Respond to future need - meeting the palliative care needs of NW London’s changing population

When we embarked on the review of community-based specialist palliative care one of the eight issues we needed to respond to was making sure that we developed services that met the future palliative care needs of NW London’s changing population.

In order to do this we committed to undertaking further demand modelling and population projections for a ten-year period to support future services modelling.

The outcomes of this work show that we can expect growth in hospice/ specialist palliative care service inpatient unit beds use to be in-line with the growth in the overall number of deaths in the NW London population over time. This is the result of an ageing population, population growth and a number of other factors such as increasing morbidity from chronic illness.

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When we factor this in, we anticipate that we have sufficient of these specialist inpatient beds across our current hospices to accommodate local need for hospice specialist palliative care beds until 2031. 

How is our population likely to change over time?

We are expecting the population of NW London to grow by 5% over the ten-year period between 2023 and 2033, similar to the growth in population expected across London.

During this time, the population size will grow from approximately 2.17 million people to 2.28 million. At this time, we anticipate the greatest growth in Hillingdon, Harrow and Hounslow.

Nationally, 85% of deaths occur in people over the age of 65 years. In NW London, the 65+ population is expected to grow by 30% over the same ten-year timeframe - a much faster rate than overall population. Looking further still, approximately 55% of deaths occur among the 80+ population and this group is expected to grow by 32% in NW London.

How do we expect deaths to change over time?

Due to the impact of Covid-19 pandemic, we are cautious about applying mortality projections based on 2020 and 2021 data. In 2022 we recorded 12,111 deaths across NW London boroughs. Based on this, we expect annual deaths to increase to 14,587 by 2033.

This is impacted by ageing population and population growth and is based on the pattern of change modelled nationally.

How many people need palliative care each year?

What are the causes that contribute to this?

Leading causes of deaths among adults include dementia, ischaemic heart disease, chronic lower respiratory disease, stroke and cancer. You can find out more about leading causes of death through the office of national statistics.

Where do people die?

National data (see below) shows that at present around half of people die in a hospital, whilst just over a quarter die at home. A further 12% of people die in care homes and 5% die in hospices. The proportion of deaths in care homes and hospices has remained broadly similar over time. Whereas the proportion of deaths occurring in hospital has fallen and the proportion of deaths at home has increased over time, indicating potential changes in proactive end-of-life care planning and changing attitudes around remaining in the home environment.

While preferences on place of death haven’t been collected locally, the National Survey of Bereaved People (2015) suggested 81% of people wished to die at home (a contrast to the 28% who actually die at home), 8% of people stated a preference for a hospice, 7% for a care home and only 3% for a hospital.

Public engagement has also highlighted that people change their mind or that their circumstances change, affecting their preferred place of death.

Figure 1: Source ONS 2022 (Death registrations and occurrences by local authority and health board)

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The model of care group used the information to look at different ways to model future demand recognising that there is no exact way of predicting this, but with an expressed desire to factor in unmet need (ie not just roll forward the activity we have now, increased to reflect population growth). This modelling approach shows we currently have sufficient numbers of the most specialist hospice in-patient beds across our current hospices to accommodate all patients who need this type of highly specialist support and care until 2031.

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