Ignorance isn't bliss: behind the unequal distribution of end-of-life demand and cost

In the January issue of Journal of Paramedic Practice, I discussed how the nearness to death effect meant that around 50% of a person's lifetime hospital inpatient demand was compressed into their last year of life (Jones, 2019). Planning in the NHS currently relies on the erroneous assumption that demand is entirely a result of age and deprivation. A recent study has demonstrated however that omission of the absolute number of deaths from the NHS funding formula leads to the incorrect allocation of funds (Jones and Kellett, 2018).

Clearly, 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.