How much unplanned hospital activity is for people in their last year of life and how did the Covid-19 pandemic impact this? A 10-year population study for England (2014-2023)

Objectives The aim of this study is to investigate the impact of the Covid-19 pandemic on the proportion of unplanned hospital use that is for people in their last year of life in England, and to examine changes over time from 2014 to 2023. Design A whole population study using secondary analysis of linked routinely collected health data. Setting England between 1st January 2014 and 31st December 2023. Participants Adults aged 18+ years using unplanned hospital care. Main outcome measures Unplanned hospital activity for people in their last year of life. Results Between 2014-2023, Emergency Department (ED) visits for people in their last year of life increased from 900,295 (6.2% of total) to 1,089,365 (6.1% of total); ambulance conveyances to the ED increased from 696,395 (17.3% of total) to 769,545 (19.5% of total); unplanned hospital admissions increased from 835,960 (18.0% of total) to 889,920 (16.4% of total); and unplanned hospital bed days increased from 11,180,815 (29.2% of total) to 11,491,915 (28.2% of total). The Covid-19 pandemic was associated with an increase in the proportion of unplanned hospital admissions that were for people in their last year of life, with the largest increase observed among people living in more deprived areas (after adjusting for age and sex). Conclusions These findings show that people in their last year of life account for a substantial proportion of demand for acute hospital and ambulance services. The changes observed during the Covid-19 pandemic underscore the need to consider end-of-life care needs when planning and delivering acute hospital services during periods of exceptional pressure. Improving the quality and coordination of end-of-life care across hospital and community care services should be a key consideration in efforts to meet the needs of an ageing population while managing pressures on the health system.