Recommendation 4

Too many patients spend their last days receiving palliative care in acute hospitals, which does not always achieve the best outcomes for patients nor represent value for money. Patients are frequently receiving palliative care and reaching the end of their lives in settings they would prefer not to be—in hospitals rather than at home or in a hospice—and which are more expensive. Around one in four adults cared for in acute 4 hospitals are in the last year of their life, accounting for about 10 million bed days each year, when many could be in other settings that are better suited to supporting their needs. Hospices annually support around 20,000 people to die in community settings rather than in hospital, saving the NHS approximately 1.5 million bed days and around £800 million. NHS England use a dashboard to track patients at the end of their lives across all ICBs, which highlights the significant number of people who need not be in hospitals and would rather be at home. recommendation NHS England should explain, in detail, how it will move more palliative and end-of-life care out of acute settings and into the community, and the savings it expects this will deliver.