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 leading 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 [2].

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 [2].

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 [3] 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.

Novel palliative care services such as the Responsive Emergency Assessment and Community Team (REACT) service delivered by Marie Curie and developed with partners in Bradford [4] offer direct provision of palliative care services in emergency departments that proactively identify, assess, and treat people arriving in A&E, and offer an alternative to hospital admission through a supported transition into community palliative care.

For 400 people in their last year of life supported through REACT, the average number of unplanned bed days in hospital was reduced from 38 to 17. Over 21 months,10,932 total bed days were saved, producing a conservatively estimated cost saving of between £1.74m – £2.44m compared to a REACT service cost of £1.31m in the same period.

Gillian Holtom, 62, from Oldbury, says she wasn't given the care and support needed following her husband Terry's diagnosis of stomach cancer. Despite his wish to die at home, Terry, a former metal spinner, died in hospital in June 2021.

"Terry knew he was dying, he wanted to die at home and be pain-free. He basically said, 'All I want is not to be in any pain.' And I don't think that happened when he got into hospital. I'm not sure that he would have been worse off at home, with the lack of palliative support I had.

"I've tried to think about what I could have done differently, because there were periods of time when he suffered and was in a lot of pain, and I just remember desperately trying to get help but not getting anywhere which made me feel very helpless a lot of the time, and not really knowing what I could do.

"There really wasn't any consideration given to how he might be functioning as a human being, so I feel frustrated. I don't feel that we were given the care or support that we needed."

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."

ENDS
[1] Estimated UK public expenditure on health care, social care and social security in 2022 for people aged 18 or older in the last year of life
[2] 44% of the costs of independent hospice services are funded by the public purse, the remaining 56% funded by charitable contributions. Hospice expenditure estimates exclude NHS hospice care.
[3] Johansson T, Pask S, Goodrich J, Budd L, Okamoto I, Kumar R, Laidlaw L, Ghiglieri C, Woodhead A, Chambers RL, Davies JM, Bone AE, Higginson IJ, Barclay S, Murtagh FEM, Sleeman KE (King's College London, Cicely Saunders Institute; Hull York Medical School at the University of Hull; and University of Cambridge, UK). Time to care: Findings from a nationally representative survey of experiences at the end of life in England and Wales. Research report. London (UK): Marie Curie. (September 2024) mariecurie.org.uk/ policy/better-end-life-report
[4] REACT is funded via a 3-year Social Impact Bond funded by Macmillan, Better Society Capital and Commissioning Better Outcomes.

For more information or to arrange interviews with our spokespeople, please contact:
Interviews with Marie Curie and Case Studies: lucy.boddy@mariecurie.org.uk / 07455851528
For media interviews with the Nuffield Trust: Eleanor.pearson-martin@nuffieldtrust.org.uk or emma.cooper@nuffieldtrust.org.uk or call 020 7462 0500

About Marie Curie
Please note we are 'Marie Curie' (not 'Marie Curie Cancer Care')
• Marie Curie is the UK's leading end of life charity.
• The charity provides expert end of life care for people with any illness they are likely to die from, and support for their family and friends, in our hospices and where they live. It is the largest charity funder of palliative and end of life care research in the UK, and campaigns to ensure everyone has a good end of life experience. Whatever the illness, we're with you to the end.
• Marie Curie is the UK's largest charitable funder of palliative care research. The aim of its research is to deepen the understanding of what makes a good end of life, highlighting challenges and gaps in care, and improving support for everyone affected by dying, death or bereavement.
• If you're living with a terminal illness or have been affected by dying, death and bereavement, Marie Curie can help. Visit www.mariecurie.org.uk or call the free Marie Curie Support Line on 0800 090 2309.
• facebook.com/MarieCurieUK
twitter.com/mariecurieuk
instagram.com/mariecurieuk

About Nuffield Trust
The Nuffield Trust is an independent health think tank that aims to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
www.nuffieldtrust.org.uk

About Health Economics Unit
The Health Economics Unit evaluates health-related innovations ranging from digital health, artificial intelligence, medicines and medical technology, algorithms, new models of care, and interventions including surgical procedures.