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Introduction People living in more deprived areas of England have shorter life expectancy at birth and live more years in poor health than those in less deprived areas (Office for National Statistics. Health state life expectancies by national deprivation deciles, England: 2018 to 2020. ONS. 2022 [internet]). This analysis was undertaken to help Royal Trinity Hospice understand local deprivation, how deprivation influences access to its services, and to support the organisational aim of addressing avoidable and unfair health inequities.Aims To analyse the relationship between deprivation and access to Royal Trinity Hospice services, using geographic and patient data, and inform targeted strategies to promote equity.Methods Geographic Information System software (QGIS) was used to map all 17,332 postcodes in Royal Trinity Hospice’s catchment area to their corresponding Lower layer Super Output Areas (LSOAs) – geographic units of 400 – 1,200 households. Pseudonymised data for 5,578 Royal Trinity Hospice patients (January 2020–September 2022) provided information on geographic distribution. The presence of a recorded preferred place of death (PPD) was used as a proxy for service engagement.LSOAs were matched to their 2019 Index of Multiple Deprivation (IMD) (Ministry of Housing, Communities & Local Government. English indices of deprivation 2019. Gov.UK. 2019 [internet]) decile to examine relative deprivation across the catchment area and among patients. Routine statistics were used to contextualise local demography.Results Mapping revealed contrasting patterns by service type. In areas offering community, inpatient, and outpatient services, higher deprivation was associated with higher patient rates (5.6% decrease per 1-decile IMD increase). In areas with only inpatient and outpatient services, higher deprivation was associated with lower patient rates (8.7% increase per 1-decile IMD increase). Patients from less-deprived areas were more likely to have a recorded PPD, with a 1.06 increase in odds for each 1-decile IMD increase.Conclusion Understanding the deprivation profile of the catchment area and its impact on access and engagement supports local service development. Targeted outreach is recommended to address underrepresentation. Further disaggregation by service type is needed to better understand access patterns.