New research has found that nearly a third (29%) of unplanned hospital bed days and almost one in five (18%) unplanned hospital admissions in England over the last decade, were for people who were in the last year of their lives.
The study, commissioned by end of life charity Marie Curie and carried out by researchers at King’s College London, reveals that the number of people nearing the end of life who are accessing unplanned, emergency care is increasing.
Findings show that in 2023, people in the last year of life in England accounted for:
- almost 770,000 ambulance conveyances to emergency departments (+11% on 2014)
- just under 1.09 million Emergency Department visits (+21% on 2014)
- almost 890,000 emergency admissions (+6% on 2014)
- almost 11.5 million unplanned hospital bed days (+3% on 2014)
The findings show the significant scale of unplanned hospital activity involving people in their last year of life. Marie Curie says that while some of this care will be necessary and appropriate, gaps in access to 24/7 palliative and end of life care in the community are resulting in individuals and families turning to urgent and emergency care for help in times of crisis.
Dr Sam Royston, Executive Director of Research and Policy at Marie Curie, said: “Behind some of these statistics will be patients and families who have called an ambulance or gone to hospital because, in their time of need, there was nowhere else for them to turn. Access to care and support closer to home currently varies across the country, particularly outside of normal working hours, resulting in unequal care at the end of people's lives. This is not fair, and it's not right.
"Opportunity for change is on the horizon. The UK Government is due to publish a new plan - a Modern Service Framework (MSF) - for palliative and end of life care in England this year. The MSF provides an opportunity to reduce the variation in services and ensure that people receive the right care and support at the right time, and in the right place."
Retired GP Shan Newhouse cared for her husband Grant, before his death from pancreatic cancer in 2024. Shan said: "Four or five weeks before Grant died, there were two consecutive nights when we had to visit ED. Grant was admitted but there wasn’t a bed available, so we had to sit on chairs in a corridor. I noticed about 25 beds in the corridors, some of them with people who to my eye were obviously dying, probably about three or four of them. I couldn't see that there was an enormous amount of support for anyone, and that night casualty was more or less overwhelmed. They were working very hard, but they weren't managing to keep up with the demand. The doctors knew Grant had pancreatic cancer, but they still couldn't find a bed. He was feeling ill and vomiting, so in the end he had to lie across a few of the chairs. The general impression I had was of a system that was completely overwhelmed, working desperately to try and cope."
Dr Joanna Davies, Senior Author on the research paper and Research Fellow from the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation at King’s College London said: “This study has important implications for NHS policy and service planning. It shows caring for people approaching the end of life is a core function of hospitals and ambulance services. As health systems seek to reduce avoidable hospital use and shift care into the community, our findings demonstrate that improvements in palliative and end-of-life care must be central to these efforts. Better coordination across hospital, community, and ambulance services will be essential to meeting the needs of an ageing population while maintaining health system sustainability.”
Marie Curie is warning that due to England’s ageing population and an increasing need for palliative care, pressures on emergency care are likely to remain high without urgent action. A previous report by the charity revealed that almost 1 in 3 people are currently missing out on the end of life care and support they need1.
The UK Government aims to reduce non-elective admissions and hospital bed days for people at the end of life by 10% over the coming three years. Given that numbers of both emergency admissions and inpatient bed days have risen markedly in recent years, Marie Curie believes that it is unrealistic to expect this to happen without a significant change in the current approach.
Along with five medical Royal Colleges and other charities and partners, Marie Curie is calling on the UK Government to relieve growing pressure on hospitals in England by investing in a time-limited ‘Transformation Fund’ for palliative and end of life care.
The charity says that a three-year fund of at least £200 million per year would help support the delivery of the Modern Service Framework (MSF) and accelerate improvements needed in access, quality, sustainability and equity in palliative care across all settings.
Sam Royston continued: "Backing the MSF with targeted investment on this scale would help to make the changes needed to palliative and end of life care a reality. It would support local health systems to redesign services and shift resources towards care that delivers better outcomes for patients and avoids unnecessary hospital use. Without this, it would be unrealistic for the Government to fulfil its aim of reducing non-elective admissions and hospital bed days for people at the end of life by 10%, which could generate annual acute trust savings of between £775 million and £790 million.
"Marie Curie is investing in services alongside GP surgeries and hospital A&E teams to identify people at the end of life sooner, so they get the right care and support earlier and don’t have to turn to hospital care in a crisis. Working in partnership with the NHS, the charity is helping to reduce hospital admissions and overnight stays, but scaling up these new services quickly requires resources and commitment from both government and local health systems.
“The choice is clear: invest in better end of life care now, so more people can get the support they need at home and fewer families are left with nowhere to turn in a crisis."
The report can be read in full at www.mariecurie.org.uk/document/unplanned-hospital-admissions-england