Palliative care strategy - population data and research: overview
This additional paper gives an overview of current population data and service use provided by Public Health Scotland. Scottish Government analysts made projections for changes in population health based on 2021 data up to 2040 and show that those are predicted to lead to increased palliative care needs.
2. Population palliative care needs
2.1 Total numbers of deaths and place of death
In 2022/23, a total of 61,443 deaths were registered in Scotland (excluding sudden or accidental deaths) and of these deaths 45.8% were in hospital (27,926), 30.7% at home (18,797), and 18.8% in care homes (11,529). Approximately 4.7% of deaths (2,882) were in a hospice or specialist palliative care unit.
Where people die is influenced by their age, social circumstances, and health conditions. In hospital, the highest proportions of deaths were from circulatory diseases (25.5%) and cancer (23.1%) with a smaller proportion from respiratory diseases (14.8%). For deaths at home, proportions were 33.7% from circulatory diseases and 33.7% from cancer. Care homes differed with the main causes of death being the group of diseases called mental and behavioural disorders that currently includes dementia (21.2%), other diseases of the nervous system (20.9%) and circulatory diseases (20.3%). A majority of deaths in hospices or specialist palliative care units were from cancer (86.7%). Table 1. In 2022/23, for people aged 69 or under 43% of deaths occurred at home. This compares to 27% of deaths in people aged 70 or above. In addition, 3.3% of deaths occurred in a care home for people aged 69 or under compared to 23.4% for people aged 70 or above.
Cause of Death Group |
Care Home |
Home |
Hospice/ Palliative Care Unit |
Hospital |
Other |
|
|---|---|---|---|---|---|---|
Cancers |
12.1% |
33.7% |
86.7% |
23.1% |
14.3% |
|
Circulatory system diseases |
20.3% |
33.7% |
4.0% |
25.5% |
25.7% |
|
Nervous system diseases |
20.9% |
4.3% |
1.8% |
4.9% |
11.4% |
|
Respiratory system diseases |
8.7% |
9.0% |
2.3% |
14.8% |
11.4% |
|
Mental and behavioural disorders (includes dementia) |
21.2% |
4.1% |
0.3% |
3.5% |
17.1% |
|
Other Causes |
16.9% |
15.3% |
5.0% |
28.3% |
20.0% |
|
Source: Public Health Scotland
Deprivation category is based on the Scottish Index of Multiple Deprivation (SIMD). There are five deprivation categories and approximately 20% of the population of Scotland are within each deprivation quintile with deprivation category 1 relating to the most deprived areas and deprivation category 5 to the least deprived areas. The proportion of deaths in care homes is higher for those living in the least deprived category (24.6%) compared to the most deprived category (14.2%). Table 2.
Deprivation Quintile |
Care Home |
Home |
Hospice / Care Unit |
Hospital |
Other |
|---|---|---|---|---|---|
1 - Most Deprived |
14.2% |
33.6% |
4.1% |
48.0% |
0.0% |
2 |
15.5% |
31.4% |
4.7% |
48.3% |
0.0% |
3 |
19.8% |
29.9% |
4.6% |
45.5% |
0.1% |
4 |
22.5% |
30.3% |
4.8% |
42.4% |
0.1% |
5 – Least Deprived |
24.6% |
26.8% |
5.5% |
43.0% |
0.1% |
Source: Public Health Scotland
2.2 Place of care
People continue to spend most of their final six months of life at home or in a community setting (89.1% in 2022/23 compared with 88.0% in 2018/19). Table 3.
Setting |
2016/17 |
2017/18 |
2018/19 |
2019/20 |
2020/21 |
2021/22 |
2022/23 |
|---|---|---|---|---|---|---|---|
Community (%) |
88.8% |
88.0% |
88.0% |
88.3% |
90.2% |
89.7% |
89.1% |
Hospice/Palliative care unit (%) |
0.7% |
0.7% |
0.6% |
0.6% |
0.4% |
0.4% |
0.4% |
Community hospital (%) |
2.1% |
2.1% |
2.1% |
2.0% |
1.6% |
1.5% |
1.5% |
Large hospital (%) |
8.5% |
9.2% |
9.3% |
9.1% |
7.8% |
8.3% |
9.0% |
Source: Public Health Scotland
The proportion of the last six months of life spent in different places of care varies by age group. In 2022/23, the proportion of time spent in the community was 90.9% for people under 65, 88.1% for those aged 75-84 and 89.0% for those aged 85 and over. Older people spent less time in a hospice/palliative care unit in their last six months of life.
Setting |
Under 65 |
65-74 |
75-84 |
85+ |
|---|---|---|---|---|
Community (including care homes) (%) |
90.9% |
89.4% |
88.1% |
89.0% |
Hospice / Palliative care unit (%) |
0.8% |
0.6% |
0.3% |
0.1% |
Community hospital (%) |
0.4% |
1.0% |
1.7% |
2.1% |
Large hospital (%) |
7.8% |
9.0% |
9.9% |
8.8% |
Source: Public Health Scotland
There was little variation in percentage of time spent at home or in the community in the last six months of life across the different deprivation categories. In 2022/23, the percentages ranged from 88.7% (deprivation category 2) to 89.4% (deprivation category 4).[2]
Contact
Email: Palliativecareteam@gov.scot
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