Are People Dying Where They Want to Die?

The proportion of people dying in hospital has fallen steadily over the past decade, from 53% in 2010 to around 46% in 2022^[1], as policy and preference have aligned around enabling more people to die at home or in community settings. Home deaths rose from 20% to 28% over the same period — the largest shift.^[1] This reflects both the expansion of community palliative care and the impact of the COVID pandemic, which accelerated movement away from hospitals in 2020. Surveys consistently show that around 70% of people would prefer to die at home or in a hospice, yet only around 34% do so.^[2] The gap between preference and reality reflects inadequate 24-hour community care, lack of carer support, and the crisis-driven default to hospital admission.

Hospices are the primary providers of specialist palliative care for the most complex cases, yet they receive only around 34% of their costs from NHS funding^[2] — a proportion that has not increased in over a decade despite rising demand and inflation. The remaining two-thirds is raised through charity: shops, legacies, and public fundraising. This creates a structurally fragile system where the quality of end-of-life care varies significantly by geography — postcode-dependent on the fundraising strength of local hospices. The Marie Curie annual report estimates that 100,000 people die each year without access to the palliative care they need.^[3] An ageing population will place further pressure on an already stretched system.