Public Health Funerals in England 2014/15 - 2020/21

The study of those who die without either sufficient finances to afford their own funeral, or kin to support it, is important for understanding who lacks support at the end of life. Moreover, interpreting the geographical patterns of public health funeral rates is useful for highlighting localities where NHS Trusts and Councils may require additional resource. Using data collected through Freedom of Information requests to all Councils and NHS Trusts in England, this study measures public health funeral rates in England and maps the spatial variation of key correlates. To the best of our knowledge this is the first study defining and measuring public health funeral rates in all Local Authorities of England, and mapping the geographical distribution of risk factors. We also believe it is the first that includes data from NHS Trusts and estimates their costs. The findings suggest that publicly funded funerals are more prevalent among deceased people who are male and aged over 60, compared to females and those who are younger when they die. The estimated annual number of public health funerals in England rose from 4,760 in the financial year 1st April 2014- 31st March 2015, to 7,020 in the financial year 1st April 2020 - 31stMarch 2021. On average, NHS Trusts provided almost one quarter of all public health funerals that were reported by providers (1,379 per annum). We believe this figure has previously gone unreported. While the total number of public health funerals is important, with each individual funeral representing the end of a life and a public expense, the study found that while the actual numbers increased, the regional rate of public health funerals did not, except in London. Regional public health funeral rates were comparatively stable between 2014/15 and 2018/19. During this period, only the East saw an increase, from the lowest public health funeral rate in 2014/15 of 7.6 per 1,000 deaths, rising to 10.2 by the year 2018/19. After 2019/20 most regions saw an uptick in rates. During the Covid-19 pandemic, those most likely to die of the virus were also male, older and more deprived; the same characteristics that were found to be most strongly correlated with receipt of a public health funeral. However, outside of London, no significant increase in receipt of public health funerals was observed, suggesting that expected demand was met by other sources. Because regions are large areas that can mask significant variation, the study also investigated what is happening in local authorities. For these smaller areas the numbers were too small to look at yearly rates, so the 7-year rate 2014/15 to 2020/21 was used. In this period, public health funeral rates per 1,000 deaths were highest in London Boroughs. Other metropolitan areas such as Birmingham, Manchester, Nottingham and Bristol also have relatively high rates compared to other Local Authorities. The findings suggest areas that have higher population density, greater homelessness and more overcrowding have higher public health funeral rates. Many coastal areas, such as Blackpool, Hastings, and Hartlepool, also have high rates. As well as having older age structures, coastal areas have previously been found to be characterised by high deprivation which is associated with demand and provision of public health funerals. The public health funeral rate of a local authority is associated with the area’s level of income deprivation among older people measured by the Income Deprivation Affecting Older People Index 2019 (IDAOPI 2019). On average, a one unit increase in IDAOPI 2019 results in 56 more public health funerals per 1,000 deaths, per annum. Only 57% of NHS Trusts in the sample reported cost. In the period 2014/15 to 2020/21 the total costs reported by this subset of NHS trusts came to £5.97 million. The estimated the average cost per funeral to Trusts in this time period was between £924 and £1042. Extrapolating this cost to all publicly funded funerals reported by NHS Trusts between 2014/15 and 2020/21 leads us to estimate the actual cost to the NHS during this period at between £8.92 million and £10.06 million, or £983 per funeral / £1.36 million per annum. Due to a low response rate for the question on costs, the estimates should be used with caution, but even at the low end they represent a significant cost to the NHS that has not previously been estimated. It is important to note that the data lacks information on individual socio-economic characteristics that might contribute to the risk of receiving a public health funeral. At the micro level the gender imbalance in who receives a public health funeral is important when thinking about future provision; if family change, separation and divorce, continue to increase it may be that lone men have even fewer kin upon which to draw support in the future. At the macro level, this study provides important evidence that deprivation drives the need for a funeral provided by the public purse. These findings are of importance to Councils and Trusts administering public health funerals as well as for government economic planning and efficiency. Investment in reducing multiple indicators of deprivation for older people may reduce the need for public health funerals – thus reducing expenditure on such provision.

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