Over 80% Of Healthcare Cost In The Final Year Of Life Spent On Hospitals
New research from the Nuffield Trust and the Health Economics Unit, commissioned by end-of-life charity Marie Curie, finds that UK public expenditure for people in the last year of life across healthcare, social care and social security is in the region of £22 billion.
Over half (53%) of this public spending in the final year of life is spent on healthcare (£11.7bn) – or £18,020 per person who died.
Hospital care represents the largest share of healthcare spending, accounting for 81% of total healthcare spend (£9.6bn). More than half of this healthcare spend (56%) goes on emergency hospital care (£6.6 billion). Put another way, for every £5 of healthcare spend, £4 was spent in hospital, with £2.80 spent on emergency hospital care.
In contrast, public spending on primary and community healthcare makes up only 11% (£1.3bn) of health expenditure for people in the last year of life, with less than 4% (£414m) spent on hospice care.
The figures reveal that the UK public purse spends five times the amount supporting people in the final year of life as hospital inpatients than it does supporting them with primary, community health and hospice care .
In the most comprehensive analysis of public spending costs at the end of life for over a decade, the research draws on published data and statistics and stakeholder expertise to provide up to date estimates of public spending on healthcare, social care and social security across the UK. It looks at costs incurred for every one of the 652,000 adults who died in the UK 2022, overall and for each nation separately.
Marie Curie says there is a significant lack of access to end-of-life care in communities, leaving people dying alone, without the care they want at home and too often forced towards emergency services, such as ambulances and A&E, and admitted to hospital for their final moments.
Previous research from the charity’s Better End of Life Report revealed 53% of people who die visit A&E at least once in their final three months and today’s new public spending research reveals that an estimated £307m is spent on A&E visits in the last year of life.
Nuffield Trust Deputy Director of Research and report co-author Sarah Scobie said:
“High quality care at the end of life is an essential part of ensuring that people can die well, but policymakers are flying blind when it comes to understanding what costs are incurred in supporting those in their final year of life.
“It is staggering that there is no real overview of how much public money is spent on this vital care. Our report marks a crucial step in shedding light on how much money is spent and where; while revealing that poor and disparate data means we still don’t have the full picture.
“The UK government has pledged to move more care out of hospitals as part of its 10 Year Health Plan for the NHS in England. But with £4 in every £5 of health care spend for those in their last year of life going on hospital care, our findings show the government has a serious challenge ahead to make this a reality for those in need at the end of life.”
Executive Director of Research and Policy Marie Curie Dr Sam Royston says the research shows that we are disproportionately supporting people in hospitals at the end of life and reforming the sector must be a priority for all UK governments.
“The research underlines what we’ve known for a concerningly long time. Too many people are spending their last months of life in hospital, visiting A&E or forced to call out ambulances rather than receiving well-anticipated, coordinated and holistic care in the community. Most devastatingly, too many people are dying in places where they don’t want or need to be.
“There must be a clear long-term ambition for all UK governments to shift health expenditure on people at the end of life from hospital to community settings supported by appropriate targets. For example, a long term target to reduce hospital expenditure by 20% and a corresponding increase in expenditure on community-based health services over a 10-year period would double current expenditure on community services.
“In the short term, transformation funding should support the development and scaling of proven models that have proven impact on enabling the shift from hospital to community-based end of life care. Strong investment into innovative services is needed to ensure equitable, accessible care that is right for them and their loved ones.”
Marie Curie is calling for a ‘transformation fund’ to invest in innovative community-driven ways of caring for those at the end of their lives to help reduce hospital expenditure in line with targets and ultimately improve access to care and support for dying people.
Dr Sam Royston continues:
“There is only one chance to get end of life care right, and alongside increased support for community services, we’re calling on the government to deliver a sustainable, long-term funding plan, that includes ways to future-proof the workforce, so that wherever you live, whatever your illness, you’ll be able to rely on good care right to the end.
“All UK governments must prioritise palliative care to ease the strain on the overburdened and underfunded NHS and create a system that works for everyone. We must see significant plans and allowances in both the NHS 10 Year Plan and the Comprehensive Spending Review. We cannot afford to wait—the time to fix end of life care is now.”