United Kingdom
A tax-funded national health service alongside charity-funded hospices, with a long-recognized palliative medicine specialty and non-medical prescribing of controlled drugs. Also a high-consumption reference point on the opioid sales scale.
9 domains reviewed · 9 high-confidence · 1 dated estimate · 9 material gaps
WHO region: Europe. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 11
- Sources behind this dossier
- 28
- Newest source 2026
Lessons from United Kingdom
- Letting trained nurses and pharmacists prescribe controlled drugs adds routes to end-of-life medicines, but only if training costs, employer support and prescribing systems keep pace.245,246
- Anticipatory prescribing became routine national practice before robust outcome evidence existed. Systems adopting it should build evaluation in from the start.243
- Heavy reliance on charitable income, alongside historical block contracts, produced wide local variation in spending and sustainability risk as deaths rise.249,228
- As deaths shift to homes and care homes, community capacity must grow, and distance to inpatient hospice care shapes where rural patients die.247,248
- Home hospice in England runs mostly on charitable income, and hours, rapid response and referral rules vary widely between services.339
- Hostel staff already care for dying residents, and regular in-reach by palliative specialists can support them.497
Palliative care
Is morphine available in United Kingdom?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
- 638.72 MME per 1,000 people per daySOURCE-CHECKED · 2019 DATA
Opioid analgesic consumption, United Kingdom, 20193
Method: IQVIA MIDAS pharmaceutical sales data for opioid analgesics, in morphine milligram equivalents per 1,000 inhabitants per day (Ju et al. 2022; abstract read September 2026). A sales-based proxy for availability, not a measure of palliative access. Last checked 2026-09-25.
Cite this figure:
Anticipatory prescribing of injectable end-of-life medicines is routine in community care, though robust evidence of its effectiveness is missing. Community pharmacy access is delayed by stock and communication problems, and in England, commissioned pharmacy stocking schemes remain unevaluated and out-of-hours cover is patchy.3,243,244,245
Are opioid availability and dispensing for palliative patients adequate UK-wide?
Help answer it:Search PubMedHow does United Kingdom regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
A 2012 amendment to the Misuse of Drugs Regulations for England, Wales and Scotland lets nurse independent or supplementary prescribers prescribe and administer controlled drugs, with added accountability for safe management.246
What are current controlled-drug stocking, dispensing and governance rules, including in Northern Ireland?
Help answer it:Search PubMedWho can prescribe morphine in United Kingdom?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Doctors, and nurses and pharmacists who complete prescribing training, may prescribe. In England, most nurse and pharmacist prescribers in community palliative care prescribe controlled drugs, though many specialist nurses are not trained as prescribers because of cost and lack of employer support.245,246
How many non-medical prescribers actively prescribe controlled drugs for palliative care nationally?
Help answer it:Search PubMedHow does palliative care reach patients in United Kingdom?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
In England, community palliative care is free at the point of delivery, from general practitioners, community nurses and specialist nurses employed by hospices or NHS trusts. Deaths are shifting from hospital to home and care homes, and longer travel time to a hospice means fewer hospice deaths, especially in rural areas.245,247,248
Does access to specialist palliative care differ by diagnosis, deprivation or ethnicity across the UK?
Help answer it:Search PubMedWho pays for palliative care in United Kingdom?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Much care is delivered by charitable providers reliant on donations, a model described as possibly unsustainable. In England, statutory palliative spending per death varied widely by area and providers were largely paid through historically based block contracts.249,228
What is the current split between NHS and charitable funding for hospices?
Help answer it:Search PubMedHow are palliative care clinicians trained in United Kingdom?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Palliative medicine has been a medical specialty since 1987. Trainees report strong research interest, but supervision and protected research time vary by region.250,251
Which body awards specialist certification, and how large is the consultant workforce?
Help answer it:Search PubMedHow does United Kingdom prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
UK primary care prescribing of multiple strong opioids at end of life dipped by about 7.5% around the time of the Shipman case, in which a doctor murdered patients with opioids. Coroner reports on opioid deaths during or soon after hospital stays described zero-tolerance policies and undertreated withdrawal or pain, and called for hospital guidance on take-home naloxone, continued opioid agonist therapy and access to palliative care.700,701
How do current UK controlled-drug rules and monitoring affect timely opioid access for people dying at home, and how often do people on opioid agonist therapy receive palliative care?
