Official Statistics

Palliative and end of life care profile December 2023 update: Statistical commentary

Published 5 December 2023

Applies to England

What’s new

New data for 2022 has been added to the Palliative and end of life care profile.

This update includes new data for 7 indicators for England and local areas.

Five place of death indicators have been updated, each including data by age (all ages, under 65 years, 65 to 74 years, 75 to 84 years, 85 years and older). These indicators are, the percentage of deaths that occur:

• in hospital
• at home
• in a care home
• in hospice
• in other places

Two other indicators have been updated. These indicators are the percentage of deaths:

• in care homes who were temporary residents of a care home
• with 3 or more emergency admissions in the last 90 days of life by age (all ages, under 75 years, 75 years and older)

Introduction

The aim of palliative and end of life care profile is to improve the availability and accessibility of information and intelligence around palliative and end of life care (PEoLC). It provides an overview across multiple geographies in England, to support commissioning and planning of local services.

Main findings

In 2022:

• hospital is the most common place of death (43.4%) although more than half of deaths (56.6%) occur either at home (28.7%), in a care home (20.5%), a hospice (4.7%) or in other places (2.6%)
• the percentage of people who died at home remains higher (28.7%) than seen before the COVID-19 pandemic (24.4% in 2019)
• 41.2% of people who died in care home were temporary residents, higher than the percentage before the pandemic (36.6 % in 2019)
• 6.2% of people who died had 3 or more emergency admissions to hospital in their last 90 days of life, lower than every other reported year (since 2015)

The need to consider percentages and counts

There have been significant changes in the annual number of deaths in recent years due to the COVID-19 pandemic. One effect of this is that changes in “percentage of deaths” measures can be due to changes in the number of people counted by the measure (numerator), the total number of deaths (denominator), or both. 

The need to consider both the number of people counted in an indicator as well as the percentage value is illustrated by the deaths in the hospital indicator. The percentage of people who died in hospital was lower in 2022 (43.4%) than it was before the pandemic in 2019 (44.9%). However, the number of people who died in hospital was higher in 2022 (233,922) than in 2019 (221,844). This is because the total number of people who died was considerably higher in 2022 than it was in 2019.

Place of death

During the COVID-19 pandemic there were abrupt changes in where people die. These changes have in the main persisted.

Figure 1 shows that in 2022 compared to 2019:

• a higher percentage of people died at home (28.7%, 154,686 people compared to 24.4%, 120,445 people)
• a lower percentage of people died in a hospice (4.7%, 25,345 people compared to 5.9%, 28,968 people)
• a lower percentage of people died in hospital (43.4% compared to 44.9%), although this actually represents an increase in the number of deaths in hospital (233,922 compared to 221,844)

Before the pandemic, in 2019, 22.5% (111,178 people) died in a care home.  This rose to 23.6% (134,578 people) in 2020 and in 2022 was 20.5% (110,455 people).

Figure 1: Trend in percentage of place of death by place of occurrence, all ages - 2013 to 2022

Place of death varies across local areas, for integrated care board (ICB) areas:

• the percentage of deaths in hospital ranges from 37.2% to 50.8%
• the percentage of deaths at home ranges from 26.2% to 33.6%
• the percentage of deaths in a care home ranges from 12.5% to 28.9%

Place of death varies by age. Figure 2 shows:

• the percentage of people who died at home decreases with age, in 2022 from 38.6% for those aged under 65 years to 22.5% for those aged 85 years or older
• the percentage of people who died in a care home increases with age, in 2022 from 2.6% of those aged under 65 years to 34.6% of those aged 85 years or older
• the percentage of people who died in a hospice decreases with age, in 2022 from 7.9% of those aged under 65 years and lowest (2.2%) for those aged 85 years or older

Figure 2: Percentage of deaths by place of death and age at death, 2022

Deaths in care homes who were temporary residents

When considering end of life care and care homes, three groups can be identified:

• people who lived and died in a care home
• people who lived elsewhere and died in a care home (temporary residents)
• people who live in a care home and died elsewhere

Deaths in care homes who were temporary residents describes the number of people who lived elsewhere and died in a care home as a percentage of the number of people who died in a care home.

