Background Within routine clinical practice in the UK palliative care clinicians report that many referrals are made in the last weeks and days of life.

Methods We audited referral patterns relating to 5,613 cancer patients made between March 2012 and March 2014 to three specialist palliative care services in Leeds: Leeds Teaching Hospitals Trust Specialist Palliative care team, Wheatfield’s Hospice and St Gemma’s Hospice. For each patient referred to any of the above services we identified the date of their first referral and calculated the median interval between first referral and death.

We also calculated how referral time varied across and within cancer type.

Results Of the 1,680 cancer patients referred to St Gemma’s Hospice the median interval between first referral and death was 41 days (6 weeks). The same dataset showed wide variability in timing of referral across 15 cancer types, of 1,623 cancer patient referrals to Wheatfields Hospice, median interval between referral and death was 60 days (8 weeks), with similar variation across and within cancer types to the St Gemma’s Hospice data.

The median interval between referral and death for 2,310 cancer patients within the Leeds Teaching Hospitals Trust palliative care team was 24 days (3 weeks). Adjusting for duplication (17% of patients referred to the LTHT palliative care team were subsequently referred to either of the Leeds hospices) our dataset contains data on 5,221 individual patients in whom median interval between referral to any Leeds specialist palliative care service and death is 42 days (6 weeks).

Based on the number of cancer deaths in Leeds for the same period, approximately 30% did not receive specialist palliative care before death.

Conclusion This study demonstrates that the level of access to and current timing of referral may impair the opportunity to enable high quality end of life care for many patients.