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/5F43768A-CDC1-45D4-8015-7978B4F0C6F3/0/Beaufort_Survey_Report.pdf.

ACTUAL PLACE OF DEATH For England and 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 62 % Home 20 % Hospice 3 % Nursing Home 8 % Other institution 4 %

HOME-DEATH RATES

6 HIGHEST HOME-DEATH RATES Pembrokeshire Blaenau Gwent Ceredigion Carmarthenshire Monmouthshire Anglesey *indicates county also one of 6 lowest in England and Wales

6 LOWEST HOME-DEATH RATES Denbighshire Conwy Wrexham Newport Flintshire Rhondda Cynon Taff *indicates county also one of 6 lowest in England and Wales

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 home-death 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 home-death 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 home-death 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 home-death 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 home-death 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 home-death 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 - £4.7k per patient Avon study (Abel J(2009), £3.2k per patient

WHY DOES THIS MATTER? If the whole of Wales had the same home-death 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