Palliative and end of life care factsheet: Patterns of care, England 2023

Patterns of care related to 4 major conditions: cancer, dementia, cardiovascular disease and respiratory disease

Version 4 published 4 March 2025

Background

In society every person should receive high-quality, compassionate care from diagnosis through to the end of life.

The government’s health mission aims to shift more healthcare out of hospitals and into the community. The palliative and end of life care sector will continue to be at the heart of delivering this shift. This will help ensure that patients and their families receive personalised care in the most appropriate setting.

The purpose of this factsheet is to describe patterns of care near the end of life related to 4 major conditions. It includes experimental statistics describing the number of deaths, the number of hospital admissions in the months before death and the place of death.

The major condition groups are here defined broadly to capture the impact of these conditions on people at the end of their life and include both chronic and acute conditions. A brief description of how underlying cause of death is determined from the death certificate is included in the Supporting information section together with the definition of how the underlying and contributory causes of death were used to identify people living with major conditions. In this factsheet

• respiratory disease includes chronic conditions such as chronic obstructive pulmonary disease (COPD) and acute conditions for example pneumonia. It does not include COVID-19

• cardiovascular disease includes chronic conditions such as heart failure and acute conditions for example myocardial infarction (“heart attack”). It does not include diabetes or renal failure

• dementia includes both dementia and Alzheimer’s disease

A person is described as dying “of” a condition if it is the underlying cause of death recorded on the death certificate, and dying “with” a condition if it is a contributory cause of death only.

More data is available in the accompanying spreadsheet which includes more detailed information by specific underlying causes of death within the major conditions, age, sex, socio-economic deprivation and ethnicity.

Main findings

• the overwhelming majority (88%, 477,302) of people who died in 2023, died of or with one of the 4 major conditions

• 68.2% (369,790) of all people who died in 2023, spent time in hospital during the 6 months before they died, staying for a total of 8.5 million days in hospital

• 69.1% (277,697) of people who died in 2023 of one of the 4 major conditions, spent time in hospital during the 6 months before they died, staying for a total of 6.2 million days in hospital

• 48.0% of the inpatient care provided by hospitals (measured in terms of days in hospital) for people aged 85 year or older is for people in their last year of life

• 60.3% of all people who died had a least one emergency admission in their last 3 months of life, 6.2% having three or more emergency admissions in their last 3 months of life

• among the major conditions, the likelihood of having an emergency admission in the 3 months prior to their death is greater for people who died of cancer (69.5%) or respiratory disease (71.1%) than for people who died of cardiovascular disease (53.1%) or dementia (41.3%)

• the condition(s) people are living with in their final weeks can affect where they are cared for and where they ultimately die; comparing the 4 major conditions with each other

  • people who died of cancer were the most likely to die at home (35.9% compared to 28.4% of all deaths) or in a hospice (16.0% compared to 5.2%)
  • people who died of dementia were the most likely to die in a care home (63.7% compared to 21.0%)
  • people who died of respiratory disease were most likely to die in hospital (61.8% compared to 42.8%)

Characteristics of those who died

In 2023

• 542,300 people died (excluding neonatal deaths)

• 74.1% (401,939 people) died of one the 4 major conditions

• the overwhelming majority (88%, 477,302) of people died of or with at least one of the 4 major conditions

Table 1 and Figure 1 show that in their final months before death, many more people are living with cardiovascular disease, dementia and respiratory disease than would be suggested by underlying cause of death alone. For example, about 2 times more people who died with than died of respiratory disease.

Counting people by underlying cause of death will underestimate the number of people living with these conditions near the end of their life. A better estimate uses both the underlying cause of death and the contributory causes of death. However, this is still an underestimate of people living with these conditions prior to death as it only counts people for whom the doctor recorded these conditions as contributing to the death.

The underlying and contributory causes of death for any individual may encompass several of the major conditions. Consequently, while any one person will only be counted in a single underlying cause of death group, a person may be counted in up to 4 contributory cause of death groups. Due to this double counting, it would be wrong to add together counts that include people by their contributory causes of death.

Table 1: Number and percentage of people who died of or with 4 major conditions, England 2023

Figure 1: Number of people who died of or with 4 major conditions, England 2023

The deaths in each major condition group vary by demographic characteristics. For example;

• people who died of cancer are on average the youngest, 43% of people who died of cancer were under 75 years compared to 31% of all deaths

• among people who died of dementia, 64% were female and 36% male compared to 49% female and 51% male for all deaths. They are also the most elderly with 67% aged 85 years or older compared 40% of all deaths

Table 2 and Figure 2 show the 4 major conditions are the underlying or contributory cause of death for the overwhelming majority of deaths (at least 79%) in each of the categories within sex, age, ethnicity and socio-economic deprivation.

Figure 2: Percentage of people who died of or with 4 major conditions by demographic group, England 2023

Table 2: Number and percentage of people who died of or with 4 major conditions by demographic group, England 2023

Time spent in hospital

Among the people who died in 2023

• a total of 369,790 people were seen in hospital as an inpatient during the 6 months before they died (68.2% of all deaths), staying a total of 8.5 million days in hospital

• within the last 6 months of life, the majority of the time in hospital is during the final 3 months (6.3 million days in the last 3 months out of 8.5 million days in the last 6 months). Table 3 shows this is similar for each of the major conditions

• nearly 15,400 of the people seen in hospital as an inpatient during their final 6 months were admitted as a day case only. A day case is admitted and discharged on the same day, and is reported here with a length of stay of zero days

Figure 3 shows the variation in the total time spent in hospital for inpatients during their final 6 months of life. This will, for some people, be a total time over multiple admissions. The distribution is highly skewed with and for most people their length of stay is not close to the average length of stay.The figure also shows

