WHO WHERE AND WHY Place of death in

WHO, WHERE AND WHY? Place of death in Wales Sophie Thomas Matron Paul Sartori Foundation

PREFERRED PLACE OF DEATH • Preferred and actual place of death varies widely across different groups • Bell C, Somogyi-Zalud E, Masaki K. Methodological review: measured and reported congruence between preferred and actual place of death. Palliat Med. 2009 Sep; 23(6): 482 -90. – 12 papers – Between 35% - 94% preferred home-death – Congruence – 30% – 90%

PREFERRED PLACE OF DEATH • In the UK, the preference for home death is probably at least 50% with some studies suggesting higher figures • Higginson I, Sen-Gupta G. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences. J Palliat Med. 2000; 3(3): 287 -300. • Beaufort Research Ltd. Marie Curie Cancer Care Survey - Technical Report & Tabulations. Cardiff: Beaufort Research Ltd; 2006 [Accessed 04 Oct 2009]; Available from: http: //campaign. mariecurie. org. uk/NR/rdonlyres/5 F 43768 A-CDC 1 -45 D 4 -80157978 B 4 F 0 C 6 F 3/0/Beaufort_Survey_Report. pdf.

ACTUAL PLACE OF DEATH • For England Wales – approx 20% home deaths (ONS 2007) • Likely that a large number of people do not achieve their preferred place of death

ONS FIGURES • Divide place of death into: – Psychiatric hospitals (NHS and other) – Non-psychiatric hospital (NHS and other) – Nursing homes (NHS and other) – Other institutions (convents, residential homes, etc) – Home – Other (roads, beeches etc)

WALES - 2007 Hospital Home Hospice Nursing Home Other institution 62 % 20 % 3 % 8 % 4 %

HOME-DEATH RATES

6 HIGHEST HOME-DEATH RATES • • • Pembrokeshire Blaenau Gwent Ceredigion Carmarthenshire Monmouthshire Anglesey

6 LOWEST HOME-DEATH RATES • • • Denbighshire Conwy Wrexham Newport Flintshire Rhondda Cynon Taff

WHY? • • • Age profile of county? Deprivation? Rurality? Employment? Single occupancy households? Services? All demographic stats are from 2001 census

AGE • 1 out the 6 counties with the highest home -death rates is also amongst the 6 with the most people over 65* • 2 of the 6 counties with the lowest homedeath rate are also amongst the 6 with the most people over 65

‘LIVING AS A COUPLE’ • 1 out the 6 counties with the highest home -death rates is also amongst the 6 with the highest number of people ‘living as a couple’ • 1 of the 6 counties with the lowest homedeath rate is also amongst the 6 with the most single occupancy households

UNEMPLOYMENT • 2 out the 6 counties with the highest home -death rates are also amongst the 6 with the highest unemployment levels • 3 of the 6 counties with the lowest homedeath rate are also amongst the 6 with the highest unemployment levels

RURALITY • 4 out the 6 counties with the highest home -death rates are also amongst the 6 most rural • 0 of the 6 counties with the lowest homedeath rate are also amongst the 6 most rural* *Population density figs, 2001 census

INPATIENT HOSPICE PROVISION • 0 out the 6 counties with the highest home -death rates have inpatient hospice services • 5 of the 6 counties with the lowest homedeath rate have inpatient hospice services *Hospice as distinct from specialist palliative care beds

ADDITIONAL SERVICES* • 6 out the 6 counties with the highest home -death rates have additional services • 1 of the 6 counties with the lowest homedeath rate have additional services *additional to NHS community CNS and Marie Curie contract

CAUSE AND EFFECT • Do 70%+ of Pembrokeshire residents want to die at home because they know there is a high level of free home care? Or did the home care service develop because of the high rate of preference for home death? • Is there a virtuous spiral?

WHY DOES THIS MATTER? • Patient preference • Cost of avoidable deaths in hospital – National Audit Office Sheffield study - £ 4. 7 k per patient – Avon study (Abel J(2009), £ 3. 2 k per patient

WHY DOES THIS MATTER? If the whole of Wales had the same homedeath rate as Pembs, £ 7. 2 million p. a could be transferred from the acute sector to the community • Approx £ 2. 50 per head of population

WHO, WHERE AND WHY? Place of death in Wales Sophie Thomas Matron Paul Sartori Foundation