Deaths at home during the Covid-19 pandemic and implications for patients and services

Abstract

Background

Since the start of the Covid-19 pandemic, a third more people have died at home in England, raising important questions about whether people can access the care they need at home and the quality of that care.

Methods

We compared the services used by people who died at home in England in the first year of the pandemic to the year prior to the pandemic, explored indicators of quality of care, and looked for any differences between sociodemographic groups. With the approval of NHS England we used the OpenSAFELY-TPP platform which includes linked GP clinical records, hospital data and death registrations covering a population of 24 million people. We identified people who died at home and calculated GP, community and hospital service use in the last months of their lives.

Results

We found that, for most services, similar or greater volumes of care per person were provided during the pandemic, but with the increased number of people dying at home, there was a shift towards more care being delivered in the community. Our findings highlight the significant health needs of people approaching the end of life, as well as evidence of unmet need and inequalities, both before and during the pandemic. Around 60% of people who died at home either before or during the pandemic did not have palliative care needs recorded in their GP record.

Conclusions

The increased number of people dying at home has significant implications for resources and capacity across community services and primary care. Integrated care boards have a legal duty to ensure the provision of palliative care. Better use of routine data, including from primary and community services, could inform more equitable and responsive care for people approaching the end of life, their families and loved ones.