Support at the end of life: The role of hospice services across the UK

Covid-19 created huge disruption to end of life care services, with many thousands more people dying at home than previously. Hospices play a vital role supporting people and their families at the end of life, but little is known about how these services are being delivered and the issues they are grappling with. This new analysis by Nuffield Trust based on a survey carried out by Hospice UK plugs that gap and provides a picture of a sector undergoing rapid change in the face of fast-changing circumstances.

The pandemic led to major disruption to services right across health and social care, as well as a huge shift in where patients are dying, with more than 105,000 extra deaths at home in the UK over the first two years of the pandemic. The reasons for this are not fully understood, but have profound implications for the experience of people dying and their families and carers, and for the type and quality of care they receive. 

Hospices play an important role in providing care at the end of life, supporting people and their families, and others who are affected. Although only a small proportion of people die in a hospice – under 5% of the 650,000 people who died in 2021, hospices play a huge role in supporting a much wider group of people at the end of life and their families.

This new analysis draws on a nationwide survey of hospices conducted by Hospice UK to address a large gap in our understanding of the services that the hospice sector provides across the UK, including how the Covid-19 pandemic has impacted those services. 

Key findings

  • In 2020/21, hospices supported an estimated 300,000 people in the UK, including people at the end of life, families, carers and bereaved relatives. 
  • During the pandemic there has been a shift in where and how services are provided, with much more care delivered at home. In 2020/21, there were almost a million ‘hospice at home’ contacts. In contrast, day services and hospice outpatient settings saw a decline in the number of contacts and people seen, and fewer people were hospice inpatients. 
  • In addition, the complexity of patients’ needs may have increased, with patients receiving inpatient care having more contacts each, and contacts per person for bereavement services also increasing. 
  • In 2020/21, more than 120,000 community support contacts were delivered virtually, along with virtual welfare, bereavement and therapy services. Hospices switched to providing services remotely, to respond to concern from patients about attending appointments and to reduce the risk of Covid-19 infection. 
  • In 2020/21, there was a drop in the number of people who hospices supported but this was small, particularly when compared to the significant falls in activity across other health services during the pandemic.

The data collection issues and challenges we experienced in carrying out this research limit our findings. 

More consistent and better-quality data on what hospices do, who they support and how, is vital to enable hospices to improve their services and demonstrate their value, as well as enable health systems to understand local needs, address unmet needs and provide the most appropriate care for the population.

New service models that hospices have developed over the past two years, along with closer working between organisations at a local level, could provide the basis for improving care at the end of life, and deliver services within communities rather than acute care settings.

Suggested citation

Keeble E, Scobie S and Hutchings R (2022) Support at the end of life: The role of hospice services across the UK. Research report, Nuffield Trust