High-quality end of life care is important to ensure people approaching the end of life, and their family and carers, have access to appropriate treatment and support during a vulnerable and difficult time in their lives. Principles of good end of life care include care personalised to the preferences of the individual, effective mechanisms in place for pain and symptom control, co-ordination between different services, and support available for carers/family. The NHS Long Term Plan includes a commitment to roll out personalised care planning for everyone identified as being in their last year of life and make access to end of life care equitable.
Here, we look at the proportion of patients who experience three or more emergency admissions in the last three months and the last year of life. Frequent hospital admissions are indicative of poor care planning and poor quality of end of life care. We also look at the proportion of deaths that occur in a person’s usual place of residence and at a hospital, as survey data suggests that the majority of people would prefer to die at home, with few wishing to die in hospital. More information on the quality of care received by those who died at home during the Covid-19 pandemic can be found in this report.
Between 2009 and 2021, the proportion of people with three or more emergency admissions in the last three months of life increased slightly from 5.6% to 7.1%. Similarly, there was an increase in the proportion of people with three or more emergency admissions in the last year of life, from 21% in 2009 to 25% in 2018 (data not published for 2019 onwards).
Despite the NHS Long Term Plan ambition to deliver personalised care planning for everyone identified as being in their last year of life to reduce avoidable emergency admissions, this trend has increased over the last decade.
The proportion of people dying in hospital or at their usual place of residence show opposite patterns over time. The proportion of people dying at their usual place of residence (home, care home or religious establishment) has increased over time, from 35% in 2004 to 50% in 2022. The proportion of deaths occurring at hospitals decreased from 51% in 2011 (data for previous years is unavailable) to 44% in 2021.
Between June and September 2020, during the coronavirus (Covid-19) pandemic, the number of deaths at home was above the average of the previous five years, while deaths in hospitals and care homes fell. This may reflect patient choice to die at home during the pandemic, when hospital and care home visiting was restricted. It could also indicate that people were deterred from seeking medical help or avoided being admitted to a care home due to concerns about catching Covid-19. Concerns over Covid-19 may have reinforced patients’ preference to die at home, as opposed to in a hospital, a finding based on survey data recorded prior to the pandemic.
About this data
Emergency admissions at the end of life
This indicator uses data from Public Health England. The numerator is the number of people with three or more emergency admissions in the last three months or year of life, taken from Hospital Episode Statistics (HES) with linked Office for National Statistics (ONS) mortality data. The denominator is the total number of deaths, excluding neonatal deaths. Figures are for deaths of people resident in England, and are based on deaths registered rather than deaths occurring each year.
Place of death
This indicator uses data from the National End of Life Care Intelligence Network, which is now part of Public Health England. It uses the percentage of deaths in usual place of residence as a proxy for the quality of end of life care.
The place of death indicator is a percentage calculated as: deaths at usual residence or those at hospitals/all deaths*100. Usual residence is defined as: home, care homes (local authority and non-local authority) and religious establishments. Deaths in usual residence exclude all deaths from external causes, defined by International Classification of Diseases Tenth Revision (ICD-10 codes V01-Y89 and U50.9) and exclude neonatal deaths. Deaths in hospital are based on deaths from all causes. Note that due to this difference in classification, the proportion of deaths in usual residence is based on a smaller value of total deaths (smaller denominator) than deaths in hospital. Figures are based on deaths registered, rather than deaths occurring in each year, and are based on the latest boundary and establishment type information. The figures are updated every quarter and published as rolling annual death registrations.