Temporary admission to a care home may occur:

• when someone is unable to stay in their own home due to their terminal illness
• following discharge from hospital during a terminal illness
• when someone needs short term support recuperating from an illness

In 2022, 41.2% of people who died in a care home were temporary residents (45,543). This is higher than in the 3 previous years.

The variation in the total deaths in care homes (the denominator) has a significant effect on the value of this indicator. In 2020, the worst of the pandemic, 134,578 people died in a care home. This is over 20,000 more than in 2019, 2021 or 2022.  The indicator value was at its lowest in 2020 (35.2%) despite the number of deaths of temporary residents in care homes being greatest (47,334).

In all regions of the country this indicator is higher in 2022 than it was before the pandemic. Figure 3 shows that it is highest in East of England and London.

Figure 3: Trend in percentage of deaths in care homes who were temporary residents, by region - 2015 to 2022

Deaths with 3 or more emergency admissions in the last 90 days of life

The percentage of people who died with 3 or more emergency hospital admissions in the last 90 days of life has fallen from a peak in 2019. In 2022 about 33,300 people (6.2%) had 3 or more emergency hospital admissions in their last 90 days compared to about 40,400 (8.2%) in 2019. Figure 4 shows that this percentage is higher for people who died aged under 75 years than for those 75 years and older. For both these age groups the percentage has fallen since 2019. 

Figure 4: Trend in percentage of deaths with 3 or more emergency admissions in the last 90 days of life by age - 2015 to 2022

There is considerable variation in this percentage between local areas.

Figure 5 shows that while the percentage of deaths with 3 or more emergency admissions in the last 90 days of life has fallen in the most recent 3 years, the spread across the middle 90% of ICB areas is the greatest it has been since 2016. In 2022, ICBs at the top of this range had more than double the percentage of deaths with 3 or more emergency admissions than ICBs at the bottom of the range.

Figure 5: Variation between ICB areas in the percentage of deaths with 3 or more emergency admissions in the last 90 days (All ages) - 2015 to 2022

Further information

Local considerations: care homes

When interpreting indicators on care homes commissioners and service providers should consider:

• is generalist and specialist palliative care provision for care homes adequate, in and out of hours?
• does this meet the needs set out in the Enhanced Health in Care Homes Framework?
• is there adequate provision for education, training and support for care home staff?
• are arrangements for rapid access to medicines and equipment, including syringe drivers sufficient?

Local considerations: hospital

When interpreting indicators on hospital use at the end of life, commissioners and service providers should consider:

• do hospitals have adequate arrangements for recognising when someone is likely to be in the last year of life and also when someone is imminently dying?
• how do hospitals ensure that all the clinical and support staff have adequate training to support people near the end of life?
• is there access to specialist palliative care advice any time of day or night?
• what arrangements do hospitals have for ensuring high quality PEoLC for the person, including care after death, and for those important to them and for bereavement?

Local considerations: home

When interpreting indicators on people who died at home commissioners and service providers should consider:

• whether their community specialist palliative and social care home services can adequately meet the needs of those who wish to die at home?
• whether the levels of identification and offer of personalised care and support planning can be improved?
• is there adequate support for unpaid carers involved in looking after the person at home?

Other resources

Further information relating to these indicators is available from 3 factsheets also published by the Office for Health Improvement and Disparities (OHID):

• Place of death describing the monthly trends in place of death
• Care homes describing the number of deaths in care homes and the availability of care home beds
• Patterns of care  describing hospital admissions and place of death by socio-demographic characteristics and for 4 major cause of death groups (cancer, circulatory disease, dementia, and respiratory disease)

Responsible statistician, product lead: Andy Pring, Julia Verne

For queries relating to this document, please contact: neolcin@dhsc.gov.uk

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