Palliative Care and End of Life

This topic area covers statistics and information relating to palliative care and end of life in Hull including local strategic need and service provision. Further information is available on Causes of Death under Population, and for specific diseases and medical conditions under Health Factors under Adults.

This page contains information from the Office for Health Improvement & Disparities’ Fingertips. Information is taken ‘live’ from the site so uses the latest available data from Fingertips and displays it on this page. As a result, some comments on this page may relate to an earlier period of time until this page is next updated (see review dates at the end of this page).

Headlines

• The aim of palliative care and end of life services is to enable patients with advancing progressive life limiting illness to be cared for and to die in their preferred place of care with optimal pain and symptom management, supported by skilled staff.
• In 2023/24, 1,136 (0.4%) patients registered with Hull GPs were recorded as requiring palliative care which was considerably lower than England (0.5%) and across Humber and North Yorkshire Integrated Care Board (0.7%).
• In 2023, just under half (48%) of deaths among Hull residents occurred in hospital, just over one-quarter occurred at home (27%), 16% in care homes, 6% in hospices and 3% in other places.
• The majority of people aged 65-84 years were more likely to die in hospital than other age groups. Not surprisingly, few people aged under 65 years died in a care home (3%) but the percentages more than doubled for those aged 65-74 years (to 8%) and more doubled again for those aged 75-84 years (to 19%) and three in ten people aged 85+ years died in a care home.
• In 2019 prior to the pandemic, almost three in ten of all deaths among care home residents were among people who did not live in a care home but were temporarily living there. However, in 2023, this has increased to 37%. It is not particularly surprising that this is relatively high. Temporary residents of care homes are likely to be people who have left hospital and cannot look after themselves at home whilst they are recuperating, but as they have had a recent hospital admission are thus probably at a greater risk of death. The percentages of deaths that occur at home reduces with age from 38% among those aged under 65 years to 17% among those aged 85+ years. This is partly associated with more deaths in care homes as people age. People aged 85+ years are the least likely to die in a hospice (which is likely associated with a higher percentage living in care homes) with 4% dying in a hospice. People aged under 65 years (6%), 75-84 years (7%) and 65-74 years (8%) are more likely to die in a hospice. Few people die in other places (less than 3% for those aged 65+ years and less than 1% among those aged 75-84 years), but the percentages are slightly higher among those aged under 65 years at 8%.
• The percentage of deaths that occur in hospital has decreased from 51% in 2014 to 48% in 2019 and whilst the percentages changed during the COVID-19 pandemic (reduced to 44% in 2020), the percentage in 2023 at 48% was similar to that observed in 2019. The percentage of deaths that occur in a care home was generally around 19-20% prior to the pandemic but increased to 23% for 2020 and whilst in 2021 the percentage returned to pre-pandemic levels, the percentage has fallen in 2022 and 2023 to a new low of 16% (for all ages). The percentage of deaths that occur at home has increased from 22-23% almost a decade ago to 27% in 2023. The increases have been greater with increasing age. The percentage of people dying in a hospice has been relatively variable, but with no particular strong increasing or decreasing trend over time with the percentage in 2023 similar to the range in the percentages over the previous few years for the four age groups. The percentage of deaths occurring in other places has increased among those aged under 65 years and among those aged 85+ years.
• In 2021, Hull had the highest rate of care home beds per 100 population aged 75+ years (13.6) across the region (9.9) and also higher than England (9.4), however, the number of nursing home beds per 100 population aged 75+ years was considerably lower in Hull (2.5) compared to the regional average (4.2) and England (4.6). This could influence where deaths occur.
• Almost one in ten (9.4%) had three or more emergency hospital admissions within the last three months or their life among those aged under 75 years, but this was less than one in twenty(4.6%) among those aged 75+ years. There could be many reasons why this is the case, but it is possible that this is – in part – associated with a higher percentage of the population aged 75+ years living in a care home, and pre-existing medical conditions managed within primary care.
• There is a need to work with partners to ensure that palliative and end of life care services are integrated, high quality and accessible in ways that offer people appropriate choices.

The Population Affected – Why Is It Important?

