Background During the COVID-19 pandemic, there have been significant efforts to support more people to remain at home at the end of life. In Fife, Scotland, at the beginning of the pandemic, a significant proportion of NHS Fife Specialist Palliative Care Service (FSPCS) resource was diverted towards community care. This study examined trends in place of death prior to, and during, the pandemic and described patterns of unscheduled care use over the last months of life.

Methods A retrospective cohort study was undertaken, involving data linkage of routine administrative and healthcare data for all Fife decedents between April 2016 and March 2021.

Results Over the four years prior to the pandemic, place of death remained relatively stable across Fife with 53–56% of deaths in hospital, 23–25% at home and the rest in care/nursing homes. Compared with the preceding 12 months, between April 2020 and March 2021, there was a 6% reduction in the number of people dying in hospital (111 fewer deaths) and a 40% increase in the number dying at home (383 more deaths). Of patients known to FSPCS, there was a 26% reduction in the number dying in hospital (170 fewer deaths) and a 57% increase in the number dying at home (158 more deaths). FSPCS patients spent 3297 fewer days in hospital (35% reduction) in their last 100 days of life and 1293 fewer days (30% reduction) in their last 30 days.

Conclusion Since the beginning of the pandemic, a far greater proportion of deaths in Fife have been at home and particularly when FSPCS has been involved in care. Enhanced provision of community palliative care delivers value at an individual and population level by supporting people to die in their preferred place while reducing acute hospitalisation in the last months of life.