End of life care

We look at trends in the quality of end of life care.

Indicator

Last updated: 18/02/2021

Patient experience Equity and fairness
Emergency care Social care Integrated care

Background

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. 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 to reduce avoidable emergency admissions and ensure more people are able to die in their place of choice.

Multiple emergency admissions at the end of life are disruptive and can impact on a person’s quality of life. 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. We also look at the proportion of deaths that occur in a person’s usual place of residence, as survey data suggests that the majority of people would prefer to die at home, with few wishing to die in hospital.


How has the proportion of people with multiple emergency admissions at the end of life changed over time? 18/02/2021

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Between 2009 and 2018, the proportion of people with three or more emergency admissions in the last three months of life increased from 5.6% to 7.5%. This corresponds to an increase in the number of people with three or more emergency admissions in the last three months of life, from 25,746 in 2009 to 37,749 in 2018 (data not shown).

More people experience three or more emergency admissions in the last year of life than in the last three months of life. In 2009, 21% of those who died had three or more emergency admissions in the last year of life, and this increased to 25% in 2018.


How has the proportion of people dying at their usual place of residence changed over time? 18/02/2021

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The proportion of people dying at their usual place of residence (home, care home or religious establishment) has increased substantially over time, from 35% in 2004 to 47% in 2019. Provisional data for 2020 (covering October 2019 to September 2020) shows that the proportion of people dying at their usual place of residence increased sharply to 52%.

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 avoiding being admitted to a care home due to concerns about catching Covid-19.


How does the proportion of people dying at their usual place of residence compare by region? 18/02/2021

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Provisional data for 2020 (covering October 2019 to September 2020) shows that the proportion of people dying at home in England increased in every region. There is marked geographical variation in the proportion of people dying at their usual place of residence. Between October 2019 and September 2020, London had the lowest proportion of people dying at their usual place of residence (44%) while the South West had the highest proportion (58%).


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/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. Figures are based on deaths registered, rather than deaths occurring in each year, and are based on the latest boundary and establishment type information. Figures are updated every quarter and published as rolling annual death registrations. The number of deaths registered in 2020 is provisional and covers Q3 2019/20 to Q2 2020/21 (October 2019 to September 2020).

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