Associated with: Major Causes of Mortality, Cancer, Respiratory Infections, General Mortality, Dementia, Palliative Care

 

Key Facts

  • Most people express a wish to die at home.
  • Locally 44% of people die in hospital, which is lower than the national level.
  • Most deaths in hospital locally occur at the Royal United Hospital
  • There is a higher rate of death with Dementia recorded locally than nationally, which will have implications on of life care provision.

What does the data say?

National data

Most people (67%) express a wish to die at home, however, only 22% actually do. 7% of people wish to die in hospital but 51% do. However, 60% of those who initially express a preferrence to die at home say they would change this view if doing so without support. 1


Local data

Table 1: Deaths in usual residence, CCG level vs national

Note: 'Usual residence' as used in the table above refers to home or care home, as opposed to the survey data above where home is seperated from care homes and nursing homes. Care should be taken in comparing the two directly. 

The latest CCG deaths figures show that B&NES is currently ranked 2nd in the country for percentage of deaths in the usual residence at 55.5% compared to 44.8% nationally (table 1). This rate has been increasing consistently year on year since 2010/11, though it has fallen slightly from the 2013/14 figure of 56.1%.

Locally, the great majority of deaths in hospital occur at the Royal United Hospital Bath NHS trust at 89% consistently since 2010/11. Between 3% and 5% occur in Sirona Care and Health and at University Bristol Hospital FST. 2.

Over the years the greatest proportion of deaths in hospital has consistently occurred from Norton/Radstock (approximately 25%) with significant proportions of deaths in hospital also occurring from the Bath West and Chew/Keynsham localities. 3.

Of deaths in hospital, most occur following non-elective surgery (unplanned emergency admissions), which have risen from 74% in 2010/11 to 80% in 2014/15. 4.

2010-12 deaths by age, cause of death, gender and place 5

 

Figure 1: 2010-12 Place of death by cause of death.

 

Slightly older data from 2010-2012 allows us to break down deaths locally by place, cause of death, age and gender6;

    • Locally during this period, 22% of people died at home, the same as national figures. However there was a significantly higher percentage of deaths occuring in care homes (28% compared to 20% nationally) across ages and gender. (figure 1)
    • In B&NES, a significantly lower percentage of deaths occurred in hospitals than nationally, approximately 44% of deaths in 20010/12 compared to 51% nationally (figure 1). B&NES ranked 20th of 211 CCGs nationally, ranked for lowest to highest percentage of deaths at home.
    • Additionally, a significantly lower percentage of deaths occurred in hospices compared to nationally (3% vs 6%) (figure 1)
    • Different conditions have different rates of deaths at home (figure 1). Cancer deaths are the most likely to occur at home (33%) and least likely to occur in hospital (36%) whilst deaths from respiratory disease (often occurring in the very elderly) are more likely to occur in hospital (59%) and least likely to occur at home (15%).
    • The only notable differences by gender were that males aged 0-64 were significantly more likely to die in 'other' places, and females aged 65--84 were significantly more likely to die in thier usual residence (figure 2)

 

Figure 2: 2010-12 Place of death by age and gender

 

Are we meeting the needs?

 

National care of dying audit for hospitals, England (May 2014) 7

 

This national report was a retrospective audit of the organisation of care within 131 trusts comprising 150 individual hospitals and 6,580 patient data sets.

 

Key findings;

  • Only 21% of sites had access to face-to-face palliative care services 7 days a week, contrary to national recommendations.
  • Mandatory training in care of the dying was only required for doctors in 19% of trusts and for nurses in 28%.
  • 53% of trusts had a named board member with responsibility for care of the dying.
  • Only 47% of trust reported having a formal strucured process in place to capture the views of bereaved relatives or friends prior to this audit.
  • 76% of bereaved relatives reported being very or fairly involved in decisions about care and treatment and 63% reported that the overall level of emotional support given to them by the healthcare team was good or excellent.

 

Results of audit for Royal United Hospital Bath NHS Trust; 8

  • Of the 7 KPIs reviewed by the audit, the RUH acheived none. These included access to information related to death and dying, access to specialist support, trust board representation and formal feedback processes for bereaved relatives.

 

See also Service Use and Quality of Care

 

What does the community say?

 

National Survey of Bereaved People (VOICES) 2013 9

The National Survey of Bereaved People (VOICES, Views of Informal Carers – Evaluation Of Services) collects information on bereaved peoples’ views on the quality of care provided to a friend or relative in the last three months of life, for England. The survey has now been run for three years and was commissioned by the Department of Health in 2011 and 2012, and NHS England in 2013. It is administered by the Office for National Statistics (ONS). This links in closely with Palliative Care

Key findings;

  • Overall quality of care in the last 3 months of life has not changed significantly between 2011, 2012 and 2013. In 2013, 43% of survey respondents rates care as excellent or outstanding.

  • This quality rating was significantly better in cases including dementia in the cause of death (47% excellent or outstanding)

  • Care rated as excellent or outstanding is highest for people who die from cancer (51%)

  • Quality of care was rated significantly lower for people who died in a hospital, compared to people dying at home, in a hospice or care home.

  • For those dying at home, the quality of coordination of care was rated significantly lower in 2013 compared to 2012 (from 45% in 2012 to 42% in 2013)

  • The dignity and respect for patients shown by hospital nurses and hospice nurses has increased between 2011 and 2013.

  • Pain is relieved most effectively in the hospice setting (62%) and least effectively at home (18%)