New research from King's College London and Marie Curie highlights the growing pressures on emergency healthcare services and the central role hospitals and ambulance services play in supporting people nearing the end of life.
People in their last year of life account for almost one in five (18%) emergency hospital admissions and almost a third (29%) of unplanned hospital bed days in England, according to a new study led by researchers at King's College London.
New research, published today by Marie Curie led by Dr Joanna Davies from the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation at King's College London has revealed the substantial and growing role emergency services play in caring for people in their last year of life in England.
Commissioned by Marie Curie, the research analysed a decade of NHS data between 2014 and 2023 to understand how people approaching the end-of-life use emergency healthcare services. The findings reveal that demand on ambulance services, emergency departments and hospitals remains high and has increased over time.
In 2023, people in their last year of life accounted for:
Almost 770,000 ambulance conveyances to emergency departments
Nearly 1.09 million emergency department visits
Almost 890,000 emergency hospital admissions
Nearly 11.5 million unplanned hospital bed days
Compared with 2014, emergency department visits among people in their last year of life have increased by 21%, while ambulance conveyances increased by 11%.
The research highlights the important role that emergency and acute healthcare services play in supporting people nearing the end of life. It also provides important evidence for policymakers and healthcare leaders seeking to improve care for people approaching the end of life, while ensuring services remain sustainable.
"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."
Dr Joanna Davies, Senior Author of the study and Research Fellow at the Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation.
"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."
Retired GP Shan Newhouse cared for her husband Grant, before his death from pancreatic cancer in 2024.