The aim of palliative care and end of life services is to enable patients with advancing progressive life limiting illness to be cared for and to die in their preferred place of care with optimal pain and symptom management, supported by skilled staff. It is generally recognised that too many people die in hospital and that this might not be their preferred place of death, and a proportion of these people might prefer to die at home provided that the right care is in place.

Around 1% of the population of the UK dies each year (over half a million). A quarter of all deaths are due to cancer, a third from organ failure, a third from frailty or dementia, and only one twelfth of patients have a sudden death. The considerable benefits of identifying patients in need of palliative care include providing the best health and social care to both patients and families and avoiding crises, by prioritising them and anticipating need. Identifying patients in need of palliative care, assessing their needs and preferences and proactively planning their care, are the key steps in the provision of high quality care at the end of life in general practice.

The number of patients requiring palliative care can be examined from data collected as part of the Quality and Outcomes Framework within primary care. Quality of care indicators are also included which relate to having regular multidisciplinary meetings where the team can ensure that all aspects of the patient’s care has been assessed and future care coordinated and planned proactively to ensure that the patient has the best end of life care. Local analysis of the QOF data has been completed with prevalence calculated for each GP practice and Primary Care Network group.

The Hull Picture

Numbers Requiring Palliative and End of Care Support

In 2023/24, there were 1,136 patients registered with Hull GPs who were recorded as needing palliative care which represented 0.4% of Hull’s patients (03F) and it is lower than England (0.5%) and other areas within Humber and North Yorkshire (range 0.6% to 1.5%).

The percentage of patients recorded as needing palliative care among patients registered with Hull GPs has remained relatively constant in Hull at 0.3% between 2012/13 to 2022/23 although the total numbers have increased slightly over time with the percentage increasing to 0.4% for the latest year.

From the local analysis of the national Quality and Outcomes Framework datasets, there was no statistically significant association between average age of the practice patients and the percentage of patients requiring palliative care across the 28 practices in Hull for 2022/23. There was also no statistically significant association between the percentage of patients requiring palliative care and the average deprivation score of registered patients (using the Index of Multiple Deprivation 2019). Further analysis including the percentage requiring palliative care for each practice is available within the file within Local Analysis of Quality and Outcomes Framework Data.

From the local analysis of the Quality and Outcomes Framework data, the association between the percentage of patients requiring palliative care across the 28 practices in Hull for 2023/24 and the average age of the practice patients and the average deprivation score of practice patients (using the Index of Multiple Deprivation 2019). It was found that there was no statistically significant associations for either age or deprivation. So practices with an older patient population or who had more patients living in more deprived areas of Hull had no significant difference in their percentage requiring palliative care. Further analysis including the percentage of patients requiring palliative care for each practice is available within the file within Local Analysis of Quality and Outcomes Framework Data.

Number of Deaths by Location of Death

The Office for Health Improvement & Disparities’ Fingertips also presents information on the percentage of deaths which occur at different locations by age of death.

The figures relating to 2020 and 2021 will be severely affected by the COVID-19 pandemic. From initial local analyses of mortality data, people who died in 2020 from COVID-19 were more likely to die within a care home (30%) or hospital (63%) and much less likely to die at home (5%) compared to all deaths which occurred during the five year period 2015-19 (19%, 49% and 23% respectively), although people who died of non-COVID-19 conditions in 2020 were more likely to die at home (29%) or in a care home (22%) and less likely to die in hospital (41%). Location of death also differed throughout 2020 and early 2021 during as response to the COVID-19 pandemic changed. It is also possible that bed capacity also changed over time, and could have influenced where the death occurred.

Location of All Deaths

During 2023, just under a half of all deaths occurred in hospital, just over one-quarter at home and 16% in care homes with 6% occurring in hospices and 3% occurring in other places.

Compared to England, fewer deaths in Hull occurred at home and in care homes, and more deaths occurred in hospital, hospices and in other places.

Deaths Occurring in Hospitals

For 2023, there was a higher percentage of deaths which occurred in hospital in Hull both overall and for each age group compared to England.

