Variance in deaths and pressureClearly, some areas have more deaths than others, and Figure 1 shows the distribution of deaths per 1000 population across local government areas in the UK. Data are for 2017 and are from the Office for National Statistics (ONS) (2018a). The fewest deaths per 1000 population occur in London with the 14 lowest local authorities in the UK. Slough (5.3 deaths per 1000 population) comes in at number 15. At the other end, the top five local authorities (East Lindsey, Christchurch, Inverclyde, Rother, Tendring) all have more than 14 deaths per 1000 population. Of the four countries of the UK, Northern Ireland has the youngest population with only 8.6 deaths per 1000 population compared with 10.7 in Scotland. This inherent 5-times difference in deaths per 1000 population (as per Figure 1) therefore places markedly different end-of-life pressures on NHS organisations.Figure 1.Deaths per 1000 population in 2017 for local government areas and regions throughout the United KingdomThe last year of life is characterised by functional and cognitive decline and increasing dependence on carers for the activities of daily life (Rabbit et al, 2008; Kalbarczyk-Steclik and Nicinska, 2015; Aaltonen et al, 2017). Symptoms of anorexia, dyspnoea, fatigue and pain all increase (Singer et al, 2015); hence increasing numbers of falls and accidents resulting in fractures and other injuries along with indicators of failing immune function such as respiratory and other infections (Jones and Goldeck, 2014). Any forecast of future demand therefore must take trends in deaths into account along with the usual effects of age alone (Moore et al, 2017).