Help answer it:Search PubMedHow do children get palliative care in United Kingdom?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
The prevalence of life-limiting conditions in children in England rose from 26.7 to 66.4 per 10,000 between 2001/02 and 2017/18. Among 39,349 young people with these conditions who died, 73% died in hospital, 6% in a hospice and 16% at home, and ethnic minority and more deprived children were less likely to die in a hospice.703,704
What share of children with life-limiting conditions in England receive specialist palliative care, and are pediatric formulations of key symptom medicines reliably available in the community?
Help answer it:Search PubMedHospice care in United Kingdom
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in United Kingdom?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
UK hospices run inpatient units, Hospice at Home services and day services; 199 adult inpatient hospice units operate across the UK. Of 128 Hospice at Home services in England, 88% were charity-led and 12% NHS-led, and these services date from the modern hospice movement of the late 1960s.339,340,341
Who can get hospice care in United Kingdom?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
Referral criteria vary widely by service. Among 70 Hospice at Home services in England, 17.1% cared only for actively dying patients (up to 2 weeks), while 57.1% accepted patients with over 6 months' prognosis with no upper limit.339
What criteria do inpatient hospices use, and what is the typical time from hospice referral to death nationally?
Help answer it:Search PubMedWho pays for hospice care in United Kingdom?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
Charitable funds or donations were the main income for 71.2% of Hospice at Home services in England, with NHS funding the main source for 25.8%. In children's services, 13 of 17 UK specialist paediatric palliative care teams had posts partly or fully charity-funded.339,344
What share of adult inpatient hospice costs does the NHS fund across the four UK nations?
Help answer it:Search PubMedHow many people reach hospice in United Kingdom?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
Inpatient hospice deaths in England rose to 6.0% of all deaths in 2012, but only 5.2% of hospice decedents had non-cancer diagnoses and the share from the least deprived areas increased. Within 30 minutes' travel, 97.6% of England's population could reach an inpatient hospice compared with 70.3% in Scotland and 68.5% in Northern Ireland.342,341,343
What fills the gap in United Kingdom
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
British Muslim family carers took on washing, feeding and toileting at home and shared health decisions across siblings. Concern that services would not meet faith or language needs led many families to avoid hospital admission. Scope is 12 participants.495
- Faith communities
British Muslims with palliative care needs reported mixed support from mosques and Muslim community groups during COVID-19, from welfare packs and volunteer transport to none at all. Interviews across the UK found Islamic virtues of hope and acceptance shape how many Muslim patients and families approach dying.495,496
Mixed scope- Volunteers and compassionate communities
In a Weston-super-Mare compassionate community model, a health professional helps a dying person and carer match practical tasks to people in their own network, and helpers may later join a local volunteer force. A case study of one UK Compassionate City found leadership, funding and evaluation shaped whether such work could be sustained. The Weston article is a conceptual description by its developers.493,494
Single-site evidence- Community health workers and home-based care
People in UK homeless hostels seldom receive palliative care, so the burden falls to hostel staff. London pilots embedded palliative specialists in 4 hostels for two half-days a month and trained hostel staff, with reported gains in partnership working and confidence. Evaluations involved the organizations that ran the models.497,498
Subnational evidence
Sources cited here
- 3Ju C, Wei L, Man KKC, et al.
Global, regional and national trends in opioid analgesic consumption, 2015 to 2019. Lancet Public Health 2022;7:e335-46. DOI 10.1016/S2468-2667(22)00013-5.
- 243Bowers B, Antunes BCP, Etkind S, et al.
Anticipatory prescribing in community end-of-life care: systematic review and narrative synthesis of the evidence since 2017. BMJ Supportive and Palliative Care 2024;13(e3):e612-e623. Standardized anticipatory prescribing is commonplace in the UK; robust evidence of clinical and cost-effectiveness is absent. Abstract read.
- 244Ogi M, Campling N, Birtwistle J, et al.
Community access to palliative care medicines: patient and professional experience: systematic review and narrative synthesis. BMJ Supportive and Palliative Care 2021;14(e2). Community pharmacy access delayed by stock and communication problems. Abstract read.
- 245Latter S, Campling N, Birtwistle J, et al.
