How much unplanned hospital activity is for people in their last year of life and how did the Covid-19 pandemic impact this? A 10-year population study for England (2014-2023)
- 1King's College London
Abstract
ObjectivesThe aim of this study is to investigate the impact of the Covid-19 pandemic on the proportion of unplanned hospital use that is for people in their last year of life in England, and to examine changes over time from 2014 to 2023.
DesignA whole population study using secondary analysis of linked routinely collected health data.
SettingEngland between 1st January 2014 and 31st December 2023.
ParticipantsAdults aged 18+ years using unplanned hospital care.
Main outcome measuresUnplanned hospital activity for people in their last year of life.
ResultsBetween 2014-2023, Emergency Department (ED) visits for people in their last year of life increased from 900,295 (6.2% of total) to 1,089,365 (6.1% of total); ambulance conveyances to the ED increased from 696,395 (17.3% of total) to 769,545 (19.5% of total); unplanned hospital admissions increased from 835,960 (18.0% of total) to 889,920 (16.4% of total); and unplanned hospital bed days increased from 11,180,815 (29.2% of total) to 11,491,915 (28.2% of total).
The Covid-19 pandemic was associated with an increase in the proportion of unplanned hospital admissions that were for people in their last year of life, with the largest increase observed among people living in more deprived areas (after adjusting for age and sex).
ConclusionsThese findings show that people in their last year of life account for a substantial proportion of demand for acute hospital and ambulance services. The changes observed during the Covid-19 pandemic underscore the need to consider end-of-life care needs when planning and delivering acute hospital services during periods of exceptional pressure. Improving the quality and coordination of end-of-life care across hospital and community care services should be a key consideration in efforts to meet the needs of an ageing population while managing pressures on the health system.
What is already known on the topic?O_LIFor people in their last year of life, unplanned hospital use is common and increases in the months before death. C_LIO_LIVery little is known about how the proportion of unplanned hospital use for people who are in their last year of life has changed over time and in response to the Covid-19 pandemic. C_LI
What this study addsO_LIApproximately one-third of unplanned hospital bed days are for people in their last year of life indicating that care of the dying is a core activity for hospitals. C_LIO_LIThe increase in the proportion of unplanned hospital admissions that were for people in their last year of life during the Covid-19 pandemic, highlights the need to consider end-of-life care needs when planning services during periods of exceptional pressure. C_LI
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BibTeX
@misc{davies2026much,
title = {{How much unplanned hospital activity is for people in their last year of life and how did the Covid-19 pandemic impact this? A 10-year population study for England (2014-2023)}},
author = {J. M. Davies and J. Verne and T. Bolton and J. Lewis and R. L. Chambers and A. E. Bone and K. E. Sleeman},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.23.26366298},
url = {https://www.medrxiv.org/content/10.64898/2026.10.23.26366298v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - How much unplanned hospital activity is for people in their last year of life and how did the Covid-19 pandemic impact this? A 10-year population study for England (2014-2023)
AU - J. M. Davies
AU - J. Verne
AU - T. Bolton
AU - J. Lewis
AU - R. L. Chambers
AU - A. E. Bone
AU - K. E. Sleeman
PY - 2026
DA - 2026/10/23
PB - medRxiv
DO - 10.64898/2026.10.23.26366298
UR - https://www.medrxiv.org/content/10.64898/2026.10.23.26366298v1
AB - ObjectivesThe aim of this study is to investigate the impact of the Covid-19 pandemic on the proportion of unplanned hospital use that is for people in their last year of life in England, and to examine changes over time from 2014 to 2023. DesignA whole population study using secondary analysis of linked routinely collected health data. SettingEngland between 1st January 2014 and 31st December 2023. ParticipantsAdults aged 18+ years using unplanned hospital care. Main outcome measuresUnplanned hospital activity for people in their last year of life. ResultsBetween 2014-2023, Emergency Department (ED) visits for people in their last year of life increased from 900,295 (6.2% of total) to 1,089,365 (6.1% of total); ambulance conveyances to the ED increased from 696,395 (17.3% of total) to 769,545 (19.5% of total); unplanned hospital admissions increased from 835,960 (18.0% of total) to 889,920 (16.4% of total); and unplanned hospital bed days increased from 11,180,815 (29.2% of total) to 11,491,915 (28.2% of total). The Covid-19 pandemic was associated with an increase in the proportion of unplanned hospital admissions that were for people in their last year of life, with the largest increase observed among people living in more deprived areas (after adjusting for age and sex). ConclusionsThese findings show that people in their last year of life account for a substantial proportion of demand for acute hospital and ambulance services. The changes observed during the Covid-19 pandemic underscore the need to consider end-of-life care needs when planning and delivering acute hospital services during periods of exceptional pressure. Improving the quality and coordination of end-of-life care across hospital and community care services should be a key consideration in efforts to meet the needs of an ageing population while managing pressures on the health system. What is already known on the topic?O_LIFor people in their last year of life, unplanned hospital use is common and increases in the months before death. C_LIO_LIVery little is known about how the proportion of unplanned hospital use for people who are in their last year of life has changed over time and in response to the Covid-19 pandemic. C_LI What this study addsO_LIApproximately one-third of unplanned hospital bed days are for people in their last year of life indicating that care of the dying is a core activity for hospitals. C_LIO_LIThe increase in the proportion of unplanned hospital admissions that were for people in their last year of life during the Covid-19 pandemic, highlights the need to consider end-of-life care needs when planning services during periods of exceptional pressure. C_LI
ER -