We committed to undertaking further demand modelling and population projections for a ten-year period to support future services modelling (click here to view the full analysis).
The outcomes of this work show that we can expect growth in hospice and specialist palliative care service in-patient 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.
The model of care group looked 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.
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 in NW London 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 (Monthly figures on deaths registered in England and Wales, ONS, August 2022). In NW London, the 65+ population is expected to grow by 30% over the same ten-year timeframe. This is a much faster rate than the 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 the 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 an ageing population and population growth and is based on the pattern of change modelled nationally (ONS Deaths Data)
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?
According to national data (see table below), the current statistics for NW London show that approximately half of people (48%) pass away in hospitals, while 28% die at home. Additionally, 12% of people die in care homes, and 5% pass away in hospices. These figures are consistent with the data observed in London as a whole. However, it is important to note that we have not yet reached the national average, particularly concerning deaths in care homes and homes.
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 (VOICES - Views of Informal Carers - Evaluation of Services), England, 2015 suggested 81% of people wished to die at home. 8% of people stated a preference for a hospice, 7% for a care home and only 3% for a hospital.
It should be noted that care homes are also for many people ‘their home’ although this might not be considered when expressing their wishes earlier in their end-of-life journey.
Public engagement has also highlighted that people change their mind or that their circumstances change, affecting their preferred place of death.
Source: ONS 2022 (Death registrations and occurrences by local authority and health board)