- Deaths in people’s homes up by 30-40 per cent (750-850 deaths) each week
- Some are hopeful covid has accelerated people’s wishes to die at home
- But experts warn it is more likely they are missing out on important care and end of life support
The number of people dying at home compared to those ending their lives in hospitals or care homes has increased significantly in the wake of the covid pandemic’s peak in April and May.
Figures released by the Office for National Statistics yesterday show the number of people dying of all causes in hospital has been below the seasonal average since the end of May; and for care homes this has been the case since mid June.
Yet deaths in people’s own homes have been consistently 30-40 per cent (750-850 deaths) above the five year average since early June. Very few of these deaths have been recorded as covid-related.
Hospital deaths have fallen by a similar number (650-850), suggesting that many of those dying at home may, in the absence of covid, have died in hospital. In total, deaths have been slightly below the seasonal average for several weeks.
The share of deaths taking place at home has moved from 24 per cent historically to 34 per cent, and the share in hospital fallen from 46 per cent to 38 per cent.
There has long been a movement for more people to be given the choice to die at home with appropriate end of life care, rather than in hospital. HSJ understands that national officials looking at the shift in place of death are hopeful that, at least in part, it is due to that trend being accelerated by covid, which brought intense pressure to avoid and free up space in hospitals.
However, several experts said it was more likely to indicate people had been, and were still, avoiding healthcare, in some cases despite needing it urgently. They said it was unlikely the extra people dying at home were receiving the support they needed, as many community-based health and care services are still running below capacity or not at all.
Age UK charity director Caroline Abrahams said: “A number of factors are probably responsible, including lack of access to treatment during the pandemic for both existing conditions and new ones.
“We know that many older people remain deeply concerned about contracting the virus and about ‘making a fuss’ so even now they may be disinclined to seek urgent medical attention.
“Social care has become more rationed in some areas and significant numbers of older people have turned paid carers away for fear of becoming infected. Deconditioning may be leading to more falls and depression, caused by months of isolation, to malnutrition among other problems that are weakening resilience.”
She added: “What matters now though is that we do everything we can to get health and care services back and helping older people again…We are still hearing from older people who are struggling to access their local GP.”
Ms Abrahams also called for “proactive outreach” including NHS England working with GPs on “turbo charging the ‘anticipatory care’ element of the NHS long-term plan”.
“Referral rates have not bounced back to anything like pre-covid levels”
Results of a survey carried out in the week ending 13 July, published by Public Health England, found that 51.6 per cent of people who said they had a worsening health condition had not sought advice for it.
Asked for reasons why, 58.3 per cent said to avoid putting pressure on the NHS; 35.1 per cent said they were concerned about catching covid-19; 30.2 per cent that they were concerned about leaving the house; and 28.1 per cent chose another reason (multiple reasons were allowed).
Meanwhile, emergency attendances and admissions and GP referrals remain below normal levels.
NHSE/I chief operating officer Amanda Pritchard told its board meeting on Tuesday: “Referral rates have not bounced back to anything like pre-covid levels. We don’t have a line of sight to those [patients] who have not presented.”
She said better messaging was needed from local leaders and clinicians that people should feel confident to come and have appointments and go to hospital.
Martin Vernon, consultant geriatrician and former national clinical director for older people’s care, said undiagnosed covid-19 was a possible factor, along with “a reluctance to seek [and] lack of access to” care.
“These issues can be expected to persist even as lockdown is eased,” he said. “Crucially increased likelihood of physical, cognitive and mental health decline as a result of enforced social isolation is already known to increase risk of death among older people and those with complex conditions.”
There should be “an adequate balancing community support offer to the most vulnerable… if we are to avoid a second peak in excess community deaths”, he said.
Iain Lawrie, a palliative medicine consultant in North Manchester and Association for Palliative Medicine president, said many fewer people had gone to hospital with common signs of serious illness such as cancers during the pandemic.
“People who really did need hospital care weren’t coming in,” he said. “You can’t say, ‘had I seen you in March that the outcome would have been any different’, but… Even if we were not able to save their life, we could have given them a better quality of life [for the remaining months].
“It means someone suffering at home for three months who we could have [helped].” There was a need for “proper investment in community palliative care”, he added.
In April, government provided £200m for the NHS to buy extra support from hospices, both for beds and community services.
Source
Analysis of ONS data and interviews by HSJ
Source Date
July 2020
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