Authors' objectives: Around half a million people die in England each year, and this number is expected to increase 17% by 2030. If currents patterns of care continue, unchanged forecasts estimate we would need a 20% increase in hospital beds to maintain current levels of care. As treatments are developed to extend life, our population is ageing and increasingly people die following a chronic or progressive illness, requiring palliative care in the last months or weeks of life. The focus of care needs to shift from the disease , to the person with the illness and their family. Often people go into hospital, but for most, this is not their preference. Indeed many would prefer to be cared for at home for as long as possible and two-thirds of those who die would prefer to die at home. Consequently, the UK end of life care strategy set a target to enable people who die in their place of choice, usually home. However, although recent research has shown that for the first time in over 30 years, home deaths have slightly increased in the UK, hospital remains the most common place of death, with almost two-thirds of the people who die, dying in hospital. There is little information on how best to meet this national target. In our previous NIHR project GUIDE_Care we identified great local variation in where people died, ranging from <10% to 70% death at home across the UK. We examined this on a national basis and identified factors concerned with patient characteristics (e.g. marital status and age) which influenced the variation. However, this explained only a quarter of the variation and even less for cancer and some LTC s (~10%). We suspect that services have a greater influence on where people die. This idea is supported by a small amount of research and an earlier literature review we conducted, but has never been examined thoroughly in the UK. Therefore, in this follow-on project (GUIDE_Care Services), we wish to examine the role of services influencing where people die. If we can identify service configurations that make it possible for more people to die in their place of choice, then we will be able to identify ways to improve care. GUIDE_Care Services is a population-based study. Thus we have a fully representative sample of the population, rather than a selected group. This gives us reliable and generalisable results. We will use information from national registers. This has the advantage of placing no burden on patients and families at such a difficult time in their lives, and is also cost-effective. The information is anonymised, so we cannot identify any individual person. The data is constantly checked to ensure that no personal details are reported. We will link the data collected from different databases regarding where people have died in an area, alongside information about services available in that area. We will examine service factors in three ways: services provided, services used and proximity to care facilities. We will then assess the roles of service factors in where people die, by major disease groups, and also by local areas (e.g.local authority or general practice). The findings will be disseminated widely and tailored according to different audiences including service users, commissioners, NHS management and, policy-makers and service providers. We have integrated patient and public involvement into all stages of the project, from planning to dissemination.

Project Status: Completed

URL for project: http://www.nets.nihr.ac.uk/projects/hsdr/141922

Year Published: 2015

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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