End of Life Care

There are approximately 500,000 deaths in England every year. This number is expected to rise by 17% from 2012 to 2030. Of these deaths, approximately three quarters are expected and therefore there is potential to improve the experience of end of life care for 355,000 people and their friends and family every year. In 2010-11 the total expenditure on adult end of life care was £460 million with wide variation across regions. The national picture is described in the NHS England document ‘Actions for End of Life Care: 2014-16 http://www.england.nhs.uk/wp-content/uploads/2014/11/actions-eolc.pdf

There are inequalities in where people die. These inequalities involve gender, age, deprivation, cause of death, marital status, and locality. Place of death is related to cause of death – 38% of all deaths from cancer were in hospital compared to 63.4% of deaths from respiratory disease. Marital status is the second biggest predictor of place of death.

Devon has an older population profile than nationally and the older population in Devon is predicted to grow. A number of Devon residents have residential and nursing homes as their place of residence and for many, this will be the setting for end of life.

Table 10.9 shows the average annual number of all deaths in Devon and deaths from selected prominent causes, plus a crude rate of death per 100,000 population. There are over 8,000 deaths occur per annum in Devon. Due to the older population profile in Devon crude death rates are higher than the South West and England, and are particularly high in Southern areas of the county on account of this.

Table 10.9, Average Annual Incidence of Deaths from All Cancers, Cancer, Circulatory Disease (ICD10 I00-I99), Coronary Heart Disease (ICD10 I20-I25), Stroke (ICD10 I60-I69) and COPD (ICD10 J40-J44), Devon, 2011 to 2013

Northern Eastern Western Southern Devon South West England
All Deaths 1,810 3,940 888 1,697 8,344 52,999 464,398
Rate * 1141.86 1064.86 1073.83 1196.08 1115.17 999.62 874.11
Cancer 530 1,128 247 481 2,390 14,866 132,335
Rate * 334.63 304.98 298.40 339.32 320.64 281.59 250.60
Circulatory 564 1,122 262 512 2,463 15,099 130,810
Rate * 356.08 303.36 316.54 360.94 330.30 285.98 247.64
CHD ** 232 501 107 217 1,058 6,644 59,578
Rate * 146.39 135.51 129.84 152.98 141.97 125.86 112.82
Stroke # 181 312 73 146 713 4,218 33,177
Rate * 114.21 84.33 88.71 102.92 95.60 79.91 62.82
COPD 67 155 30 78 331 2,473 24,285
Rate * 42.49 41.80 35.89 55.22 44.36 46.85 45.99

* Crude Rate per 100,000 population ** Coronary Heart Disease # Chronic Obstructive Pulmonary Disease. Source: Compendium of Population Health Indicators and Primary Care Mortality Database 2015

Figure 10.17 shows the increasing trend in deaths at home and in care homes and decrease in deaths in hospital. The proportion of total deaths occurring at home increased from 19.7% in 2008 to 24.0% in 2014. The proportion of total deaths occurring in care homes increased from 23.4% in 2008 to 28.3% in 2014. The proportion of total deaths occurring in hospital decreased from 49.5% in 2008 to 40.1% in 2014. The proportion of deaths in hospice and other settings remained steady across the period.

Figure 10.17, Trend in place of occurrence of death in Devon, 2008 to 2014

Figure 10.17 Trend in place of occurance of death 2008-2014
Click to enlarge

Source: Primary Care Mortality Database, 2015

Whilst the proportion of deaths at home has increased in recent years, there is still a gap between people’s preferred place of death and their actual place of death. This is shown in figure 10.18 which shows where people want to be die compared to where they actually die.

Figure 10.18, Preferred and actual place of death in Devon, 2014

Figure 10.18 Preffered and actual place of death in Devon 2014
Click to enlarge

Source: Primary Care Mortality Data, 2015

Table 10.10 and table 10.11 show the estimated number of deaths per annum by religion and ethnic group respectively in Devon between 2011 and 2013.

Table 10.10, Estimated Annual Deaths by Religion, Devon, 2011 to 2013

Religion Population (2011 Census) Estimated Annual Deaths
All categories: Religion 746,399 8,344
Christian 458,778 6,639
Buddhist 2,726 12
Hindu 818 2
Jewish 685 9
Muslim 3,091 7
Sikh 263 1
Other religion 4,261 24
No religion 213,045 936
Religion not stated 62,732 714

Source: Primary Care Mortality Data, 2015 and 2011 Census (calculated by applying overall risk of death estimates by age group to 2011 Census population figures)

Table 10.11, Estimated Annual Deaths by Ethnic Group, Devon, 2011 to 2013

Religion Population Estimated annual deaths
All categories: Ethnic group 746,399 8,344
White: Total 728,073 8,299
White: English/Welsh/Scottish/Northern Irish/British 708,590 8,156
White: Irish 3,130 47
White: Gypsy or Irish Traveller 554 2
White: Other White 15,799 93
Mixed/multiple ethnic group: Total 6,520 18
Mixed/multiple ethnic group: White and Black Caribbean 1,750 6
Mixed/multiple ethnic group: White and Black African 787 2
Mixed/multiple ethnic group: White and Asian 2,429 6
Mixed/multiple ethnic group: Other Mixed 1,554 4
Asian/Asian British: Total 8,710 18
Asian/Asian British: Indian 1,873 5
Asian/Asian British: Pakistani 280 1
Asian/Asian British: Bangladeshi 570 1
Asian/Asian British: Chinese 3,195 5
Asian/Asian British: Other Asian 2,792 6
Black/African/Caribbean/Black British: Total 1,413 4
Black/African/Caribbean/Black British: African 845 1
Black/African/Caribbean/Black British: Caribbean 421 2
Black/African/Caribbean/Black British: Other Black 147 <1
Other ethnic group: Total 1,683 5
Other ethnic group: Arab 913 2
Other ethnic group: Any other ethnic group 770 3

Source: Primary Care Mortality Data, 2015 and 2011 Census (calculated by applying overall risk of death estimates by age group to 2011 Census population figures)