Dying patients given greater choice to die at home at no extra cost to the NHS, The King's Fund report concludes

Significantly more people have been helped to choose to die in their own homes at no greater cost to the NHS as part of a Marie Curie-led pilot project, an independent King's Fund evaluation, Improving Choice at the end of life, reveals today.

Since 2004, UK charity Marie Curie’s Delivering Choice Programme has worked with doctors and nurses in hospitals, hospices and community services to give people in Lincolnshire with terminal illnesses the choice of dying at home, rather than in hospital. A recent survey from YouGov found that two-thirds of people would like to die in their own homes if they were terminally ill but just 14 per cent thought they would be properly looked after at home.

The King's Fund's analysis of the impact and costs of the programme concludes that it represents a cost effective model of care that can make choosing to die at home a real option for dying patients. The study is limited by the fact that patients who used the new services could not be matched with similarly ill patients from before the services were in place. Nevertheless, the findings represent a positive development of services that should be further researched and understood.

King's Fund Chief Executive, Niall Dickson, said:

'Despite being a popular choice, many people are unable to die at home as they would wish. While we must be careful about drawing widespread conclusions from this limited study, we know that more people have been able to die at home at no extra cost to the NHS. This shows that a more strategic use of local services can transform care at the end of life, and these findings will be useful in taking forward our understanding of how to improve services in an area that has for far too long remained under-researched and under-supported.

'A health system should be judged on how well it treats all patients, including those at the end of life. We can do more to help some of our most vulnerable patients. This report is an important contribution to debate around how to improve the complex system of care for people who are dying.'

The programme delivered an overall rise in the proportion of patients who were able to die at home rather than in hospital – home deaths across the board rose from 19 per cent in 2005–6 to 23 per cent during the implementation of the programme in the following year. This is more pronounced in the group of patients who actually used the Delivering Choice Programme, of whom 42 per cent of patients died at home.

The study also looked at the costs of providing hospital and community services for random samples of patients before and after the new services had been put in place. It found that more of those patients that used the services had died at home while the overall combined costs of care remained unchanged.

The King's Fund analysis focused on patients who accessed two new services: a rapid response team that makes emergency and planned visits to patients at home in twilight and out-of-hours periods; and discharge community nurses who organise home care to help patients leave hospitals more rapidly and continue to receive care at home, as well as providing information and support to patients, carers and their families. 

Find out more about our work on the Choice at the end of life programme

Notes to editors: 

  1. For further information or interviews, please contact the King’s Fund media and public relations office on 020 7307 2585, 020 7307 2632 or 020 7307 2581. An ISDN line is available for interviews on 020 7637 0185.
  2. The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.