End of life care report finds 25% rise in deaths at home

The number of people dying at home or in care homes has increased by 25% in a decade, a report into end-of-life care found.

Home continues to be the preferred place of death for people in England, followed by hospices and care homes, and the report said there is a growing understanding within the health sector of what is important to people at the end of life.

While 166,800 people died at home or in a care home in 2004, representing 35% of people who died, this went up to 207,800 in 2013, or 44% of people.

During the same time the number of people dying in hospitals has dropped by 50,000, the report by Public Health England’s (PHE) National End of Life Care Intelligence Network (NEoLCIN) found.

In 2013 it was less than half of all deaths (227,748).

More people want to be in a hospice the closer they get to death – rising from 4% to 17% to 28% in the final year, months and days before death respectively.

The report said the shift is most dramatic for those with previous experience of hospice care, with 55% preferring to spend their last days in a hospice.

Other findings include that two in five people with dementia die in hospital, which has been decreasing since 2006.

The proportion of GPs reporting they had never initiated a conversation with a patient about their end-of-life wishes fell from more than a third (35%) in 2012 to a quarter (25%) in 2014, showing improvement, the report said.

Factors most importance to people at the end of their life were having pain and other symptoms managed effectively, being surrounded by loved ones and being treated with dignity.

Professor Julia Verne, clinical lead at the NEoLCIN, said: “It is of course appropriate for some patients to die in hospital but this year’s findings are encouraging as our understanding of what patients want continues to improve.

“There is still work to be done to ensure we keep focus, not just on the numbers but on people’s experience of dying. However we are now a step closer to balancing out the number of people using hospital and community care.”

NHS England’s national clinical director for end-of-life care, Professor Bee Wee, said: “Gaining a more nuanced and detailed understanding of what the evidence tells us about end-of-life care, and people’s preferences and experiences, is more important to help guide our work in the right direction.

“There remains a challenge to ensure that the quality of care for people approaching the end of their lives, and those important to them, is as good as it can be, regardless of where this takes place.”

Claire Henry, chief executive of the National Council for Palliative Care, said: “With the number of people dying each year on the rise, there’s never been a more important time to understand how and where people die, the range of services and support available and the inequalities in end-of-life care that continue to exist. That’s why this report is so important, and why it should be required reading for all those involved in health and social care.

“It’s encouraging that fewer people are dying in hospital, as we know only a minority of us say that’s where we would choose to die.

“However, to make continued progress we now need to talk more openly with people about their end-of-life wishes and the options available to them, and to ensure the right care and support is in place to make these wishes become a reality.”

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