An edited version has been published as: Jones R. The nearness to death effect and why NHS pressures are going to intensify. Journal of Paramedic Practice 2019; 11(1): 28-30. DOI: 10.12968/jpar.2019.11.1.28. Please use this to cite. The nearness to death effect and why NHS pressures are going to intensify Rodney P Jones, PhD, ACMA, CGMA Healthcare Analysis & Forecasting, UK hcaf_rod@yahoo.co.uk Since no one at the top of the NHS appears to want to speak the truth, shall we all have a confidential chat as to why NHS capacity pressures are going to keep on escalating? Figure 1 shows the trend in deaths for males and females in UK from 1974 to 2017 (Office for National Statistics 2018a). Total deaths in males steadily declined from 1974 onward and in females from 1994 onward. The alarming rise since 2011 caught actuaries completely by surprise (Jones 2017f). Figure 1: Trends in male and female deaths in the UK from 1974 to 2017 So, what have deaths to do with capacity pressures? There is a very simple answer, namely, the nearness to death effect. The nearness to death effect has been documented for around four decades and shows that healthcare demand escalates with nearness to death and not with age per se (Payne et al 2007). Around half of a person’s lifetime hospital inpatient admissions and bed occupancy is compressed into the last year of life (Hanlon et al 1998). 49.4% 49.9% 50.4% 50.9% 51.4% 51.9% 52.4% 52.9% 265,000 275,000 285,000 295,000 305,000 315,000 325,000 335,000 345,000 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 Proportion female Deaths per calendar year Male Female Proportion female (%)