Supporting patient access to medicines in community palliative care: on-line survey of health professionals' practice, perceived effectiveness and influencing factors. BMC Palliative Care 2020;19(1):148. England: commissioned pharmacy stocking services unevaluated; patchy out-of-hours cover; nurse and pharmacist prescribers, most prescribing controlled drugs; barriers to prescriber training; community care free at the point of delivery. Self-selected survey. Abstract and full text read.
- 246Griffith R.
Controlled drugs and the principle of double effect: the role of the district nurse. British Journal of Community Nursing 2016;21(12):633-635. 2012 amendment to the Misuse of Drugs Regulations lets nurse independent or supplementary prescribers prescribe controlled drugs. Legal commentary. Abstract read.
- 247Bone AE, Gomes B, Etkind SN, et al.
What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death. Palliative Medicine 2018;32(2):329-336. England and Wales: home and care home deaths rising, hospital deaths falling; community provision needs to double by 2040. Abstract read.
- 248Chukwusa E, Verne J, Polato G, et al.
Urban and rural differences in geographical accessibility to inpatient palliative and end-of-life (PEoLC) facilities and place of death: a national population-based study in England, UK. International Journal of Health Geographics 2019;18(1):8. Longer drive time to hospice linked to fewer hospice deaths, more so in rural areas. Abstract read.
- 249Jackson M.
Resourcing of palliative and end of life care in the UK during the Covid-19 pandemic. British Medical Bulletin 2022;142(1):44-51. Most care delivered by charitable providers reliant on donations; model may be unsustainable. Author from a palliative care charity. Abstract read.
- 228Groeneveld EI, Cassel JB, Bausewein C, et al.
Funding models in palliative care: Lessons from international experience. Palliative Medicine 2017;31(4):296-305. Spain: per diem for hospital services, capitation for community services, no rural weighting, unreliable public payment. Country details updated April 2015. Full text read.
- 250Barry C, Paes P, Noble S, et al.
Challenges to delivering evidence-based palliative medicine. Clinical Medicine 2023;23(2):182-184. Palliative medicine established as a specialty in 1987; research underfunded. Abstract read.
- 251Wakefield D, Dewhurst F, Koffman J, et al.
Palliative Medicine Specialist Trainee Research experience, interest and opportunities: a national survey. BMJ Supportive and Palliative Care 2024;14(e3):e2452-e2456. Research supervision and protected time vary by training region. Abstract read.
- 700Gao W, Gulliford M, Bennett MI, et al.
Managing cancer pain at the end of life with multiple strong opioids: a population-based retrospective cohort study in primary care. PLoS One 2014;9(1):e79266. UK primary care database study of 13,427 cancer patients' strong-opioid prescribing in the last three months of life, including the period around the Shipman case. Abstract read.
- 701Lewer D, Brothers TD, Harris M, et al.
Opioid-related deaths during hospital admissions or shortly after discharge in the United Kingdom: A thematic framework analysis of coroner reports. PLoS One 2023;18(4):e0283549. Analysis of 121 coroner reports (2010-2021) of opioid-related deaths during or soon after hospital stays. Abstract read.
- 702Pearce C, Honey JR, Lovick R, et al.
'A silent epidemic of grief': a survey of bereavement care provision in the UK and Ireland during the COVID-19 pandemic. BMJ Open 2021;11(3):e046872. Snowball online survey of 805 bereavement practitioners in the UK and Ireland in 2020; not a representative sample. Abstract read.
- 703Fraser LK, Gibson-Smith D, Jarvis S, et al.
Estimating the current and future prevalence of life-limiting conditions in children in England. Palliat Med 2020;35(9):1641-1651. National hospital episode data on 359,634 children with a life-limiting condition, 2000/01 to 2017/18, with projections to 2030. Abstract read.
- 704Gibson-Smith D, Jarvis SW, Fraser LK
Place of death of children and young adults with a life-limiting condition in England: a retrospective cohort study. Arch Dis Child 2021;106(8):780-785. Linked national data on 39,349 deaths of people aged 0-25 with a life-limiting condition, 2003-2017. Abstract read.
- 339Rees-Roberts M, Williams P, Hashem F, et al.
