From six to twelve months: how extending the statutory prognostic threshold affected fast‑tracked end-of-life benefit access in England and Wales

Background To evaluate the impact of the 2022 change in prognostic eligibility criteria for the Special Rules for End of Life (SREL) pathway, from an expected death within 6 months to within 12 months, on the number and characteristics of awardees for fast-tracked financial support for people living with terminal illness. Methods Interrupted time series analysis of retrospective national government data. Monthly caseload data for Personal Independence Payment (PIP) claims made under the Special Rules for End of Life (SREL) in England and Wales were obtained from the Department for Work and Pensions (DWP) via Stat-Xplore (January 2019 to July 2025). Main outcomes: (1) monthly SREL PIP caseload before and after the change in prognostic eligibility criteria; and (2) trends in award numbers by socio-demographic, geographic, and clinical characteristics. Results A total of 2,370,328 cases assigned to PiP were analysed. SREL caseload annual growth significantly accelerated from 4.3% in 2019 to 9.3% after April 2023. Growth was strongest among people with non-cancer diagnoses (from 11.9% to 18.8%) and those at or above state pension age (from an annual decline of 2.6% to an increase of 17.9%). Regional variation was marked, with the West Midlands shifting from an annual decline to a 11.1% increase, and the East of England’s growth rate increasing over fivefold. Approximately half of people deemed eligible for SREL under the 12-month criterion are in the last year of life; at the same time, over 200,000 people die each year from a life-limiting illness but are not correctly identified as suitable for referral. Conclusions Widening the statutory prognostic threshold increased fast-tracked benefit access, especially for people with non-cancer diagnoses and older adults, but regional and diagnostic disparities persist. Prognosis may not be the best mechanism for determining eligibility because the high level of uncertainty results in large numbers of people receiving SREL benefits when they are not in the last year of life and not receiving benefits when they will die within the last year of life. Trial registration Prospective registration on the Open Science Framework on 30th September 2025 (https://osf.io/avmn8/overview).