Official Statistics

Palliative and end of life care profiles January 2025 update: statistical commentary

Published 9 January 2025

Applies to England

What’s new

New data for 2023 has been added to the palliative and end of life care profiles.

This update includes new data for 6 indicators for England, local authorities and integrated care boards (ICBs).

Five place of death indicators have been updated, each including data by age (all ages, under 65 years, 65 to 74 years, 75 to 84 years, 85 years and older). These indicators describe percentage of deaths:

• in hospital
• at home
• in a care home
• in a hospice
• in other places

The other updated indicator describes the percentage of temporary care home residents who die in a care home.

For each of these indicators, new data showing the variation by deprivation deciles has been added for 2014 to 2023.

Introduction

The aim of the palliative and end of life care profiles is to improve the availability and accessibility of information and intelligence around palliative and end of life care (PEoLC). It provides an overview across multiple geographies in England, to support commissioning and planning of local services.

Main findings

In 2023:

• hospital is the most common place of death (42.8%) although more than half of deaths (57.2%) occur either at home (28.4%), in a care home (21.0%), a hospice (5.2%) or in other places (2.6%)
• the percentage of people who died at home remains higher (28.4%) than seen before the COVID-19 pandemic (24.4% in 2019)
• 47,061 (41.3%) people who died in care home were temporary residents, higher than the pre COVID-19 pandemic percentage in 2019 (36.6%)

The need to consider percentages and counts

There have been significant changes in the annual number of deaths in recent years due to the COVID-19 pandemic. One effect of this is that changes in ‘percentage of deaths’ measures can be due to changes in the number of people counted by the measure (numerator), the total number of deaths (denominator), or both.

The need to consider both the number of people counted in an indicator as well as the percentage value is illustrated by the deaths in the hospital indicator. The percentage of people who died in hospital was lower in 2023 (42.8%) than it was before the COVID-19 pandemic in 2019 (44.9%). However, the number of people who died in hospital was higher in 2023 (231,966) than in 2019 (221,835). This is because the total number of people who died was considerably higher in 2023 than it was in 2019.

Place of death

During the COVID-19 pandemic there were abrupt changes in where people die. These changes have in the main persisted.

Figure 1 shows that in 2023 compared to 2019:

• a higher percentage of people died at home (28.4%, 154,234 people compared to 24.4%, 120,445 people)
• a lower percentage of people died in a hospice (5.1%, 28,065 people compared to 5.9%, 28,968 people)
• a lower percentage of people died in hospital (42.8% compared to 44.9%), although this represents an increase in the number of deaths in hospital (231,966 compared to 221,835)

Before the COVID-19 pandemic, in 2019, 22.5% (111,178 people) died in a care home. This rose to 23.6% (134,578 people) in 2020 and in 2023 was 21.0% (113,820 people).

Figure 1: trend in percentage of place of death by place of occurrence, all ages - 2014 to 2023

Place of death varies across ICBs:

• the percentage of deaths in hospital ranges from 36.2% to 52.0%
• the percentage of deaths at home ranges from 26.3% to 33.2%
• the percentage of deaths in a care home ranges from 12.3% to 28.4%

Place of death varies by age. Figure 2 shows:

• the percentage of people who died at home decreases with age, in 2023 from 37.1% for those aged under 65 years to 22.6% for those aged 85 years or older
• the percentage of people who died in a care home increases with age, in 2023 from 2.9% of those aged under 65 years to 35.3% of those aged 85 years or older
• the percentage of people who died in a hospice decreases with age, in 2023 from 8.8% of those aged under 65 years and lowest (2.4%) for those aged 85 years or older

Figure 2: percentage of deaths by place of death and age at death, 2023

Place of death by deprivation  

This update includes data for the place of death indicators by deprivation for each year 2014 to 2023. Indicator values were produced for local areas (local super output areas) combined based on their level of deprivation. Values for all ages and age groups can be found in the PEoLC profiles labelled LSOA21 deprivation deciles in England.

Figure 3 shows that place of death (all ages) varies by deprivation. The variation by deprivation of the hospital and hospice indicators is present at each age group. However, the all age indicators are crude percentages and do not account for differences in the age distribution of deaths in each deprivation decile.

Figure 3: percentage of deaths by place of death and deprivation decile (all ages), England 2023

Deaths in care homes who were temporary residents

When considering end of life care and care homes, 3 groups can be identified:

• people who lived and died in a care home
• people who lived elsewhere and died in a care home (temporary residents)
• people who live in a care home and died elsewhere

Deaths in care homes who were temporary residents describes the number of people who lived elsewhere and died in a care home as a percentage of the number of people who died in a care home

Temporary admission to a care home may occur:

• when someone is unable to stay in their own home due to their terminal illness
• following discharge from hospital during a terminal illness
• when someone needs short term support recuperating from an illness

In 2023, 41.3% of people who died in a care home were temporary residents (47,061). This is similar to 2022 (41.2%).  

The variation in the total deaths in care homes (the denominator) has a significant effect on the value of this indicator. In 2020, during the COVID-19 pandemic, 134,578 people died in a care home. This is over 20,000 more than in any of the other 4 most recent years. The indicator value was at its lowest in 2020 (35.2%) despite the number of deaths of temporary residents in care homes being greatest (47,333). The latest figures are now approaching the peak seen in 2020 for numbers of temporary resident deaths with 47,061 recorded in 2023.

In each region in England this indicator is higher in 2023 than it was before the COVID-19 pandemic. Figure 4 shows that temporary resident care home deaths are highest in the East of England and London and lowest in the North West and North East.

Figure 4: trend in percentage of deaths in temporary resident care home deaths, by region, 2019 to 2023