Overview of the specialist palliative care population

The specialist palliative care (SPC) population comprised 52,105 people aged 40+ years who received SPC in the last year of life and died from predictable deaths in 2019–20. This represents 38% of all people who died from predictable deaths in 2019–20. 

SPC population is younger than the population not receiving SPC

At the time of death, 63% of the SPC population were aged 75 years and over – 30% were aged 75-84 and 33% aged 85 and over (see Figure 3.1). 

The SPC population, were on average, younger than people not receiving SPC – median age of 79.7 years compared with 85.4 years, respectively. Consistent with this finding, only 29% of the 85 and over age group received SPC, compared with 43–50% across all other age groups (see Supplementary Table 1a). 

Cancer is responsible for 1 in 2 deaths among the SPC population, 3 times as high as the population not receiving SPC

Over 4 in 5 (85% or 44,227) of the SPC population died from conditions potentially amenable to palliative care (as defined in Appendix Table A3). 

For the SPC population:

  • over 1 in 2 (55%) died from underlying cause of malignant neoplasms (referred to as cancer for brevity)
  • 1 in 4 (23%) died from circulatory, respiratory or renal/liver conditions – 9.1% from heart diseases, 6.0% from respiratory diseases, 5.3% from cerebrovascular diseases (or stroke), and 2.9% from renal or liver disease
  • almost 1 in 20 (4.4%) died from Alzheimer's disease, dementia, and senility (or dementia for brevity).

The SPC population were 3 times as likely to have cancer listed as the underlying cause of death than people not receiving SPC (55% vs 16%), as shown in Figure 3.1. In contrast, heart diseases and dementia were 3 times as likely to be listed as the underlying cause of death for the population not receiving SPC than SPC (26% vs 9.1% for heart diseases and 14% vs 4.4% for dementia, respectively). 

Figure 3.1: Age distribution and underlying causes of death of the SPC and non-SPC populationsThis figure shows the Age distribution and underlying causes of death of the SPC and non-SPC populations.

Source: Supplementary Table 1a. 

2 in 3 people dying from cancer received SPC. Receipt of SPC is more common for renal/ liver diseases than for other non-cancer conditions

Another way of looking at diagnosis differences is to examine specific causes of death and whether SPC was received in the last year of life. 

Consistent with the above-mentioned results, 2 in 3 (68%) people who died from cancer received SPC. People who died from renal/liver disease were more likely to receive SPC than people dying from other non-cancer conditions – 40% compared with 18% of people dying from heart diseases and 16% from dementia receiving SPC (see Figure 3.2). 

Similar results were also observed when looking at the reasons (principal diagnosis) for the last hospital admission, as shown in Figure 3.2. Over 4 in 5 (84%) people who had a principal diagnosis of cancer at their last hospital admission received SPC in the last year of life. While this was lower for neurodegenerative diseases (68%) and renal/liver disease (60%), it was still considerably higher than for other non-cancer admissions. For example, 55% and 36% of people whose last hospital admission was for stroke or heart diseases received SPC in the last year of life.

Higher receipt of specialist palliative care may reflect that these patients were in frequent contact with healthcare services in the last months of life, with health professionals alerted to the progression of these conditions and the potential need for specialist palliative care. For example, on average, people receiving SPC had 1.7 overnight hospital admissions in the last 3 months of life, with readmissions highest for people dying from cancer and renal/liver disease (mean of 1.8 and 1.9 overnight admissions; see Supplementary Table 1b). This is consistent with the above-mentioned results that showed cancer and liver/renal disease patients were more likely to receive SPC than people dying from other causes.  

Figure 3.2: Proportion of predictable deaths population who received/did not receive SPC by underlying causes of death and principal diagnosis at last admissionThis figure shows the proportion of predictable deaths population who received/did not receive SPC by underlying causes of death and principal diagnosis at last admission. Standouts include cancer, with 84% of the population receiving SPC.

Source: Supplementary Table 1a.