More people die in hospital than at home (Department of Health (DH) 2008). Yet, many people do not want to die in hospital, which can be an inappropriate environment for end of life care. The government's end of life care strategy (DH 2008) and the NHS (2009) end of life care programme (EOLCP) state that people should be able to choose where they die. This article reports on the findings of a study on end of life care of decisions by patients, relatives and care professionals, and their perceptions of care pathways in the last 48 hours of life. It also highlights the challenges that must be overcome in acute and community settings for the aims of the EOLCP to be met.