Overall though the percentage of deaths which occur in hospital has been decreasing in Hull. In 2011, 57% of deaths among Hull residents occurred in hospital but this decreased to around 50% between 2013 and 2018. The rate then fell to 47.5% in 2019, and fell further in 2020 as deaths were less likely to occur in hospital during the COVID-19 pandemic. The percentage for 2021 returned to a similar percentage as that observed in 2019, and whilst it decreased in 2022, the percentage has increased in 2023 to levels nearer levels last seen prior to the pandemic.

Of the 2,641 deaths in 2023, 1,276 occurred in hospital.

Slightly fewer deaths occur in hospital among those aged 85+ years compared to other older age groups. The percentage has generally been between 45% and 50% with a decrease in 2020 and 2021 likely associated with the COVID-19 pandemic, although the percentage in 2022 was also relatively low compared to the percentage prior to the pandemic.

The percentage of deaths that occur in hospital among those aged 75-84 years has decreased slightly from 53% in 2014 to 51% in 2023. The percentage was much lower in 2020 likely associated with the pandemic, although the percentage in 2021 appeared to follow the same trend observed prior to the pandemic.

There has been slightly more year-on-year variability among those aged 65-74 years in relation to the percentage dying in hospital. Whilst the percentage was relatively low for 2020, the percentage at 50% did not stand out in relation to other years as there were other years between 2014 and 2023 that had similar percentages or even lower percentages.

Among those aged under 65 years, the percentage of people dying in hospital has varied between 45% and 52% with year-on-year variability.

Deaths Occurring at Care Homes

For 2023, 37% of all deaths in care homes were among people whose usual place of residence was not a care home, although this was higher for England at 41%.

The indicator relating to temporary residents relates to cases where the place of death is a care home, but that care home is not their usual place of residence, and this is given as a percentage of all care home deaths.

It is possible that patients leaving hospital who need extra support temporarily could be placed in a care home, and they might have a higher mortality rate (compared to those already living in a care home) having been relatively recently discharged from hospital.

Overall, compared to England for 2023, the percentage of deaths which occur in a care home was lower for in Hull.

In 2019, 29% of all deaths in care homes were among temporary residents whose usual place of residence was not a care home. The percentage fell slightly to 27% in 2020, but it is possible that the COVID-19 pandemic had an impact on this percentage. The percentage has increased in 2021 and 2022, although remained relatively unchanged between 2022 and 2023.

Overall, 154 deaths occurred to people who were temporary care home residents out of the 414 deaths among people who were temporary or permanent care home residents.

Not surprisingly, as people are more likely to live in a care home as they get older, the percentage who die in a care home increases with age.

The percentage of deaths which occur in care home increased in Hull between 2011 and 2012, but has remained relatively static at around 20% or just under between 2012 and 2019.

The rate increased between 2019 and 2020 from 19.8% to 22.6% due to the COVID-19 pandemic. People who died during 2020 were more likely to die in a care home and this was the case for deaths from COVID-19 and other conditions.

The percentage reduced to 18.5% in 2021 and further reduced to 17.8% in 2022 and to 15.7% for 2023 which is the lowest percentage since 2014.

Of the 2,637 deaths in 2023, 414 occurred in a care home.

The percentage of deaths that occur in a care home among people aged 85+ years was around 34% to 35% prior to the pandemic although the percentage in 2019 was slightly higher at 38%. The percentage increased to 41% during the initial phases of the pandemic and remained relatively high at 38% in 2021. In 2023, the rate returned to similar levels to that observed prior to the pandemic, but there has been a further decrease in 2024 to 30% which is the lowest percentage since 2014.

Between 2015 and 2019, the percentage of deaths that occur in a care home among people aged 75-84 years was around 18% to 20% prior to the pandemic but increases to 25% in 2020. The percentage has reduced since then and the percentage in 2023 at 16% is the lowest it has been since 2014.

The percentage of deaths that occur in a care home among people aged 65-74 years varied between 7% and 9% between 2016 and 2022, but the percentage in 2023 is the lowest it has been since 2014 at 6%.

The percentage of deaths that occur in a care home among people aged under 65 years is low and has generally been 2-3%.

Deaths Occurring at Homes

During 2023, there was a lower percentage of deaths which occurred at home in Hull compared to England overall for all ages and this was particularly the case among people aged 85+ years, but the percentages were slightly higher in Hull among under 65s.

