People in the final year of their lives in England are increasingly turning to emergency services because of inconsistent access to care at home, according to a new report from Marie Curie. The charity warned that shortages in round-the-clock community and palliative care are pushing patients towards hospital services, even when their needs could be met elsewhere.
Research conducted by Marie Curie alongside experts from King's College London examined activity between 2014 and 2023. The findings show that, in 2023, people in their last year of life accounted for almost 770,000 ambulance journeys to emergency departments, more than one million A&E attendances and nearly 890,000 emergency hospital admissions, representing 11.5 million unplanned hospital bed days.
Emergency demand rises over a decade
Emergency department attendances among this group rose by 21%, from 900,295 to 1,089,365 over the period. Ambulance transfers to A&E increased from 696,395 to 769,545, while unplanned hospital admissions climbed from 835,960 to 889,920.
The researchers stressed that people in the final year of life represent approximately one in 14 (7%) of emergency department attendances between 2014 and 2023. They accounted for 19% of ambulance transfers to hospital, 18% of unplanned admissions and 29% of unplanned bed days.
Gaps in community care
The report argues that improving access to palliative and end-of-life care could ease the burden on emergency services while ensuring patients receive more appropriate support in familiar surroundings. It states: "We know that too many people die in pain and without the support they need for their symptoms, and gaps in 24/7 community care prevent people from dying in comfort at home. When timely, co-ordinated support is unavailable, people and families can find themselves turning to urgent and emergency care for help."
The authors point to the ambition of reducing urgent hospital admissions among people nearing the end of their lives by 10%. Based on 2023 hospital activity, achieving this could mean approximately 89,000 fewer unplanned admissions and 1.15 million fewer hospital bed days annually.
Several factors contribute to the growing reliance on emergency services, including uneven provision of community-based care, particularly during evenings and weekends, staffing pressures and delays in recognising when someone is approaching the final stages of life.
Call for a transformation fund
Dr Sam Royston, executive director of research and policy at Marie Curie, said the figures represented real experiences of patients and relatives who had struggled to find appropriate help. "Behind some of these statistics will be patients and families who have called an ambulance or gone to hospital because, in their time of need, there was nowhere else for them to turn," he said. "Access to care and support closer to home currently varies across the country, particularly outside of normal working hours, resulting in unequal care at the end of people's lives. This is not fair, and it's not right. Opportunity for change is on the horizon."
Marie Curie is urging the Government to establish a dedicated transformation fund for palliative and end-of-life services. Dr Royston said the funding would support the redesign of services and help prevent hospital visits that could otherwise be avoided. "The choice is clear: invest in better end-of-life care now, so more people can get the support they need at home, and fewer families are left with nowhere to turn in a crisis."
The report also highlights the personal consequences of gaps in care through the experience of retired GP Shan Newhouse, who looked after her husband, Grant, a former teacher, before he died from pancreatic cancer in 2024, aged 69. She recalled having to take him to an emergency department on two consecutive nights during the final weeks of his life.
"Four or five weeks before Grant died, there were two consecutive nights when we had to visit the emergency department," she said. "Grant was admitted, but there wasn't a bed available, so we had to sit on chairs in a corridor. The doctors knew Grant had pancreatic cancer, but they still couldn't find a bed. He was feeling ill and vomiting, so in the end he had to lie across a few of the chairs. The general impression I had was of a system that was completely overwhelmed, working desperately to try and cope."
Dr Joanna Davies, the paper's senior author and a researcher at King's College London, said the findings underlined the importance of making palliative care a central part of wider efforts to reduce hospital admissions. "As health systems seek to reduce avoidable hospital use and shift care into the community, our findings demonstrate that improvements in palliative and end-of-life care must be central to these efforts."
The Royal College of Emergency Medicine also highlighted the challenges faced by patients who end up in emergency departments during the final stages of their lives. Dr Ian Higginson, president of the college, said people approaching death should have access to specialist support and an environment that prioritises their comfort and dignity.
"People approaching the end of their life deserve comfort, dignity and access to specialist care. As this important report highlights, many patients attend emergency departments (ED), often on multiple occasions, in the last year of their life due to complications with their conditions," he said. "Sometimes, these attendances are unavoidable, and an ED is the right place for the patient. But that isn't always the case. Too many people with palliative care needs are ending up with us, some in the last days or hours of their life – and not by their own choice. These last patients typically need a quiet and comfortable environment, where they can be surrounded by loved ones and have access to specialist clinicians. Instead, they may end up in a loud, bright and overcrowded ED because of a lack of community care provision."
Charlie King, director of external affairs at Hospice UK, said the findings reflected mounting difficulties for people trying to access appropriate support towards the end of their lives. "This report confirms a worrying trend: it is getting harder and harder for people to access the end-of-life care they need. No one should die in a hospital corridor."
The Department of Health and Social Care has been approached for comment.
