Public expenditure in the last year of life

More than 600,000 people die each year in the UK. It is estimated that 90% of these people could benefit from palliative and end of life care, but access to care and the quality of care are highly variable. There is remarkably little evidence of how much public money supports people in their last year of life, and what that money goes on.

This leaves a critical gap in evidence available to decision-makers so they can make the best possible use of public funds and get care and support right. The Nuffield Trust and the Health Economics Unit were commissioned by Marie Curie to estimate the range of public expenditure that supports the care of people in their last year of life. This includes health care in community and acute settings; hospice care; social care for people in their homes and in institutions; and social security benefits.

The estimates in this report highlight the dominance of hospital care in public expenditure supporting people in their final year (as in other aspects of health care), despite stated policies in each UK nation to shift care from hospital to communities.  The evidence can be used to consider resource decisions to improve care and support across health and social care. 

We hope our work galvanises ongoing efforts to improve data and evidence collection, and, crucially, that the findings now inform national and local funding decisions to improve services for people at the end of life. 

Key findings

1. People at the end of life have significant needs for health, social care and social security. Drawing on a wide range of data sources, we estimate that in 2022 there was at least £22 billion public expenditure for people in the last year of life in the UK. This amounts to £33,960 of public expenditure per person who died. Over half of this total expenditure (almost £12 billion) was on health care, 22% (almost £5 billion) was on social care, and 25% (£5.5 billion) was on social security.
2. Of public funds spent on health care for people in their last year of life, 81% was spent in hospital, and 56% was spent on emergency hospital care. Put another way, for every £5 of health care spend, £4 was spent in hospital - with £2.80 of that on emergency hospital care.
3. We estimate that people in the last year of life account for nearly 10% of all hospital costs. However, hospital expenditure may be underestimated, because we could not fully adjust for differences in the cost of care received by people at the end of life who may have more complex needs.
4. The type of care with the largest health care spend for people in the last year of life is hospital inpatient care, accounting for 73% of health expenditure (£8.6 billion).
5. Expenditure on primary and community health care accounted for only 11% (£1.3 billion) of health expenditure for people in the last year of life.
6. Public expenditure on services provided by independent hospices accounted for less than 4% of health expenditure. The public purse funds 44% (£414 million) of the cost of services provided by independent hospices; including voluntary contributions, hospice care would still only account for 8% of health expenditure.
7. Overall, this means that we spend five times as much on supporting people in the final year of life as hospital inpatients, as we do supporting them with primary care, community health and hospice care.
8. For social care expenditure, the largest element is residential and nursing home care, which we estimate accounts for 63% of all social care expenditure on people in the last year of life (£3 billion).
9. For social security expenditure, we estimate that the state pension comprises almost 90% of expenditure for people in the last year of life (£4.9 billion), for the benefits we were able to identify.

Read the report in full

Further reading