Almost 90 more people than expected died in private households every day in Great Britain in the past year as more end-of-life patients shunned hospitals in favour of a home death, Guardian analysis shows.
This year so far, almost 22,500 people more than usual died in private homes from all causes in Great Britain, opening new questions about the resources and treatment available for end-of-life care.
That figure is a fifth higher than in average of the previous five comparable years (2020 is excluded because it would skew what constitutes a typical year).
However, the same analysis does not show excess mortality – which means the number of extra deaths above the five-year average – in other settings during 2022. In fact, it is the opposite: 2.3% fewer people died in care homes compared with the average, and about 0.5% fewer died in hospitals.
The analysis of weekly mortality data from the Office for National Statistics (ONS) and National Records of Scotland indicates that the trend of “mortality displacement” out of hospitals into people’s private houses first seen during the Covid pandemic is set to continue.
Experts say there is limited evidence to explain why more people are dying at home even when the pandemic has subsided, and more research is needed to better understand the displacement phenomenon and the quality of end-of-life care available for those who die at home.
But they point to people’s ongoing fears around exposure to the virus in hospitals, unprecedented pressures over the NHS, a positive increase in the capacity of end-of-life services in the community and in the use of hospital equipment at home as potential reasons for this change.
Dominic Carter, the head of policy, advocacy and research at Hospice UK, a national charity for hospice and end-of-life care, said it might be combination of more than one of those factors: people choosing to die “in the location of their choice and surrounded by the people and possessions that mean the most to them” married with fears around the level of care they’d receive in hospital or care homes given current pressures on both.
Dr Veena Raleigh, a senior fellow at the King’s Fund, said that if the trend of more people dying at home reflects people’s choice “that’s to be welcomed”.
“However, if it’s due to fears about using the NHS, or being unable to get admitted to hospital … then that is unacceptable in a caring society and a reflection of the parlous state of healthcare.”
As we approach winter and the pressures on the NHS continue, Carter said, “there are questions about how this ongoing displacement will be covered by services”.
“The additional funding for hospices has run out and they are impacted by the costs of inflation. Those additional costs will currently have to be covered by charitable fundraising,” said Carter.
Excess mortality in private homes has been constant since the beginning of the pandemic, registering more deaths than the average almost every week since early March 2020.
But that has not been the case in hospitals or care homes, where spikes in excess deaths closely follow Covid waves, mainly because of the prioritisation of hospital beds for people with the virus.
Between March 2020 and the beginning of September, deaths occurring in private homes were 33% higher than in a typical year. That compares with care homes (8%) and hospitals (4%).
But when Covid deaths are excluded, mortality levels at hospitals are actually below the average, suggesting that those people who would have ordinarily died in hospitals instead died at home.
Excluding Covid deaths, about 45,000 fewer deaths occurred in hospitals in 2020 and 2021 compared with the average; in 2022 to date, that figure is close to 21,500 fewer deaths.
In fact, the number of Covid deaths at home is relatively small. Only 2.8% of the deaths registered in private households since the beginning of the pandemic involved Covid. This compares with 19.4% of the total deaths registered at hospitals since March 2020, and 12.4% in care homes.
An ONS report published in 2021 concluded that deaths from other causes, such as breast and prostate cancers and diabetes, were occurring in private homes in England and Wales at a higher rate in the first year of the pandemic. Excess deaths at home for Parkinson’s disease and diabetes were up by two-thirds compared with the 2015-19 average.
Another ONS analysis published in November 2021 showed that older people were dying at a higher rate at homes. During 2020, there were 52% more deaths than expected among those aged 80 and over in private homes in England and Wales.
“With people dying at home in unprecedented numbers, it is incumbent on the government to ensure that their final days befit what an affluent, caring and just society should ensure for all its citizens,” said Raleigh.
“To ensure everyone dying at home has a dignified, comfortable, pain-free and supported death requires a shift to a community led end-of-life care model that is planned and adequately resourced to provide nursing, palliative, social and end-of-life care.”
