When I first came to work in Dumfries and Galloway, a rural area in the south west of Scotland, I began to explore the local healthcare scene and was told by several people that our region had a high rate of home deaths. Some reported that everyone wishing to die at home was able to do so. One person told me with confidence that the rates of home death were increasing here, against the general pattern elsewhere.
Of course, the researcher in me was interested in such claims and in due course it proved possible, with colleagues, to conduct a study to shed more light on where people die in south west Scotland. The results of that work have just been published in the journal Palliative Medicine and can be read in full on open access to anyone.
The paper contains a lot of detail and some of it may be open to differing interpretations. But it sheds some light on the various statements made by my informants and is a warning to those who play fast and loose with their claims.
What we found
We examined 19,697 deaths of residents of Dumfries and Galloway occurring over the 11 years from 2000-2010. In that whole period, home deaths averaged 26.5% – above the average for the United Kingdom.
But we also found that the proportion of home deaths was in decline. Fewer people in Dumfries and Galloway died in their own home in 2010 (23.2%) than had done so in 2000 (29.6%).
Now in England and Wales between 2004 and 2010 the proportion of home deaths rose – from 18% to 21%. But still to a level lower than in south west Scotland.
For me, a fascinating finding of our study was that between 2007 (when new recording procedures were introduced) and 2010 an increasing proportion of deaths occurred in the eight bed specialist palliative care unit of our main acute hospital. The proportion of all deaths in the region that took place here went up from 6% to 11%.
Compare that to a recent increase in England and Wales in the proportion of deaths occurring in hospice: from 4% to 6%.
We also found that where a person dies is in some measure determined by the cause of their death.
People with dementia and those who had experienced a stroke were very unlikely to die at home, and much more likely to do so in a care home. Almost 44% of people dying with heart disease did so at home but an almost equal proportion (41%) died in hospital – something worth investigating further. Most cancer patients (52%) died in hospital but almost 28% died at home.
We have shown that the likelihood of dying at home is reducing in Dumfries and Galloway. Elsewhere that trend seems to be ‘bottoming out’.
Will we observe the same thing for the period after 2010? And what would the results be like if we did this study for the whole of Scotland?
Researchers are rarely satisfied with their results. The urge to better explain and extend the range of our studies is ever-present. But findings such as those from this new study in Dumfries and Galloway can upset prevailing assumptions. They give us a chance to look at trends and their causes. And if we are advocating for more specialist palliative care resources they show clear evidence of an increasing workload.
Predictors of place of death in South West Scotland 2000–2010: Retrospective cohort study, Heather Black, Craig Waugh, Rosalia Munoz-Arroyo, Andrew Carnon, Ananda Allan, David Clark, Fiona Graham, and Christopher Isles. Palliative Medicine, 1-8, February 2016 (currently available online until 23 February 2016)
In the media:
- Proportion of home deaths falls in South-West Scotland, University of Glasgow news, 9 February 2016
- Palliative care study finds decline in number of people dying at home despite wishes, The Herald, 9 February 2016
- Deaths at home falling despite most wishing to end lives there, Lizzy Buchan, The Scotsman, 9 February 2016
- David Clark interview on Good Morning Scotland, BBC Radio Scotland, 0745 9 February 2016 (available online until 10 March 2016)
- Study finds fall in proportion of home deaths in south west Scotland, Tom Moran, ehospiceUK, 9 February 2016
- Home death figures down, Sharon Liptrott, Dumfries and Galloway Standard, p9, 11 February 2016
- Drop in deaths at home, Dumfries Courier, p15, 12 February 2016
(media reports updated until 17 February 2016)