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The writer is the chief medical officer of Marie Curie

The UK’s population is ageing, with more people living longer with complex, life-limiting conditions. Palliative care is therefore no longer confined to cancer or the final days of life; it is central to long-term support for people with heart failure, respiratory disease, dementia and neurological conditions.

Yet the NHS has failed to adapt. New research shows that almost one in three people in England dies without the care they need, not because their death is unexpected, but because the health system fails to properly organise end-of-life care.

The result is predictable and costly: avoidable emergency admissions, prolonged hospital stays and people dying in pain and distress. This represents a double loss — patients and families suffer while scarce NHS resources are being used inefficiently. Repercussions spread throughout the health system, placing further strain on acute services.

This is not only an economic failure but a moral one. People with non-cancer conditions, those from ethnic minorities and residents of deprived areas are consistently neglected. We found a third of people with multiple conditions had unmet needs, compared with a quarter of those without. Some 25 per cent of people who were financially comfortable had unmet needs compared with 36 per cent among those experiencing financial hardship.

Public spending in the UK on people in their final year of life amounts to about £22bn. More than half of this is swallowed by healthcare. Hospital settings alone account for 81 per cent of the end-of-life health budget, reflecting a system that defaults to crisis-driven care rather than planned, co-ordinated support.

For a few people, a hospital is the best place for end-of-life care. But for many others, including patients, families, clinical teams and the taxpayer, this is not necessarily the case.

With a growing and ageing population, the unmet need for palliative care in England will rise sharply. By 2050, 40,000 more people each year will miss out on the care they need, compared with 2025, totalling over 210,000 people annually.

We urgently need a strategy to deliver improvement. The government has committed to a modern service framework, but this achieves nothing unless it sets out concrete commitments for delivery. If the government is serious about reform, the framework must incorporate three key measures.

First, there must be a commitment to palliative and end-of-life care being available when people need it. A 24/7 phone line as a single point of access in every part of England would ensure patients, families and frontline staff know where to turn at any time, supported by professionals with the right expertise.

Second, palliative care must be accessible in every community. It should be embedded within neighbourhood health services, not treated as an add-on. This means faster support, fewer crisis admissions and a greater chance of people staying where they feel safest.

Finally, the workforce must be equipped to provide quality support. All health and care staff, including GPs and emergency teams, should receive mandatory training in palliative care so they feel confident supporting people in their final months.

While parliament continues to debate proposals on assisted dying, it must not be seen as a substitute for high-quality palliative and end-of-life care. No one should feel any pressure towards an assisted death due to a lack of support.

This is about doing what matters: relieving pain, avoiding unnecessary hospital use and enabling people to live and die with dignity.