Less deprived areas saw biggest increase in deaths at home during pandemic

Deaths at home increased the most in the least deprived areas during the COVID-19 pandemic, new research has found. 

The reports published today from the Better End of Life research programme provides the first evidence that the increase in deaths at home across the UK that occurred during the pandemic was accompanied by a widening of socioeconomic inequality. These new findings highlight the need for investment in palliative care and community services to reduce inequalities in end-of-life care, especially in more deprived areas.  

Better End of Life is a collaboration between King’s College London’s Cicely Saunders Institute, Hull York Medical School at the University of Hull, the University of Cambridge’s Primary Care Unit and Marie Curie. The programme examines evidence on the current state of dying, death and bereavement across the four nations of the UK and proposes a policy agenda aimed at helping to ensure that everyone has the best possible end of life experience.  

This new report is the second Better End of Life report and is the first comprehensive analysis of the impact of the COVID-19 pandemic on socioeconomic inequalities in place of death across the UK. The report highlights deaths at home increased during the pandemic across all socio-economic groups, but the increase was highest among those living in less deprived areas and smallest in the most deprived areas. The researchers suggest that people in the most deprived areas may not always have had the necessary resources, such as appropriate housing, social support, financial security, primary care and community services, to support death at home.  

Professor Katherine Sleeman, Laing Galazka Chair in palliative care at the Cicely Saunders Institute, King’s College London, and Better End of Life programme Chief Investigator said: "We know that many people would prefer to die at home, surrounded by loved ones and supported by community care. However, our research shows that there was a larger increase in deaths at home in less deprived areas during the COVID-19 pandemic. Everyone approaching the end of their life, regardless of socioeconomic background, should have the care and support they need, in the place of their choosing. It is imperative we learn from the weaknesses in care that have been exposed by the pandemic to improve end of life care for all who need it. In light of the projected increase in palliative care needs across the UK over the next 20 years, investment in primary care, community care, and palliative care services is urgently needed." 

Ruth Driscoll, Associate Director for Policy and Public Affairs at the end-of-life charity Marie Curie, says: "This is a critical moment for palliative and end of life care.  Each nation of the UK must respond to this research and wider evidence of health inequalities during the Covid-19 pandemic. Leaders must ensure that the needs of dying people in our poorest communities are prioritised in their health and care plans.  Good quality end of life care must be urgently made available for all people in all settings, including in people’s own homes." 

Professor Fliss Murtagh, Professor of Palliative Care and Associate Director of the Wolfson Palliative Care Centre, Hull York Medical School, University of Hull, and co-researcher, said: "Home deaths increased substantially during the pandemic, almost certainly in some part due to pressures on acute hospital services, and restrictions on hospital visiting for families. But the increase in home deaths was not the same for everyone; those in the least deprived areas saw the largest increase. It is important to understand why this occurred and ensure gaps in care are addressed, equitably for all." 

Professor Stephen Barclay, Professor of Palliative Care at the University of Cambridge, GP and Honorary Consultant in Palliative Care and co-researcher, said: "This new research highlights the central role of GPs and Community Nurses in the provision of End of Life Care at home and in care homes, working alongside their colleagues in social care and specialist palliative care teams." 

The research was funded by Marie Curie and carried out by an Expert Group made up of clinical academics in palliative medicine and primary care from King’s College London, Hull York Medical School at the University of Hull, and the University of Cambridge, as well as other researchers with both clinical and non-clinical backgrounds. 

The Group’s work was shaped and informed by a Patient and Public Involvement (PPI) Reference Group. It is the insights from these individuals and informal carers which lie at the centre of the research findings and policy recommendations. 

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