More than one million people in the last year of their life are ending up in A&E departments each year, according to a new report that charities have described as confirming a “worrying trend”.
A study by King’s College London, conducted with Marie Curie, found that a lack of social care support at home and insufficient palliative care means frail and terminally ill people are increasingly turning to emergency departments.
Rising emergency attendances
In the latest 12 months analysed, people in the last year of life accounted for almost 770,000 ambulance trips to emergency departments, more than one million A&E visits and almost 890,000 emergency admissions.
The joint report found that A&E visits involving people in the last year of life increased by 21% between 2014 and 2023, rising from 900,295 to 1,089,365. Some 7% of emergency department attendances during that period were made by someone in the last year of their life.
This group also accounted for 19% of ambulance transfers to hospital, 18% of unplanned hospital admissions and 29% of “unplanned bed days”. The report concludes that people in the last year of their life took up 11.5 million “unplanned hospital bed days” in the latest year analysed.
Charities call for better community care
Charlie King, director at charity Hospice UK, said: “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.”
Marie Curie said that while some patients will need hospital care, gaps in 24/7 end-of-life care in the community mean a growing number are turning to urgent and emergency care when they “don't have to be there”.
Dr Sam Royston, executive director of research and policy at Marie Curie, said: “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.
“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.”
The report says “too many” people are being identified as being in the last part of their lives too late and cannot access care and support outside working hours.
Families describe overwhelmed system
Shan Newhouse cared for her husband Grant, a former teacher, before his death from pancreatic cancer in 2024 when he was 69. Shan, a retired GP from Essex, said: “Four or five weeks before Grant died, there were two consecutive nights when we had to visit the emergency department.
“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 Ian Higginson, president of the Royal College of Emergency Medicine, said: “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.
“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.”
Treating more people out of hospital in community clinics or their own home is one of three “shifts” Labour announced for the NHS after coming to power in 2024. The new study only covers a period up to 2023.
A spokesperson for the Department of Health and Social Care said: “We recognise the financial pressures many hospices are currently facing and we are working with the sector and NHS partners to create a more sustainable funding approach, building on the £125 million we have already invested to improve hospice facilities.
“The Prime Minister and Health Secretary have made clear their commitment to improving palliative and end-of-life care. Our forthcoming Modern Service Framework will help address some of the most significant challenges facing the sector, including regional variations in access and quality, gaps in support, and workforce shortages.”
