Abstract

Provision of palliative care based solely on need is the core business of all specialist palliative care (SPC) services. This audit aims to identify inequities in access to hospice-based SPC in a deprived and ethnically diverse borough of London. Characteristics of those who died between 2010 and 2015 who were known to the hospice were compared with population deaths over the same period. Between 2010 and 2015, the number of deaths remained stable (av. 1013) while the number of residents who used SPC services increased from 359 to 525. Only 11% male/16% female deaths known to SPC were aged 85+, while 20% male/27% female overall deaths were aged 85+.

Place of birth on death certification compared with SPC users’ ethnicity showed similar proportions from Bangladeshi/other Asian groups (20%/19.6%) and Black groups (5%/5%). Fewer White British groups used SPC (53.5%) compared to the proportion of deaths of people born in the UK and Ireland (65.6%).

55% of SPC users had cancer, which caused 30% of all deaths. There was low use amongst people with circulatory (3%) and respiratory disease (5%) although these combined cause 40% of deaths. Data was not routinely recorded for groups for whom there is evidence of poor quality palliative care (learning disability, mental illness, homelessness and substance misuse).

These findings suggest the hospice has a reasonable reach across ethnic groups, although may be under-accessing the oldest old. People who died from cancer were more likely to have accessed SPC. Joint working with non-cancer specialist services is currently underway to try to address this. The hospice’s information team are exploring routine recording of protected characteristics such as learning disability and homelessness so that these can be part of future health equity audits.