Nuffield Trust report on end of life care

16 October 2012
Findings suggest there is considerable variation between local areas in the care people receive at the end of life, and that social care may prevent the need for hospital admission.

The report was commissioned by the National End of Life Care Intelligence Network and covers a population of three million people across seven different local authority areas across England. 

The authors beleive that their findings will improve understanding of where best to invest resources in health and social care, thereby helping to improve care for people in the last months of their lives.

Key findings:

  • There were significant differences in the use of social care between groups of individuals with certain long-term conditions: people with dementia, falls and stroke tended to use most social care services, while people with cancer used less (even when adjusted for age).
  • There was considerable variation in the use of social care between local authorities. For example, there were twofold differences in the proportion of people using social care in any given month prior to death – even when rates were standardised for age and sex differences between areas.
  • Individuals with the highest social care costs had relatively low average hospital costs – this was broadly the case irrespective of age, and suggests that use of social care may prevent the need for hospital care. This may become increasingly important if local authorities continue to restrict funding of care services to those people with the most critical needs only.
  • Individuals used social care well before the last few months of their lives. While hospital costs showed a sharp increase in the final few months, social care costs rose gradually up until death. The greatest increases in social care use in the last months of life were because of increasing use of residential care homes.
  • The costs of social care for people at the end of the life were reasonably predictable which led the authors to suggests that the economic risk to the Government of funding social care at the end of life – currently means-tested – would not be great.

 Dr Martin Bardsley, Nuffield Trust Head of Research and report co-author said:

 “People are very vulnerable in the last months of their lives, and achieving appropriate and well coordinated care across health and social care is critical. Our study suggests how social care might be effectively substituting for hospital care for this group of people. The worry is that if funding for social care is cut back, people may have no option but to use hospital care. This may not be the best care for people who wish to be at home in their last months of life, as well as cost far more for the NHS.“Given the short- to medium-term financial climate, this type of analysis is critical now more than ever if more value for patients is to be extracted from public funds.”

Simon Chapman, Director of Policy and Parliamentary Affairs at NCPC said:

“This important report from the Nuffield Trust provides timely evidence that introducing free social care at the end of life would not carry significant economic risks.  We only have one chance to get it right for people at the end of life and we should not expect them to go through the uncertainty and complexity of means testing before they are able to receive social care support in their own homes, which is why health and social care must be made freely available to people who are dying."

You can read the full report here.


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