• although the median days in hospital is 15 days, the most common time in hospital is 1 day

• half of the 369,790 (184,895) people who were seen in hospital as an inpatient during their final 6 months stayed in hospital between 6 and 31 days in total. Table 3 shows that this range is similar for each of the major conditions

• caring for people near the end of their life is a significant proportion of the care provided by hospitals. On average people spend 8.6% of their last six months of life in hospital, and 99,896 people (18% of all people who died) spent 30 days or more in hospital during their last 6 months

• Table 3 shows that being seen in hospital as an inpatient during their last 6 months of life was more likely for people who died of cancer or respiratory disease, compared to people who died of cardiovascular disease or dementia

Figure 3: Variation in the time spent in hospital during the last 6 months of life, England 2023

This graphic includes data for 369,790 people who were seen in hospital as an inpatient at any time during their final 6 months. It excludes 166,188 people who were never an inpatient during their last 6 months of life. Among those seen in hospital, nearly 15,400 were only seen in admissions with no overnight stay (zero days).

Table 3: Time spent in hospital in the months before death for people who died of 4 major conditions, England 2023

The 25th percentile is the value at which 25% of the data lie below that value. The median is the value at which 50% of the data lie below that value. The 75th percentile is the value at which 75% of the data lie below that value. The interquartile range is between the 25th percentile and the 75th percentile.

Emergency hospital admissions

In the 12 months October 2022 to September 2023

• there were 6.1 million emergency hospital admissions, 15.0% of which involved people in their last year of life

• a total of 32.5 million days in hospital followed an emergency admission, of these 30.0% involved people in their last year of life

Table 4 shows that;

• of all admissions, the percentage that involve people in the last year of life is highest among the oldest age group (85 years and older 40.0%) and lowest in the youngest age group (under 75 years 7.0%)

• of all days in hospital, the percentage that involve people in the last year of life is highest among the oldest age group (85 years and older 48.0% respectively), and lowest in the youngest age group (under 75 years 18.0%)

Table 4: Emergency admissions and time spent in hospital following emergency admission by age, England for the 12 months October 2022 to September 2023

Emergency hospital admissions in the final 3 months of life

During the final three months of life for people who died in 2023

• a large majority of hospital admissions were emergency admissions, 77.0% of a total of approximately 622,000 hospital admissions

• nearly two thirds of people (60.3%) had a least one emergency admission

• 6.2% of people had three or more emergency admissions

Figure 4 and Table 5 show that of the 4 major conditions, people who died of cancer or respiratory disease were more likely to have had an emergency admission in the 3 months prior to their death than people who died of cardiovascular disease or dementia.

Figure 4: Percentage of people who have emergency hospital admissions during the final 3 months of life for people who died of 4 major conditions, England 2023

Table 5: Emergency hospital admissions during the final 3 months of life for people who died of 4 major conditions, England 2023

Place of death

The condition(s) people live with as they approach the end of their life can affect where they are cared for and where they ultimately die. Table 6 presents data on where people died by the major condition they died of. It includes both the number of deaths and percentage of deaths that occur in each setting, it shows

• hospital is the most common place of death (42.8% of all deaths)

• nearly half of people die in the community, either at home (28.4%) or in a care home (21.0%)

• relatively few people die in a hospice (5.2%) or other places (2.6%) (for example public places or someone else’s home)

• people who died of cancer were the most likely to die at home (35.9% compared to 28.4% of all deaths) or in a hospice (16.0% compared to 5.2%)

• people who died of dementia were the most likely to die in a care home (63.7% compared to 21.0%)

• people who died of respiratory disease were most likely to die in hospital (61.8% compared to 42.8%)

• a large majority (79%) of the 28,091 people who died in hospice, died of cancer

Place of death varies by specific underlying cause of death within the major condition groups, Figure 5 shows for example,

• within cardiovascular disease, 62.8% of people who died of stroke occur in hospital, compared to 37.0% of people who died of coronary heart disease. 48.1% of deaths from coronary heart disease occur at home compared to 13.5% of people who died of stroke

• within respiratory disease, 56.1% of deaths from COPD occur in hospital, compared to 73.3% of deaths from pneumonia

Table 6: Place of death for people who died of 4 major conditions, England 2023

Figure 5: Place of death for people who died of 4 major conditions, England 2023

Local considerations and additional resources

Commissioners and service providers should review the data presented in this factsheet alongside several other data and intelligence tools and reports. They should also consider using locally produced data on specialist palliative care and social care services. We have provided information on the main supporting resources in this section.

Local indicators on hospital use at the end of life can be found on the Palliative and End of Life Care Profiles. These include indicators on 3 or more emergency admissions in the last 90 days of life. These profiles also include indicators describing the percentage of people who died in hospital or home by different age groups in the place of death topic section. The data for all these indicators are shown for multiple geographies.

The Place of Death Factsheet provides the data on trends in place of death at ICB level. Number and percentage of deaths in hospitals, at home, in care homes, in hospices (not community) and ‘other places’ are presented.

The Care Homes Factsheet describes data on the current provision and future need for end of life care in care homes. They also provide contextual data on care home beds, staff capacity, and training of care home staff.

Additional data on major health conditions are available from the DHSC public health profiles

• Cancer

• Cardiovascular disease

• Chronic respiratory disease

• Dementia

• Mental health

• Musculoskeletal conditions

Information and resources for health and social care professionals can be found on the National End of Life Care Intelligence Network’s Palliative and End of Life Care Resources and Publications page. This includes a comprehensive catalogue of condition and setting specific data, intelligence tools, policy and guidance.

Resources supporting this factsheet

Data used to produce this factsheet is available as a spreadsheet

Contact us

For any queries please email neolcin@dhsc.gov.uk

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Supporting information