Hospice at Home services in England: a national survey. BMJ Support Palliat Care 2019;11(4):454-460. Telephone survey of 70 of 128 adult Hospice at Home services in England (2017) describing charity versus NHS leadership, referral life-expectancy criteria and funding sources; 54.7% response rate. Full text read.
- 340Bradley NM, Dowrick CF, Lloyd-Williams M
A survey of hospice day services in the United Kingdom & Republic of Ireland : how did hospices offer social support to palliative care patients, pre-pandemic? BMC Palliat Care 2022;21(1):170. Online survey of 103 hospices in the UK and Republic of Ireland (2017-2018) describing hospice day and outpatient services; 49.5% response rate. Abstract read.
- 341Jayaprakasan AK, Doughty Herrera-Carrasco K, White N, et al.
Inpatient Hospice Access in the United Kingdom: A Spatial Provision Analysis. J Palliat Care 2026;41(4):359-368. UK-wide spatial analysis of travel time to all 199 adult inpatient hospice units, showing lower coverage in Scotland, Wales and Northern Ireland than England. Abstract read.
- 344Bedendo A, Hinde S, Beresford B, et al.
Consultant-led UK paediatric palliative care services: professional configuration, services, funding. BMJ Support Palliat Care 2023. Survey of all 17 consultant-led hospital-based or hospice-based specialist paediatric palliative care teams in the UK showing reliance on charity funding for posts. Abstract read.
- 342Sleeman KE, Davies JM, Verne J, et al.
The changing demographics of inpatient hospice death: Population-based cross-sectional study in England, 1993-2012. Palliat Med 2015;30(1):45-53. Population-based death registration study of 446,615 inpatient hospice deaths in England showing hospice deaths rose to 6.0% of all deaths in 2012, only 5.2% of hospice decedents had non-cancer diagnoses, and a shift toward less deprived areas. Abstract read.
- 343Tobin J, Rogers A, Winterburn I, et al.
Hospice care access inequalities: a systematic review and narrative synthesis. BMJ Support Palliat Care 2021;12(2):142-151. Systematic review of 130 studies of adult hospice care in the UK, Australia, New Zealand and Canada (1987-2019) finding under-representation of non-cancer patients, the oldest old, ethnic minorities and rural or deprived residents; findings pooled across four countries. Abstract read.
- 497Armstrong M, Shulman C, Hudson B, et al.
The benefits and challenges of embedding specialist palliative care teams within homeless hostels to enhance support and learning: Perspectives from palliative care teams and hostel staff. Palliat Med 2021;35(6):1202-1214. Qualitative evaluation in 4 London hostels (9 hostel staff, 7 palliative specialists); several authors are from Pathway, a homelessness health charity involved in the model. Abstract read.
- 495Hudson BF, Clarke G, Kupeli N, et al.
Somebody who understands the culture and their needs that can cater for them in their retirement time: a peer research study exploring the challenges faced by British Muslims with palliative care needs during the COVID-19 pandemic. BMJ Open 2024;14(8):e082089. Peer research with 12 British Muslim patients and family carers during COVID-19, run with the Muslim Council of Britain; small sample. Full text read.
- 496Suleman M.
The balancing of virtues-Muslim perspectives on palliative and end of life care: Empirical research analysing the perspectives of service users and providers. Bioethics 2022;37(1):57-68. Thematic analysis of 76 interviews with Muslim patients, families, clinicians, chaplains and community faith leaders across the UK. Abstract read.
- 493Abel J, Bowra J, Walter T, et al.
Compassionate community networks: supporting home dying. BMJ Support Palliat Care 2011;1(2):129-33. Conceptual description of a compassionate community project in Weston-super-Mare written by people involved in developing it; no outcome data. Abstract read.
- 494Nawaratne SD, Dale J, Mitchell S, et al.
An interpretative qualitative case study of a Compassionate Cities initiative in the United Kingdom: Lessons for implementation in other settings. Palliat Support Care 2024:1-7. Case study of one UK Compassionate City using 11 steering-committee interviews, observations and documents; leaders' views only. Abstract read.
- 498Shulman C, Hudson BF, Kennedy P, et al.
Evaluation of training on palliative care for staff working within a homeless hostel. Nurse Educ Today 2018;71:135-144. Pilot evaluation of a two-day course for staff of 2 London hostels, run by the course developers. Abstract read.