End of Life Care in Scotland

12th December 2019

Two thirds of Scots will die at home, in a care home, or in a hospice by 2040, if current trends in where people die continue, despite this currently being where less than half of deaths occur, a new study has concluded.

However, the research from Marie Curie, University of Edinburgh and Kings College London has warned that without radical investment in community health and social care services then hospital deaths will start to rise again and could peak at 37,089 (57 percent) in 2040. 

In response to the research, published by BMC Palliative Care, charity Marie Curie is today calling on the Scottish Government and Health and Social Care Partnerships to make care of people living with terminal illness a top priority. 

The research predicts there will be nearly 16 percent more deaths in Scotland in the next 20 years taking the annual figure to 65,756. If current trends continue, the proportion of people who die at home will increase from 23 percent in 2016 to 29 percent by 2040. Similarly, deaths in Scottish care homes will increase by 10 percent from 19 percent to 29 percent over the same period. The number of people dying in hospital will fall, although hospital will remain the most common place to die.

The findings contrast with a previous study reporting trends in England and Wales which found that care homes could overtake hospitals as the most common place for people to die by 2040.

The research concludes that increases in end of life care at home is very unlikely without additional investment in community-based care, including care home capacity. Worryingly, the number of care home places is currently falling.Increases in the number of people dying in care homes will only occur if there is further investment in care home capacity and an increase in staff in these settings. Care home staff need to be better equipped to care for the increasing number of people, many with advanced dementia alongside other conditions, who will die in the care home setting. Investment in palliative and end of life care education and training as well as better remuneration in the social care sector is needed. 

In a recent Marie Curie opinion poll, 61 percent of Scots said they would prefer to die at home. Marie Curie is calling on the Scottish Government and Health and Social Care Partnerships to make care of terminally ill and dying people a top priority, and to realise the Scottish Government’s commitment to double palliative care services in the community. This will go some way to ensuring these projected trends continue. Hospitals must also be given extra resource to support people with a terminal illness to be cared for and die there, as there will always be people who need and want to be cared for and die in a hospital.

Anna Bone, author and researcher at the Cicely Saunders Institute, King’s College London, said: “The rise in the number of deaths we are expecting in Scotland in the next two decades should be a red flag for the Scottish Government and a call for action. Our study found that hospital will remain the most common place to die in Scotland in 2040, in all our scenarios. This contrasts with findings in England and Wales, where deaths in care homes and at home were projected to overtake deaths in hospital. Our findings show that growing pressures on services in Scotland will be felt across hospitals, care homes and home-based care settings. This calls for a strategic and joined up response across settings to ensure that everybody receives good quality care in their final months of life.”

Please click on the link below to download the full report:

www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2016/12/health-social-care-delivery-plan/documents/00511950-pdf/00511950-pdf/govscot%3Adocument/00511950.pdf