The percentage of deaths which occur at home has been steadily increasing in Hull for all ages. Whilst the relatively large increase between 2019 and 2020 occurred – at least in part – of the COVID-19 pandemic, the increase has been maintained.

In general, there has been an increasing trend in the percentage of people dying at home over time among those aged 85+ years which increased from 13% in 2014 to 20% in 2022, although there has been a relatively sharp decrease to 17% in 2023.

Amon those aged 75-84 years, there has also been an increase in the percentage of people dying at home over time, although the increase is smaller than the increase observed for people aged 85+ years. Furthermore, the percentage has remained relatively unchanged in the last 2-3 years with around one-quarter dying at home.

Amon those aged 65-74 years, there has also been an increase in the percentage of people dying at home over time from around 28% in 2014 to a high of 35% in 2022, although there has been a decrease to 33% in 2023.

Among those aged under 65 years, a decade ago around one-third were dying at home, but this has increased slightly to 36% in 2022 and to 38% in 2023. The percentage was higher at 40% in 2020 due to the pandemic.

Deaths Occurring at Hospices

During 2023, the percentage of deaths which occurred at a hospice was higher overall and for people aged 75-84 years and 75 years, but the percentage was lower in Hull compared to England among those aged under 75 years.

Around 5-6% of all deaths in Hull occurred in a hospice between 2014 and 2019, with a decrease to just over 3% for 2020 and 2021 which is likely associated with the COVID-19 pandemic, and reduced further for 2021, although the percentage increased to 5.4% for 2022 and increased to 6.2% in 2023 which was the same as for 2019.

In general, the percentages have remained relatively unchanged over time across the different age group particularly between 2014 and 2019 although there has been considerable year-on-year variability particularly among those aged 85+ years, and the percentages do differ across the age groups (85+ years 2-4%, 75-84 years 4-6%, 65-74 years 8-9% and under 65 years 6-8%).

For most age groups, the percentages were lower in 2020 and 2021 in Hull likely associated with the COVID-19 pandemic.

With the exception of under 65s, the percentages dying in a hospice are among the highest in a decade for 2023.

Deaths Occurring at ‘Other Places’

The percentage of deaths which occur at ‘other places’ (not in hospital, a care home, the person’s own home or in a hospice) was small. The percentages differed by age and were under 2% among those aged 65+ years. The percentages were higher among people aged under 65 years where external causes of death account for a higher percentage of the overall deaths among this age group.

Between 1.8% and 3.1% of deaths to Hull residents occur in ‘other places’, and there is year-on-year variability. The percentages have increased across all age groups although this is strongly influenced by the low percentage in 2014 and the higher percentages in the last four years. If the particularly low value in 2014 was due to random variation and was excluded from consideration, there is less of a trend over the period 2015 to 2023.

The numbers have been quite variable with no particular increasing or decreasing trend for people aged 65-84 years, although the percentages appear to have increased among under 65s and among those aged 85+ years although for the latter the percentages could have been influenced by other factors such as the pandemic.

Location of Death by Cause of Death

Heart Failure

Information is also given on the percentage of deaths from heart failure which occur at home or at the deceased usual residence. The percentage in Hull is considerably lower than England for the two-year period 2022-23 (36.6% versus 59.6%).

Just over half of all heart failure deaths in Hull occurred at home or their usual place of residence for 2012-13, but this has steadily decreased to 43% for 2018-19. The percentage increased for 2019-20 and 2020-21, but this could be associated with the pandemic with fewer people being admitted to hospital and thus dying in hospital. The percentage in 2021-22 was lower than the percentage prior to the pandemic, but the percentage has further fallen to a low of 37% for 2022-23.

A significantly lower percentage of people with heart failure die at home or their usual place of residence in Hull compared to England. Many factors could influence this which might include patient choice, family support mechanisms and facilities at home (for example, making room for medical equipment or having a downstairs toilet in the home etc).

Chronic Obstructive Pulmonary Disease

The percentages of deaths from chronic obstructive pulmonary disease (COPD) that occur in care homes, hospital and at home is also available on Fingertips. For 2021, slightly more COPD deaths occurred in hospital and at home in Hull (03F) compared to England.

