Bereavement Counselling in the NHS (Taking the sting out of death)

Posted by Vale

Pat is a Bereavement Counsellor working in an NHS Trust hospital. Her job is to help people affected by a death in a hospital, supporting them through their grieving. Pat is the subject of a long article inSaturday’s Guardian. It can be found here.

It’s a heartening read. Death in a hospital can be a very fraught business. Treatment, perhaps in intensive care, is hard to comprehend, and the workings of the institution are often alienating and frustrating to people who want to support someone they love at the end of their lives. And death comes in so many forms that it’s sometimes difficult simply to come to terms with what has happened.
Pat’s role – carried out, it is clear, with great love and understanding –  is to help people come to terms with what has happened. Sometimes it is a matter of looking at notes, talking to doctors and taking time to explain why someone died. Sometimes it is just about making space for grief. Pat:

“has a mantra that “nothing is wrong in grief”. She almost always honours requests from bereaved relatives, however unusual. A common wish is to touch the body of a loved one: hold their hands, or kiss their foreheads or even wash their face. One woman asked Pat if she could help her retrace the journey her 15-year-old daughter’s body made from the hospital to the mortuary, after she died from a very protracted illness. She then wanted to see where she had been blessed in the mortuary. “And there’s nothing wrong with that,” she says.”

It’s good to know that hospitals are recognising that the death of a patient is both an ending and, for bereaved family and friends, the beginning of another vital process – the need to grieve, mourn and say farewell. Important too that they recognise that their role in this next stage is crucial. Reading about the work that Pat does, however, did make me want to ask more questions about the way that the NHS treats people at the point of death.

If there is recognition of these human issues after death, is there the same concern for people as they die? How well are patients supported at those last moments? How easy is it for people to sit with the person they love; hold them and comfort them; share in the business of dying?
I’ve tried to find the relevant NHS guidance, but with little success. I did, however, turn up a Scottish NHS report called Shaping Bereavement Care – a framework for action. It has 14 recommendations, some of them recognisably relating to the good work that Pat does. The recommendation relating to the process of dying though is this one. It is a commitment to:

“undertake a review of all current policies and procedures relating to care of the dying patient, and care of the deceased, to ensure that they reflect good quality care and to assess and reduce any real or potential negative impact of these processes on those who have been bereaved.”(Recommendation 3)

It suggests that there are important connections yet to be made in this area – in the Scottish NHS at least. Although, surely, it’s not hard to join the dots between the way that people feel when they are not involved in a death and the need to involve them more in the process of dying itself? It seems clear enough to me that if the humanity, care and understanding that Pat so clearly brings to her work after a death could be brought into the hospital itself and allowed to take their place at the bedside of the dying patent, then acceptance, understanding and the grieving process itself would be immeasurably improved.

But maybe the NHS in England is already there?