Ratio of people dying in hospices doubles since 1993

The proportion of people dying in hospices in England has nearly doubled since 1993, but the gap in hospice deaths between people living in the least and most deprived areas appears to be growing, find a new study by the Cicely Saunders Institute at King’s College London. 

The study, funded by the National Institute for Health Research  HS&DR Programme (09/2000/58) through the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) and published in the journal Palliative Medicine, examined all hospice deaths in England over a 20-year period, including almost 450,000 deaths from 1993-2012. The study investigated how trends in hospice deaths have changed over time. It also examined the relationship between dying in a hospice and factors such as age, diagnosis and socio-economic position. 

The UK hospice system is the most developed in the world, with 223 adult inpatient hospice units in England. Around half of all admissions to these hospices are for end-of-life care, with the remainder being for symptom control or respite. In addition to offering inpatient care, many hospices also provide community services and day care. This is the first study to use whole-population data to examine how hospice deaths have changed over time, and the factors related to hospice death.

The study found a steady increase in the annual number of hospice deaths from 17,400 in 1993 to 26,000 in 2012. This accounted for 3.4% of all deaths in England in 1993, and 6.0% in 2012. 

Most of those who died were married (55%) or widowed (26%), half were men, and the average age of death was 70. The vast majority died from cancer, with just 5% of all deaths occurring in people with non-cancer diagnoses, although this proportion increased from 3.9% to 7.7% over the study period.

The study also found that people who died in hospice were more likely to be resident in affluent than deprived areas, and that this gap grew by 25% over the study period.  

Dr Katherine Sleeman, first author from the Cicely Saunders Institute at King’s College London, says: “For over 40 years hospices in England have played an important role in end-of-life care, particularly for people with cancer. However, the demographics of death are changing, and people are dying at older ages, and increasingly from chronic conditions with long periods of decline. 

“The annual number of UK deaths is predicted to rise, and policy makers and practitioners need to consider whether the current models of hospice care are best suited to the changing needs of an ageing society.

“It is concerning that trends suggest that when it comes to death in hospice, the gap between rich and poor is increasing. We must ensure that access to specialist hospice care is available to everyone.”