PALLIATIVE CARE Goodbye To All That


Investment in community-based care for those approaching the end of life could ease financial pressure on hospitals and allow more people to pass away in their own homes, suggests a new report by the Nuffield Trust. Tanita Cross reports.


Terminally ill patients who are facing death head on deserve high-quality care in the setting of their choice. Last year, the Office for National Statistics (ONS) found that 79% of terminal patients would prefer to die at home, but only half (50%) of those people actually do. According to the Department of Health, a quality marker for end of life care is that an individual should be able to die in his or her place of choice. The statistics demonstrate that this is not often the case.


In the UK, there are countless organisations working to improve end of life care for all patients. A growing concern for these groups – as well as for the government – is how to support people’s preference to be cared for at home as they approach the end of their lives.


It is widely recognised that hospital costs are by far the most expensive element of end of life care. However, there has typically been limited information about the costs of community-based care available for comparison. In September 2014, the Nuffield Trust published a report to rectify this: Exploring the Cost of Care at the End of Life.


Prompted by a 2012 study commissioned by Marie Curie Cancer Care on the impact of its nursing service on place of death and hospital


Average Cost of Care per Patient during Last 90 Days of Life


Hospital: £4,500 GP (av. 4 to 5 visits): £147 District Nurse: £278


Social Care (Local Authority Funded): £1,010 Hospice: £550


- 22 -


use, this latest analysis was started to find out if shifting end of life care services away from hospitals and into the community would save money, as well as catering to the wishes of more patients. Nuffield Trust’s analysts compared the average cost of hospital care, GP services, community nursing, council-funded social care and institutional hospice care per patient in the last 90 days of life.


element of end of life care.


With hospital care averaging over £4,500 per person for those who died during the final 90 days of their lives, it was unsurprisingly the most expensive part of end of life care. A large chunk of this price tag was a result of emergency hospital admissions. Where appropriate, helping people to stay out of hospital seems to be the more cost-effective option for health care services.


However, only one-third of patients had contact with a district nurse, which means the average cost recorded per person was fairly low. Plus, there was a notable increase in activity in the final days of life, with the most intensive 10% of users seeing a district nurse for 40-50 minutes per day on average.


Just over a quarter of patients used local authority funded social care during their last 90 days of life, but the high costs of nursing and residential care drove the average up to £1,010 per person who died.


While the data collected by the Nuffield Trust does have some


Hospital costs are by far the most expensive


unavoidable limitations, the estimated figures do paint a more detailed picture of end of life care than ever before. Following the publication of the study, Dr Jane Collins, Chief Executive of Marie Curie, emphasised the significance of the report’s findings for healthcare commissioners:


“This research is really important as it provides further evidence to inform decisions about shifting care for people with a terminal illness away from hospitals into the community, leaving vital hospital resource for people who really need to be there. The lack of data available about the use and cost of different community care services at end of life has always hampered making this shift a reality, but this research should give commissioners greater confidence to make the important decisions that are needed.”


Using data collected in 2012 about Marie Curie’s home-based palliative care service, the study also considered whether such services could reduce end of life care costs. Even when accounting for the costs of GP, district nursing and social care, the Nuffield Trust estimates that the Marie Curie service could save total care costs of approximately £500 per patient, compared to normal hospital care.


Industry experts seem to be convinced that spending more on community- based end of life care services would benefit both hospital budgets and patients. Simon Chapman, Director of Public and Parliamentary Engagement at the National Council for Palliative Care (NCPC), commented:


“This important report provides further evidence that what we need now is a reinvestment in end of life care services, away from


www.tomorrowscare.co.uk


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48