8 November 2019
Revised analysis of CSO place of death statistics further underlines need for co-ordinated end-of-life care support in all care settings
The Irish Hospice Foundation (IHF) has today welcomed the publication of revised analysis of place of death by the Central Statistics Office (CSO) which sees the place of death updated and re-categorised, and includes a retrospective analysis using these categories for deaths from 2013-2016.
Previous data analysis showed a lack of clarity on deaths in community (HSE) hospitals, private hospitals and elsewhere. Now, for the first time, we can see more accurate analysis of reported place of death, including deaths in hospices. The CSO uses death certificates to record place of death.
Welcoming the publication of the revised figures, the IHF CEO, Sharon Foley said that a clearer understanding of place of death in Ireland should help frame a better response to the needs of those facing death and bereavement in all care settings. Crucially, it allows us to project capacity requirements in various care settings and exposes current and future pressure points which need additional support.
She added: “We now have very accurate data for place of death which shows that nearly half of the 30,000 people who die each year, die in a hospital setting. Four out of ten people will die in an acute hospital. These figures have remained steady over the past number of years. The scale of this can be illustrated by the fact that almost 200,000 beds days per annum are used for patients who die – the equivalent of 535 hospital beds nationally being used on a full-time basis each year ONLY for patients who die. This would be the same capacity of a major teaching hospital such as the Mater Misericordiae in Dublin.”
“These needs will be further exacerbated by an estimated 23% increase in the number of deaths in Ireland between 2019 and 2031 as a result of an ageing, and growing population. Hospitals need to be forward-thinking, and build the resources and quality improvement supports now.”
The IHF has long supported hospital leadership in reaching the understanding that dying is part of their business through its Hospice Friendly Hospitals (HFH) programme. The scale of the challenges they face now, and in the future, means there must be swift and effective action from Government, the HSE and hospital management to address priority needs including:
- Increasing resources for specialist palliative care (SPC) in the acute hospital setting to ensure appropriate care for all patients with SPC needs.
- Embedding and strengthening initiatives such as the HFH programme which enables and supports staff in providing high-quality care at end of life
- Urgently and consistently providing essential skills training and supports for staff caring for patients at end of life, including Final Journeys acute hospital staff training.
- Upgrading end-of-life hospital infrastructure such as family rooms and mortuaries. These should reflect excellence in care for those at end of life and respect for the deceased and the bereaved.
The IHF notes with concern the lower percentage of deaths at home in the reclassified data, averaging around 23% previously believed to be between 25% and 26%. In line with Sláintecare and a number of other state policies, this shows more investment in home care – including SPC homecare, primary care and community supports – is required to enable people to remain at home as they near end of life.
The percentage of deaths in hospices has risen year-on-year, from 6.4% of annual deaths in 2013 to 8.1% in 2017, reflecting a welcome addition of new in-patient hospices. This illustrates the need for additional and ongoing investment in SPC to build on the welcome €10 million promised in Budget 2020 and the funding needs for the sector identified in Sláintecare, Adult Palliative Care Services: Model of Care for Ireland and National Palliative Care Services: Three Year Development Framework (2017-2019).