Chart of the week: In which areas of England and Wales are more people dying at home?

The pandemic has seen a big shift towards more people dying at home, rapidly accelerating previous trends, and continuing even as Covid-19 deaths have declined and lockdowns have eased. The rate of deaths at home registered between April and June 2021 was higher than the five year average for the same time of year in 94% of local authorities in England and Wales. Only 20% of areas had a rate of above 64/100,000 in 2015-19, compared with 60% now.

The rates show us where there is demand for community services for people dying at home. And they partly reflect differences in demographic factors such as age and location. Where mortality rates are higher the population tends to be older. Additionally, there are higher rates of home deaths in rural areas and this pattern has become even more pronounced in 2021. Those local authorities that have seen a decrease in deaths at home tend to be more urban, for example Cambridge. However, some more urban regions have also seen an increase in rates, such as west London. 

Further analysis is needed to understand the characteristics of people dying at home, such as socio-economic factors and availability of informal care, as well as the impact of structural factors such as deprivation, health inequalities and availability of and pressures on health and care services.

Most people have a preference to die at home, and there has long been a health policy focus to enable more people to do so. While a big shift can be observed in the place of death since the start of the pandemic, it is unclear whether the experience of dying at home during the pandemic has been a positive and dignified one and whether services have been able to respond appropriately and adapt to changing patterns in place of death.