The latest crisis concerning UK end of life care arose in June 2018 with the publication of the Jones inquiry into opioid related excess mortality at Gosport War Memorial Hospital in the 1990s. Hundreds of premature deaths resulted from misuse of diamorphine and syringe drivers, which often followed the clinical instruction ‘please make comfortable’. It is hard to overstate this scandal, one of many in the NHS. The report highlights patient safety failures at multiple levels, concerns about institutional culture, insufficient challenging and investigation of poor practice, and poor support of whistleblowers. Pocock et al’s editorial considers whether this was the result of a rogue clinician or systemic failures, while assessing the effect on palliative care provision. What merits further discussion is the complexity surrounding opioid prescribing in palliative and end-of-life care, with its repercussions on both public and political discourse in the UK and further afield.