Hospitals: Death

(asked on 4th June 2018) - View Source

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment he has made of the (a) extent and (b) causes of regional variation in the proportion of deaths in hospital in England; and if he will make a statement.


Answered by
Caroline Dinenage Portrait
Caroline Dinenage
This question was answered on 12th June 2018

Place of death is an important measure of the quality of end of life care. We know more people would, given the choice and conditions being right, prefer to die at home and fewer wish to die in hospital than is currently the case. However, we also know that preferences can change over time, and that it is important we work to ensure patients receive the right care and support wherever they are being cared for.

Nationally, hospital is currently the most common place of death, with the latest rolling annual data (2016/17 quarter 4 – to 2017/18 quarter 3) showing that 46% of patients (all deaths) died in hospital, but it is important to note this has reduced since 2004 when the figure was 57%. Between clinical commissioning groups (CCGs) the percentage of deaths in hospital ranges from 35% to 63%. Reasons for variation are complex, and in addition to the differences between geographical areas, there are also differences between the conditions people may be dying of at the end of life; between ethnic groups and between deprivation groups.

Public Health England’s (PHE) National End of life care intelligence network collects and publishes data and analysis on services and outcomes for care at the end of life care, including place of death nationally, regionally, by CCG and local authority, and a range of resources to support commissioners to improve delivery of their end of life care services can be found on the Intelligence Network’s website at the following link, including PHE’s ‘What we know now’ series, which examines issues of variation in end of life care:

www.endoflifecare-intelligence.org.uk

On 5 July 2016 we published ‘Our Commitment to you for end of life care’, which set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality, personalised care a reality for everyone. This includes measures to enable personalisation; improve care quality; enhance education and training in end of life care; and encourage the spread of innovative models of care. The commitment sets out that by 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home. On 21 September 2017 we published ‘One Year On: The Government commitment to everyone at the end of life’, setting out the good progress made over the first year in implementing the Choice Commitment. Copies of ‘Our Commitment to you for end of life care’; and ‘One year on: the government response to the review of choice in end of life care’ can be found at the following links:

www.gov.uk/government/publications/choice-in-end-of-life-care-government-response

www.gov.uk/government/publications/choice-in-end-of-life-care-government-progress

We remain committed to improving services and ending variation in end of life care by 2020. Through the Mandate, we have asked NHS England to deliver the Choice Commitment, and through NHS England’s National Programme Board for End of life Care, a range of activity is being undertaken with all key system partners and stakeholders to achieve this. NHS England works to support local commissioners in improving the services they provide, including palliative care, and has recently collaborated PHE and the Care Quality Commission to provide bespoke end of life care support to all sustainability and transformation partnerships.

For 2018-19, the Government’s Mandate asks NHS England to increase the percentage of people identified as likely to be in their last year of life, so that their end of life care can be improved by personalising it according to their needs and preferences at an earlier stage. NHS England will use the Quality and Outcomes Framework to demonstrate such an increase by looking at the percentage of people who are on the general practitioner register for supportive and palliative care, and consider expected levels based on local populations. Currently the national English average is 0.37%, it is anticipated this figure will increase in the 2018/19 period. Further work will also be undertaken to develop indicators that will enable NHS England to scrutinise the effectiveness of local health economies in delivering choice and quality in end of life care.

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