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Proportion of people dying in hospital is falling

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4722 (Published 27 August 2010) Cite this as: BMJ 2010;341:c4722
  1. Andrew Cole
  1. 1London

    For the third year running, the proportion of people in England who died in hospital has fallen, while the proportion dying at home continues to creep up, according to the second annual report on the End of Life Care Strategy.

    A central objective of the Department of Health’s strategy, which was launched in 2008, is to enable more people to choose where they die. At the moment most people die in hospital despite surveys showing that 56-74% would prefer to die at home.

    Latest Office for National Statistics figures reveal that 55% of people died in NHS hospitals in 2008 compared with 20% in their home, 17% in care homes, and 5% in hospices. This represents a 1.6% rise in home deaths and a drop of nearly 3% in hospital deaths since 2005.

    The annual report welcomes the evidence of this “slow trend” towards more home deaths but says it now needs to be speeded up “if end of life care is to deliver its potential quality and productivity gains.”

    The report also points to variations across the country in implementing the end of life care strategy with some primary care trusts failing to spend their portion of the extra £88m (€107m; $136m) allocated to end of life care in the 2009-10 financial year.

    The strategy’s own audit showed that while some trusts invested substantial sums in a range of services, others used the money to support additional posts in services that already existed, whereas others “are making very little or no investment.” So although Hampshire invested £5.4m—equivalent to 8% of the total spend nationwide—Blackburn reported no new investment at all.

    Professor Mike Richards, national clinical director for end of life care, suggests in the report that many care home residents are ending their days needlessly in hospital “simply because care home staff don’t know what else to do.”

    Seventeen per cent of people died in care homes at the moment, he said. “Since the care home in effect becomes home for these residents we should be making every effort to increase that figure just as we are working to increase the number of people supported to die in their own home.”

    The report highlights a number of areas of progress in the last year, including:

    • Launch of e-learning on end of life care for health and social care staff

    • Launch of the Dying Matters Coalition to raise public awareness of the issues

    • End of life care locality register pilots to improve coordination of care

    • A £40m grant for hospices to improve the care environment.

    Notes

    Cite this as: BMJ 2010;341:c4722

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