The percentage of COPD deaths that occur in hospital has been gradually decreasing and the percentage occurring in care homes and at home have been gradually increasing, although there has been year-on-year variability over time.

Number of Care and Nursing Beds

For 2021, Hull has the highest rate of care home beds per 100 people aged 75+ years across the region, but among the lowest number of nursing beds per 100 people aged 75+ years. This could influence where deaths occur.

The number of care home beds per 100 people aged 75+ years increased in Hull between 2011 and 2014, but has since decreased. The number of care home beds has been consistently higher than both England and the region. Furthermore, the reduction in Hull has been less than the reduction across England (faster rate of reduction across England).

In contrast, the number of nursing home beds has been consistently much lower than England since 2011. There were around three nursing home beds per 100 people aged 75+ years in 2011 and 2012 but rose to just over four beds per 100 population between 2013 and 2016, but has since fallen to back to around three beds per 100 population but has fallen further to 2.5 beds per 100 population for 2021. It is possible that the recent fall between 2020 and 2021 could have been affected by COVID-19 and could be influenced by changes in the types of beds available in Hull because of workloads, staff shortages, etc.

Emergency Hospital Admission In Three Months Prior to Death

There is also information on the number of patients who have three or more emergency admissions to hospital within the last three months of their life.

In 2022, the percentage of deaths with three or more emergency admissions within the last three months of their life was higher among those aged under 75 years in Hull compared to England, but the same for those aged 75+ years.

Among those aged under 75 years, just over one in ten had three or more emergency hospital admissions within the last three months or their life, but it was around one in twenty among those aged 75+ years. There could be many reasons why this is the case, but it is possible that this is – in part – associated with a higher percentage of the population aged 75+ years living in a care home, and their medical conditions are managed within the care home in conjunction with primary care as well as the different causes of death (and management of those conditions if applicable) among those aged under 75 years and 75+ years.

The percentage with three or more emergency admissions within the last three months of life has been increasing for all ages from 7.4% in 2015 to 10.5% in 2019 before falling to 7.2% for 2020 with the fall likely associated with the COVID-19 pandemic. However, the rate has further decreased in 2021, although remained relatively unchanged between 2021 and 2022.

Over the same period, the percentage has also been increasing for those aged 75+ years from 6.9% in 2015 to 9.8% in 2019, before falling in 2020 to 6.3%, and falling further to 5.0% in 2021 with no real change between 2020 and 2021.

For those aged under 75 years, the trend is less clear with the percentage ranging between 8% and 12% between 2015 and 2019 with year-0n-year variability.

The percentage also decreased between 2019 and 2020 which is likely associated with the COVID-19 pandemic, but in contrast to those aged 75+ years the decrease was relatively small and the rate increased between 2020 and 2021, although as with those aged 75+ years, the rate remained relatively unchanged between 2021 and 2022.

Strategic Need and Service Provision

There is a need to work with partners to ensure that palliative and end of life care services are integrated, high quality and accessible in ways that offer people appropriate choices. There is a need to work with partners to promote self-care and mutual support in community settings including hospices and the patient’s home so this is viewed as the norm and reduce reliance on residential or care homes. There is a need to reduce inappropriate hospital admissions and to ensure robust and effective “wrap around care” covering 24 hours and to focus on earlier advance care planning which respects individual needs and allows for people’s cultural and religious preferences. Advice and support needs to be timely, and advice and support around other areas which can cause stress, such as housing and benefits, would be of benefit to individual and their families. This in turn will improve quality of end of life and ensures that people receive care in their preferred place and die in their preferred place. In order to achieve this it is imperative that we have a suitably skilled and competent workforce delivering high quality care supported through a comprehensive end of life care education programme.

There have been some positive developments over recent years in Hull with statutory and voluntary agencies committed to working together to provide these services.

Resources

The Office for Health Improvement & Disparities’ Fingertips: https://fingertips.phe.org.uk/

NHS Digital. Quality and Outcomes Framework. https://qof.digital.nhs.uk/

Updates

This page was last updated / checked on 21 January 2025.

This page is due to be updated / checked in September 2025.