really very simple.

Research in the States has shown that the phrase Do Not Resuscitate is not used by many families because it is a negative and sounds scary, whereas Allow Natural Death (AND) connotes a positive, it implies permission.

It also gains plus points because it uses the word Natural, as in Natural Childbirth and Natural foods.

What starts in the US quickly cross the ‘pond’, and because part of My Last Song’s mission is to encourage people to address their later life decisions before it’s too late, we think AND should be adopted in the UK.

It will give impetus to the Dying Matters coalition’s goal of changing attitudes towards death, dying and bereavement and make it more likely that the patient, the patient’s family and the family GP will discuss the chosen end of life treatment.

My Last Song has created a Death Plan template, within the Lifebox, which makes it easier for people to make the decisions that will result in a ‘good death’. The old and terminally ill will be more in control of the end of life experience they want.

It will encourage families and GPs to talk about death and to plan for it thus reducing the fear of the unknown.

We only die once and, if possible, it should be the experience we want it to be.

The Demos report, Dying For Change, is a closely argued and important pamphlet.

For those without much time I commend the executive summary, and for those with less time, the thesis of the report is as follows.

The demographics of this country mean more people will be dying of old age every year. Such deaths are usually drawn out, complex and costly.

The good news is that much of our extended lives will be better spent…the bad news though is that we are more likely to die lonely and impersonal deaths in hospitals, hospices and care homes. Not surprisingly,  two thirds of people asked in a related survey wanted to die at home.

To reverse the increasing numbers of people who will die in hospital, and to reduce the escalating end of life costs to the NHS, Demos propose some radical changes.

The least radical is to improve the way hospitals and care homes look after people who are dying.

Improving these services won’t meet people’s aspirations to die at home, nor will they reduce the costs to the NHS. So Demos put forward effective community alternatives.

The report suggests that the NHS should invest £500 million a year, only 2.5 per cent of its spending on end of life care, “to create the backbone for community services” to allow a far higher number people to die at or close to home.

These community services include:

• Creating new places for people to die close to home where they could be with friends and family;
• Strengthened family capacity to care by providing a dedicated compassionate care benefit or care leave entitlement to provide financial support to look after a dying relative;
• Creating a properly trained volunteer support network;
• Setting up dedicated 24/7 nursing support;
• Establishing dedicated end of life telephone help lines;
• Setting up a national ‘hospice at home’ service to tend those dying at home;
• Providing people with a key relationship to end of life advisers.

I can only praise a report that addresses the issues that My Last Song faces full on, and in particular the confirmation that the only way to improve how we die is by people addressing dying. As the report points out people are frightened not by death but by dying because family and many family doctors are unable to talk about it. Ignorance and fear go hand in hand, and fear is not what you should feel as you approach your end.

Which is a prompt for me to extol the virtues of the death plan which is in the My Last Song Lifebox, ready to be filled in when most convenient, and with the participation of close family and even the family doctor.

This is not another version of the Advanced Care Plans or Preferred Priorities of Care forms which concentrate on the medical care and treatment.

The My Last Song death plan instead addresses the more spiritual and existential needs of a dying person.

Who do they want to be present? What do they want to see? What do they want to hear? What do they want to smell? How do they want to be touched? How much do they want that their loved ones to know?

The death plan also enables them to be reassured their affairs are in order and that they need have no concerns about family, friends or pets.

If the patient, the family and the medical staff collaborate to fill in the death plan, it will help people leave this life as content as possible which while not something you can put a value on, is priceless.

Following the British Medical Journal’s website discussion about death and dying, Dr Chris Browne who edits the health and fitness section of My Last Song, has put out a statement saying that doctors treating the very old or terminally ill should encourage them to write their own personal death plans.

“The reluctance of patients and their families to discuss death as the likely outcome of an illness or because of old age makes their end of life medical management more difficult.

“If by filling in a death plan the patient, the family and the appropriate health professionals have a more meaningful discussion, the result is likely to be a more positive approach with obvious benefits for the patient, their loved ones and the medical staff treating them.

“By having a personal death plan, the patient and the family will be more reassured that the time leading up to the final moments will be as comfortable and comforting as possible.

“As a GP I believe that death plans should be encouraged as a way of changing attitudes towards death and dying.”

Within the Lifebox section of My Last Song is a death plan templatewhich allows people to state:

• how much they want to be told about their condition,
• where they want to die,
• the level of medical intervention they want,
• who they want to be responsible for their end of life treatment,
• who they want to visit them when they are dying,
• who should be there when they die,
• what they want to hear, (music, poetry, drama, prayers…),
• what they want to smell (incense, scented candles, oils, flowers…),
• how they want to be touched (hand held, caressed, gentle massage…),
• issues to be cleared up so they have no worries at the end (knowing their loved ones, pets are cared for, their estate is in order, their will is up to date…).

Too many people still die a lonely, impersonal and frightening death which reinforces society’s reluctance to discuss the subject. We only die once so it should be, if possible, the experience we want it to be. Personalised death plans will make that more likely.

Thankfully there is now a concerted move to reduce the taboo surrounding death. The Dying Matters Coalition, of which My Last Song is a member, is spearheading this change of attitude towards dying, death and bereavement.

On 1 July, the General Medical Council published Treatment and Care Towards the End of Life, recommending that death should become an explicit discussion point when patients are likely to die within 12 months.

Then in September, the BMJ’s website published a piece called We’re All Going to Die. Deal with it which highlighted the need for candid discussion about palliative care and end of life medical treatment.

My Last Song supports visitors to address all their end of life issues, put their legal and financial affairs in order, organise their care options and plan their own funerals.

This information can be stored in a secure online Lifebox. Only the Lifebox owners can store and edit the information until they give permission to a close family member to open it, normally towards the end of their lives or on their death.