People in South Yorkshire dying 'needlessly' in hospital due to gaps in end-of-life care
We've been speaking to Rotherham Hospice about the issues they're facing
Patients at the end of their lives are being increasingly forced to rely on emergency support due to variable access to care closer to home, a charity has warned.
While some patients will need hospital care, gaps in 24/7 end-of-life care in the community mean a growing number are turning to urgent and emergency care when they “don’t have to be there”, Marie Curie said.
A new report from the charity and experts at King’s College London highlights how the scale of emergency care support in England given to people in the last year of their lives “has grown”.
In 2023, people in the last year of life accounted for almost 770,000 ambulance trips to emergency departments, more than one million A&E visits and almost 890,000 emergency admissions – taking up 11.5 million “unplanned hospital bed days”, according to new analysis, which has been shared with the Press Association.
Emergency department visits involving people in the last year of life increased by 21% between 2014 and 2023, from 900,295 to 1,089,365, the authors found.
Ambulance transfers to A&E increased from 696,395 to 769,545 while unplanned admissions rose from 835,960 to 889,920 in the same time frame, the authors said.
Experts said that investing in end-of-life and palliative care could alleviate pressure on busy emergency services after they found that people in the last year of life also account for a “substantial proportion” of urgent and emergency care.
Around one in every 14 (7%) emergency department attendances were made by someone in the last year of their life between 2014 and 2023, the research team found.
Meanwhile, this group also accounted for 19% of ambulance transfers to hospital, 18% of unplanned hospital admissions and 29% of “unplanned bed days”.
“We know that too many people die in pain and without the support they need for their symptoms, and gaps in 24/7 community care prevent people from dying in comfort at home,” the report states.
“When timely, co-ordinated support is unavailable, people and families can find themselves turning to urgent and emergency care for help.”
The report highlights ambitions to reduce urgent hospital admissions among people approaching the end of their life by 10%.
If this were applied to 2023 hospital activity, this would equate to around 89,000 fewer unplanned hospital admissions and 1.15 million fewer hospital bed days each year, experts said.
The report says a number of factors are behind the rise in emergency hospital admissions among end-of-life patients, including inconsistent access to community support, particularly outside normal working hours, constraints on workforce and that “too many” people are being identified as being in the last part of their lives too late.
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 charity is calling on the Government to relieve growing pressure on hospitals in England by investing in a ‘transformation fund’ for palliative and end-of-life care.
Dr Royston said such a fund would help redesign services and help reduce unnecessary hospital visits, adding:
“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.”
Retired GP Shan Newhouse cared for her husband Grant, a former teacher, before his death from pancreatic cancer in 2024 when he was 69.
“Four or five weeks before Grant died, there were two consecutive nights when we had to visit the emergency department,” she said.
“Grant was admitted, but there wasn’t a bed available, so we had to sit on chairs in a corridor.
“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 paper and from King’s College London, said:
“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.”
Commenting on the report, Dr Ian Higginson, president of the Royal College of Emergency Medicine, said: “People approaching the end of their life deserve comfort, dignity and access to specialist care.
“As this important report highlights, many patients attend emergency departments (ED), often on multiple occasions, in the last year of their life due to complications with their conditions.
“Sometimes, these attendances are unavoidable, and an ED is the right place for the patient. But that isn’t always the case.
“Too many people with palliative care needs are ending up with us, some in the last days or hours of their life – and not by their own choice.
“These last patients typically need a quiet and comfortable environment, where they can be surrounded by loved ones and have access to specialist clinicians.
Instead, they may end up in a loud, bright and overcrowded ED because of a lack of community care provision.”
Charlie King, director of external affairs at Hospice UK, added:
“This report confirms a worrying trend: it is getting harder and harder for people to access the end-of-life care they need. No one should die in a hospital corridor.”
Caroline Abrahams, charity director at Age UK, said: “Too many people are ending up in emergency departments and hospitals at the end of their lives because the care they need is not available in the community.”
Royal College of Nursing general secretary and chief executive, Professor Nicola Ranger, added:
“Such vulnerable and unwell people deserve to be treated close to home but instead are forced to turn to overcrowded and understaffed A&Es where they could spend their final hours in a corridor.”
Matt Cottle-Shaw is the Chief Exec at Rotherham Hospice:
"Less than 40% of our funding comes from the government for what we're expected to deliver.
"This gives us a £2 million short fall for the services we actually provide.
"The public can often think we're fully funded by the government, but we're not - we're a charity and we're reliant on our community to raise the other 60% to keep our vital services running.
"We already know that people are dying in hospital settings when they should be in hospices, and they're having very poor experiences at the end of their lives.
"It shouldn't be down to the public to keep our services running.
"We fully fund maternity care when people come into this world, why aren't we funding the end-of-life services in a similar way?
"Last year, our hospice alone kept 2,791 admissions away from hospital and GP surgeries."
A government spokesperson said:
“Hospices provide vital care and support to patients and families at an incredibly difficult time, including in Rotherham, and the Chancellor recognises the pressures facing the sector.
“We have made the biggest investment in hospices in a generation and are committed to improving palliative and end-of-life care, with a new framework to modernise services and tackle variation across the country.
"The Budget protects continued increases in public spending while taking responsible decisions on the public finances, and we will continue working to support sustainable hospice and community care as part of our wider plans for the NHS.”