P-57 Hospice care for deprived areas – a local review of the equity of hospice services

Abstract

Background A recent report commissioned by Marie Curie found significant inequalities at the national level in the provision of palliative care across several domains, including social deprivation. Given the national inequalities, it is important to explore local variations in service use. Our hospice accepts referrals from areas including some of the 20% most deprived in the country. Aim To determine whether social deprivation influences service uptake at a hospice in south east England. Method A review of computerised records was conducted for all patients (n=634) referred to the hospice inpatient unit or hospice at home service over a 12 month period (01/10/14–30/09/15). Indices of Multiple Deprivation (IMD) data were used to identify patients from the most deprived quintile. Data collected included demographic background, diagnosis, and referrer, and median scores were compared between the overall patient population and most deprived for duration of service use, preferred and actual place of death. Results 14% (n=107) of referred patients were from the most socially deprived IMD quintile of the population. Overall access to hospice services appeared broadly equitable between groups. For patients from the most deprived areas, median time under the care of hospice at home was lower (three vs five days). Once admitted, a stay over 21 days was more likely in the most deprived areas (25% vs 19%). Preferred place of death (PPD) was less likely to be recorded for the most deprived (68% vs. 63%) and home death was less likely (47% vs. 50%). PPD was achieved more commonly in those from deprived areas (87% vs 82%) although place of death was less likely to be recorded. Full statistical analysis to follow. Conclusions Despite small variations, service use at our hospice appears less inequitable on the basis of social deprivation than the national picture. Investigating local audit data can provide insights regarding current variations between regions of the UK, and these findings require further investigation.