Postcode lottery in end-of-life care, says report

Patients face a postcode lottery for where they can expect to die and whether wishes for end-of-life care will be granted, a report has shown.

The study from the National End of Life Care Intelligence Network was commissioned by the DoH to collect data on behalf of the National End of Life Care Strategy, launched in 2008.

Its first report shows that 62% of the poorest people in the UK die in hospital, compared with 55% of the most affluent.

Nationally, just 19% of deaths occur at home, with 58% in hospital. But the difference is more marked at local level: 78% of deaths in the London borough of Waltham Forest occur in hospital compared to 45% per cent in Torbay, Devon.

The report concludes that age, gender, cause of death and socio-economic factors affect where people die.

Lead author Dr Julia Verne, director of the South West Public Health Observatory, said: ‘Everyone should have the best possible chance of a "good death" but the evidence here suggests that this is not always the case.

‘The high rates of hospital deaths are in stark contrast to the wishes of people who usually prefer to die at home.’

She added however that the picture was complex, and for some a hospital death may be more appropriate.

The report also found:

  • Men over 85 in the most deprived fifth of the population are most likely to die in hospital, with 66.2% of deaths in hospital)
  • Women over 85 in the most affluent two-fifths of the population are least likely to die in hospital (50%), and men under 65 from the most affluent fifth (51%).
  • Cardiovascular disease is the most common cause of death in hospital (90,618 deaths per year on average; 33%)
  • 69% (45,193) of people with respiratory disease die in hospital
  • 48% (62,577) of people who die as a result of cancer die in hospital, compared with 17% (22,228) in hospices and 24% (30,920) at home.

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