Although the difficulties faced by the project team in post-communist Russia at first appear overwhelming, the more I thought about it, the more it struck me that it wasn't that long ago that things were much the same in the UK. Furthermore, it's not as if we've got it all sorted by any means. Take social services and home care nursing, for example. The way different authorities prioritise support of this type varies hugely according to where you live and, with financial cutbacks, the threshold for providing such services for free is going up. The whole concept of a fully comprehensive, free National Health Service has been under attack in the UK. GPs have now been saddled with the dual burden of doing what's best for patients whilst being responsible for enacting a highly contentious government overhaul of how all services throughout the NHS are paid for.
Morphine is freely prescribable for MND patients but often left until long after discomfort or breathlessness could have first benefitted. Fears on the part of some doctors still exist of being accused of killing patients post-Shipman.
Whilst it is rare for patients not to be informed of a life-threatening diagnosis these days, the skill with which this is done and the on-going psychological support can leave much to be desired.
So, although the degree of the difficulties isn't the same, I think there are more similarities than differences between our countries. I was fortunate to enter palliative care in the UK well after these issues had been identified, often against a lot of resistance. I greatly admire those I met in Moscow who are pioneers in changing traditional attitudes and practice. It's bound to take time but, as has happened elsewhere, I'm sure they will succeed. Thanks for having me, guys. I loved every minute of it.
PS. Anastasia's microscope slide was safely delivered to a courier at Heathrow Airport. I often think of her and wonder how she is doing.