Palliative care strategy - population data and research: overview

3. Service use

3.1 Urgent and emergency care

Unscheduled NHS services are important whenever people in their last months of life have rapid or unpredictable changes in their health or care and need urgent help and support.

For 2022/23^[3], during the last six months of life:

• 7,359 patients (12%) had 3 or more emergency admissions recorded
• 59,112 emergency department attendances (1.0 per death) were recorded
• 71,064 unscheduled care pathways^[4] (1.2 per death) were recorded

There were also high rates of emergency admissions in the last six months of life:

• 69,867 emergency admissions (1.1 per death) compared to 4,743 elective admissions (0.1 per death).
• Emergency admissions represented 94% of total admissions, and the rate of emergency bed days per death was 16.4.
• Patients with metastatic cancer had the highest rate of emergency admissions (1.74 per death) followed by those with liver conditions (1.53 per death), heart failure (1.40), lung disease (1.40), and other cancers (1.40). People dying with dementia had the lowest rate of emergency admissions per death (0.80).

The rates of elective and emergency admissions returned to 2016/17 levels in 2022/23 as did rates of attendances at emergency departments (A&E). Rates of emergency bed days were higher in 2022/23 (16.4%) compared to 2016/17 (14.8%) but lower than 2018/19 (17.8%). Unscheduled care pathways (out of hours patient journeys) were lower at 1.2 per death in 2022/23. Table 5.

Source: Public Health Scotland

*Within a patient's single encounter with an unscheduled care or out of hours service, a patient may have multiple consultations with different out of hours services and health care professionals. Consultation type can include home visit, attendance at a Primary Care Emergency Centre/Primary Care Centre or Out of Hours Primary Care advice from a GP or nurse advice plus any other type (mainly district nurses or community psychiatric nurses). It also includes calls to the NHS24 111 line. These are sometime called Unscheduled Care Pathways or CUPs.

3.2 Unscheduled NHS services research

A research study looked at all deaths in Scotland in 2016 to find out how unscheduled NHS services were used over the last year of life.^[5] One or more of the five unscheduled NHS services (NHS 24, primary care out-of-hours, Scottish ambulance service, emergency departments, and emergency hospital admissions) were used by 53,509 people in Scotland during their last year of life in 2016. There were 206,841 continuous unscheduled pathways (CUPs) of linked unscheduled service use for these people equating to an average of 3.9 CUPs per individual in their last 12 months of life, with 34.2% of contacts occurring in the last month of life.

For continuous unscheduled care pathways, 64.8% started in the out-of-hours period, mostly via the NHS 24 telephone advice service or primary care out-of-hours. The most common out-of-hours care pathway, especially for frail people and care home residents, began and ended in primary care. The cost of providing services in the community was estimated at 3.9% of total unscheduled care costs despite handling most out-of-hours calls.

In this research, people living in the most deprived areas were:

• less likely to access primary care out-of-hours (46.6%) compared with those from the least deprived category (56.9%)
• accessed help from the Scottish ambulance service more often(77.2%) than people in the least deprived category (69.5%)
• more likely to attend an emergency department(67.3%) compared with people in the least deprived category (58.4%)
• admitted to hospital more often(76.4%) than people in the least deprived category (72.7%)