End of Life Care

What are the key inequalities?

Inequalities in end of life care can relate to:

  • Age
  • Ethnicity
  • Gender
  • Disease  (e.g. cancer compared to other diagnosis)


Nationally we know that preference for home death is highest in younger patients. For the East of England 62% have home as preferred place of death with 32% reporting a preference of hospice. Older patients (75+) have the highest preference (41%) for hospice as preferred place of death, but in fact have the lowest proportion of those that actually achieve this.  Our local data (figure 4) shows that younger patients are accessing hospice care in higher numbers and proportions than older patients.


Fig 4 also show the gender breakdown for place of death. It would appear that males may be have more hospital deaths than females This may be related to the fact that males have a shorter life span and a higher proportion die younger, and the higher numbers of older females in residential care or other social or demographic influences.


A recent national review of national and international research (Calzani, et al 2013) has highlighted the low uptake of end of life services for people from BAME groups. This can be the result of a  number of factors:

  • Lack of referrals
  • Lack of knowledge about services and what palliative care involves
  • Religious traditions and family values in conflict with the idea of hospice and palliative care.  This may include where western values underpin decisions about end of life care and these may not be shared.
  • Structural issues (including location of hospice in predominantly white middle class areas)
  • Previous negative experience of accessing general health care

Local data/ information on the experience of BAME groups in relation to end of life care is not available at the current time.


Palliative care services have historically been focused and developed in relation to cancer care. The inclusion of non-cancer patients within palliative care has been more recent and as a result is less well developed.

Proportion of death from heart failure that occur at home or usual place of residence, 2007 - 2011

Proportion of death from heart failure that occur at home or usual place of residence, 2007 - 2011 Source: PHO annual deaths extract, ONS

Locally there is evidence that patients with non-cancer disease may not be accessing palliative care services to an optimal level.  The PEPS register of care consists predominantly of cancer patients (91% having cancer diagnosis). This is in contrast to cancer being the cause of death in 23% of patients and shows that there is an underrepresentation of non cancer patients on the PEPS register.

Further evidence that non cancer patients may be underrepresented are the lower than national proportions of deaths in usual place of residence for heart failure patients in Central Bedfordshire.

Last updated Friday, 22nd April 2016