The UK’s healthcare system is facing a growing challenge: providing adequate end-of-life care for an aging population with increasingly complex health needs. While traditionally focused on cancer patients, palliative care must now extend to individuals with conditions like heart failure, respiratory disease, dementia, and neurological disorders. Despite this evolving landscape, the National Health Service (NHS) has been slow to adapt, resulting in significant gaps in care and avoidable suffering.
New research reveals that nearly one in three people in England die without receiving the care they need, not because their death is unexpected, but because the system fails to properly organize and deliver end-of-life support. This systemic failure leads to avoidable emergency admissions, prolonged hospital stays, and patients experiencing pain and distress. The consequences are not only deeply personal for patients and their families but also place a substantial strain on already stretched NHS resources.
The economic burden of inadequate end-of-life care is considerable. Public spending in the UK on individuals in their final year of life amounts to approximately £22 billion, with over half allocated to healthcare. A disproportionate amount – 81 percent of the end-of-life health budget – is spent on hospital settings, indicating a reliance on crisis-driven care rather than proactive, coordinated support. For many, a hospital is not the most appropriate or desired place to spend their final days.
Disparities in access to palliative care are also a significant concern. Individuals with non-cancer conditions, those from ethnic minority groups, and residents of deprived areas are consistently neglected. The recent research indicates that a third of people with multiple health conditions experience unmet needs, compared to a quarter of those without. 36 percent of those experiencing financial hardship have unmet needs, compared to 25 percent of those who are financially comfortable.
Looking ahead, the demand for palliative care is projected to increase dramatically. By , an estimated 40,000 more people each year will miss out on the care they need compared to , totaling over 210,000 people annually. This underscores the urgent need for a comprehensive strategy to improve end-of-life care services.
A key component of this strategy must be a commitment to 24/7 access to palliative and end-of-life care. Establishing a single point of access – a dedicated phone line – in every part of England would ensure that patients, families, and frontline staff know where to turn at any time, supported by professionals with the necessary expertise. This would provide crucial support during moments of crisis and help prevent unnecessary hospital admissions.
palliative care needs to be integrated into community-based healthcare services. Embedding it within neighborhood health services, rather than treating it as an isolated specialty, would facilitate faster support, reduce crisis admissions, and increase the likelihood of individuals remaining in the comfort of their homes. This requires a shift in focus towards proactive, preventative care.
Addressing the workforce shortage is also critical. All healthcare and care staff, including general practitioners and emergency medical teams, should receive mandatory training in palliative care. This would equip them with the confidence and skills to effectively support patients in their final months, regardless of their underlying condition.
The ongoing parliamentary debate surrounding assisted dying should not overshadow the fundamental need for high-quality palliative and end-of-life care. Providing comprehensive support, relieving pain, and enabling individuals to live and die with dignity should be the priority. No one should feel compelled to consider assisted dying due to a lack of adequate care and support.
Recent reports have highlighted instances where NHS funding for palliative care is withdrawn from patients who unexpectedly live longer than initially predicted. BBC analysis revealed that over 1,300 patients a year experience this, raising concerns about the rigidity of the system and the potential for inadequate ongoing support. One family shared their experience of funding being withdrawn for their mother with dementia, leaving them feeling unheard and as though the system was prioritizing cost-cutting over patient needs.
The current situation also contributes to delayed discharges from hospitals. As reported in January , over 13,000 patients in England and 4,000 across the rest of the UK are occupying hospital beds despite being medically fit for discharge. Many of these individuals require support in the community, highlighting the need for improved coordination between hospital and community care services. The financial cost of these delayed discharges is substantial, exceeding £225 million per month in England alone.
improving end-of-life care is not only an economic imperative but a moral one. It is about ensuring that all individuals, regardless of their condition or background, have the opportunity to live as fully as possible until the end of their lives, and to die with dignity, comfort, and peace.
