End-of-life care in the UK: options and who pays
By sima kornbluth · Published 2025-10-28 · Last reviewed 2026-09-18
End-of-life care in the UK can be given at home, in a care home, a hospice or hospital, and focuses on comfort, dignity and support for the family. NHS and hospice care are free. In England, people deteriorating quickly towards the end of life should be considered for fast-track NHS continuing healthcare, which can fund care in full. Advance statements and lasting powers of attorney help make wishes known.
End-of-life care in the UK can be given at home, in a care home, in a hospice or in hospital, and aims to keep the person as comfortable as possible and support their family. Hospice care is free, and in England people whose health is deteriorating quickly towards the end of life can be fast-tracked for NHS continuing healthcare, which funds care in full. Planning ahead helps make sure the person's wishes are known and followed.
This guide explains the options, who provides care, how it is paid for, and the planning documents that matter.
What is end-of-life care and when does it start?
The NHS describes end-of-life care as support for people in the last months or years of life, to help them live as well as possible and die with dignity. People are usually considered to be approaching the end of life when they are likely to die within the next 12 months, although this is often hard to predict.
Palliative care is care for anyone with an illness that cannot be cured. It manages pain and other symptoms and includes psychological, social and spiritual support for the person and their family. It can start much earlier than the last months of life, alongside other treatment.
Care may involve GPs, community and district nurses, hospital doctors, hospice staff, specialist palliative care teams, social care workers, occupational therapists, chaplains and counsellors. When someone is cared for at home or in a care home, their GP usually has overall responsibility.
Where can end-of-life care be given?
At home
Many people prefer to die at home. Care can include visits from district nurses and specialist palliative care nurses, help from home care workers, equipment such as a hospital bed, and night sitting services from charities such as Marie Curie in some areas. Family carers often do a great deal, so ask early about support for them.
In a care home
People who already live in a care home can usually receive end-of-life care there, supported by their GP and community nursing or palliative care teams. Nursing homes have registered nurses on duty around the clock. Ask any home how it cares for residents at the end of life and whether families can stay overnight.
In a hospice
Hospices provide specialist care for people with an incurable illness, including inpatient beds, day services and care at home. Marie Curie confirms that hospice care is free, paid for by a mix of NHS funding and public donations. Referral is usually through a GP, district nurse or consultant, and some hospices accept self-referrals.
In hospital
Some people are cared for in hospital, particularly if their needs change suddenly. Hospitals have specialist palliative care teams who can advise on symptom control and, where possible, help arrange a move home or to a hospice. NICE guidance on care of dying adults in the last days of life (NG31) sets out how dying people should be recognised, involved in decisions and kept comfortable.
Who pays for end-of-life care?
- NHS care is free. GP care, community nursing, hospital care and specialist palliative care are provided by the NHS without charge.
- Hospice care is free.
- NHS continuing healthcare (CHC) fast track. In England, if someone's health is deteriorating quickly and they are nearing the end of life, they should be considered for the CHC fast-track pathway, which should normally be arranged within 48 hours. CHC is not means-tested and can pay for care at home or care home fees in full. Ask the GP, district nurse or hospital team to complete the fast-track form. Scotland, Wales and Northern Ireland have their own arrangements.
- Social care. Where CHC does not apply, help with personal care at home or in a care home may be arranged by the council (or Health and Social Care Trust in Northern Ireland) and is usually means-tested. In Scotland, personal care is free for those assessed as needing it.
- Benefits. People likely to have 12 months or less to live can claim some benefits, including Attendance Allowance, PIP and Universal Credit, under the Special Rules for end of life. Claims are fast-tracked, and a doctor or other medical professional completes an SR1 form to support them. Scotland has its own rules for the benefits it runs.
How can you plan ahead?
Planning ahead lets someone record what matters to them while they are able to. The main options are:
- Advance statement: a record of wishes and preferences, such as where they would like to be cared for, who they want with them, religious practices and how they like to be cared for. It is not legally binding but must be taken into account.
- Advance decision to refuse treatment: in England and Wales, a legally binding decision to refuse specific treatments in future. To refuse life-sustaining treatment it must be in writing, signed, witnessed, and state that it applies even if life is at risk.
- Lasting power of attorney for health and welfare: in England and Wales, appoints someone to make decisions about care and treatment if the person loses capacity. Scotland and Northern Ireland have their own powers of attorney.
- DNACPR decisions and emergency care plans: a do not attempt cardiopulmonary resuscitation decision, or a wider emergency care and treatment plan, is made with the person's doctor and should be discussed with them and their family.
- A will and practical wishes: funeral preferences, and where important documents are kept.
The NHS guide to planning ahead explains each of these.
What are the signs that someone is in the last days of life?
Changes often include sleeping more, eating and drinking less, changes in breathing, cold hands and feet, and becoming less responsive. These can be distressing to see but are a natural part of dying. Staff should explain what is happening, keep the person comfortable, including with medicines for pain, breathlessness or agitation, and support family members to be present.
Is assisted dying legal in the UK?
No. Assisted dying and assisted suicide are not legal anywhere in the UK. In England and Wales, encouraging or assisting suicide is a criminal offence under the Suicide Act 1961, as the NHS page on euthanasia and assisted suicide explains. Proposals to change the law have been debated in the UK and Scottish Parliaments, but none has become law. Refusing treatment, and receiving good palliative care to relieve symptoms, are both lawful.
What support is there for families?
- Hospices and palliative care teams usually offer emotional support to families, and many provide bereavement support.
- Carers can ask the council for a carer's assessment.
- Marie Curie, Macmillan and local hospices run helplines and information services.
- Employees can take unpaid carer's leave, and many employers offer compassionate leave.
This article is general information. The person's GP or palliative care team can advise on their own situation.
Frequently asked questions
Can someone die at home if they want to?
Often, yes, with support from district nurses, palliative care teams and carers. Tell the GP early so they can plan care, equipment and medicines for symptoms. It helps to have a back-up plan if needs change.
Does the NHS pay for a care home at the end of life?
In England, if someone is rapidly deteriorating and nearing the end of life, they should be considered for fast-track NHS continuing healthcare, which can pay care home fees in full. Ask the clinician responsible for their care to complete the fast-track assessment.
How do I find a hospice?
Ask the GP, district nurse or hospital team for a referral. Some hospices accept direct contact from patients and families. Hospice care is free.
What is the difference between palliative care and end-of-life care?
Palliative care is for anyone with an incurable illness and can last months or years. End-of-life care is part of palliative care and usually refers to the last year of life, including the final days.
Who decides about resuscitation?
A DNACPR decision is made by the senior clinician responsible for the person's care, and they should discuss it with the person, or with their family or attorney if the person lacks capacity. A health and welfare attorney cannot demand treatment that clinicians judge will not work.
Key takeaways
- End-of-life care can be given at home, in a care home, a hospice or hospital.
- NHS and hospice care are free; in England, fast-track CHC can fund care in full.
- Benefits can be claimed quickly under the Special Rules if someone may have 12 months or less to live.
- Advance statements, advance decisions and lasting powers of attorney help make wishes known.
- Assisted dying is not legal anywhere in the UK.