Dying well at home

Think tank: The King’s Fund

Author(s): Alex Baylis; Loreen Chikwira; Ruth Robertson; Luca Tiratelli

February 23, 2023

This report from UK think tank The King’s Fund looks at commissioning quality end-of-life care.

Increasingly people are dying at home rather than in hospital and this trend is set to continue. This raises questions about whether there are the right staff with the right skills to support people in their home at the end of life, and whether the health and care system is prepared for changing levels of demand. We interviewed NHS commissioners in 10 areas of England, and social care commissioners in a further 5 areas, to find out how they assess need, plan services and assure the quality of care for people who die at home. Commissioners had limited ability to assure the quality of care for people who die at home. They were not making full use of available data or national resources for assessing local needs, and were not monitoring quality across health and social care. All commissioners recognised the importance of inequalities in end-of-life care, but none had yet started taking action to reduce them. There is a moment of opportunity for commissioning end-of-life care. Developing integrated care systems (ICSs), a new statutory duty for commissioning end-of-life care, and new ways of working create potential for commissioners to develop end-of-life care as an integrated service with patients and carers’ needs at its heart. We make recommendations for commissioners, integrated care boards (ICBs) and national bodies to ensure the opportunity is grasped.