End-of-life demand is highly volatile and shows unexpected trends

This series on NHS capacity planning has highlighted the role of the nearness to death effect upon hospital inpatient demand (Jones, 2019a; 2019b) and this will serve as the third article in this short series. The absolute number of deaths serves as a retrospective measure of the end-of-life pressure faced by each locality, where around half of a person's lifetime inpatient demand is compressed into the last year of life.

NHS demand is therefore highly sensitive to the volatility in deaths. The sad fact is that deaths are highly volatile and that the magnitude of this volatility is location-specific (Jones, 2012). This implies that the marginal changes in demand and cost pressures are location-specific and largely outside of the control of the NHS. No recognition of this basic fact is given in the NHS funding formula (Jones and Kellett, 2018).