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End of life care
Introduction
About 1% of the population in the UK die each year (over half a million), with an average of 20 deaths per GP per year. A quarter of all deaths are due to cancer, a third from organ failure, a third from frailty or dementia, and only one twelfth of patients have a sudden death. The considerable benefits of identifying patients in need of palliative care include providing the best health and social care to both patients and families and avoiding crises, by prioritising them and anticipating need. Identifying patients in need of palliative care, assessing their needs and preferences and proactively planning their care, are the key steps in the provision of high quality care at the end of life in general practice. This indicator set is focused on the maintenance of a register (identifying the patients) and on regular multidisciplinary meetings where the team can ensure that all aspects of a patient’s care have been assessed and future care can be co-ordinated and planned proactively [1].Data Overview
This indicator measures the percentage of patients in need of palliative care/support, as recorded on practice disease registers, irrespective of age. As of 2022/23, there were 1,243 patients identified as being in need of palliative care/support registered with an Oldham GP. This represents 0.5% of the adult population, equal to the average for England. Oldham's rate is slightly below the North West rate of 0.6%. Since 2009/10, the rate has significantly risen across all areas, increasing by 4 times in Oldham. Oldham has the third highest rate across Greater Manchester.Figure 1: Palliative/supportive care: QOF prevalence (all ages) trend
Source: Office for National StatisticsFigure 2: Palliative/supportive care: QOF prevalence (all ages) across Greater Manchester
Source: Office for National StatisticsPlace of death is used as a proxy indicator of quality of end of life care. The analysis that follows explores deaths by place for all ages.
Over the last decade, the percentage of deaths that occur in hospital has decreased by 10% nationally. Decreases have also been seen regionally (-8.1%) and in Oldham (-7.5%). The dip observed in 2020 is contributed to by the Covid-19 pandemic and an increased number of care home deaths within the time period. Oldham has the 3rd lowest rate of deaths in hospital across Greater Manchester and is 5th highest when compared to CIPFA nearest neighbours.
Figure 3: Percentage of deaths that occur in hospital (all ages) trend
Source: Office for National StatisticsFigure 4: Percentage of deaths that occur in hospital (all ages) across Greater Manchester
Source: Office for National StatisticsFigure 5: Percentage of deaths that occur in hospital (all ages) across CIPFA neighbours
Source: Office for National StatisticsThe largest proportion of deaths occur in hospital and this has remained consistent. For the latest available year of data (2022), Oldham had 47% of deaths in hospital, 29.5% at home, 16.5% in a care home, 4.5% in a hospice and 2.6% elsewhere. Recent trends indicate a decrease in the percentage of deaths that occur in care homes and an increase in those that occur in a hospice setting. There is also an increasing trend of deaths occurring at home.
Figure 6: Percentage of deaths by place of death, Oldham residents (all ages)
Source: Office for National StatisticsFigure 7: All age Oldham resident deaths by place of death, 2022
Source: Office for National StatisticsWhen compared regionally and nationally, Oldham has a higher proportion of deaths occurring in hospital and at home and a lower percentage happening within care homes.
Figure 8: Deaths by place, 2022
Source: Office for National Statistics Further Information & Resources
OHID Palliative and End of Life Care ProfilesThe goal of these profiles is to improve the availability and accessibility of information and intelligence around palliative and end of life care. The profiles provide an overview across multiple geographies in England to support commissioning and planning of local services.