A new study by the Nuffield Trust linking the normally separate health and social care records of more than 133,055 people – aged 75 and over – has found that local authority funded care home residents had fewer hospital admissions than those receiving high intensity social care support in their own homes.
The results lend further support to the argument that cuts to social care budgets may lead to increased hospital admissions.
Writing for the Journal of Health Services Research and Policy, the analysts describe how their methods allow researchers to examine interactions between the two systems of care at the individual patient level. The study is believed to be the largest of its kind in the UK so far.
Further research is needed to understand the causes behind these phenomena but the results emphasise once again that changes in social care can have knock on effects in the NHS
Dr Jennifer Dixon, Chief Executive, Nuffield Trust
Many of the results are unsurprising. For example people using the social care system were more likely to use hospital services when compared with those who did not use any social care. In most cases there was a nearly twofold difference. However, analysis of hospital usage according to the type of social care revealed a more complex picture.
58 per cent of care home residents were admitted to hospital – a lower proportion than the group receiving high-intensity support in their own homes, of which 73 per cent were admitted. When the figures were broken down further it was found that the care home group also had fewer outpatient attendances than those receiving care in their own homes – lower in fact than even the people who received no social care at all.
The study did not aim to demonstrate the cause behind these patterns, but the authors suggest two types of explanations. On a positive note the differences may reflect that:
- Care homes are effective in avoiding the need for hospitals, for example through more intensive GP supervision, or in reducing the risks of falls.
- Care home staff may be in a better position to support people and manage their health problems in ways that do not require a trip to the hospital; for example by monitoring the blood glucose levels of a person with diabetes and adjusting the therapy as necessary.
On the other hand, this effect may arise from problems accessing hospital care for some people living in care homes. The researchers point out that the low rate of outpatient attendances in the care home group would support this hypothesis.
Of the findings, Dr Martin Bardsley, Nuffield Trust Director of Research and lead investigator on the study said:
'The significance of these observations is twofold. Firstly that reduction in social care budgets and access to care homes may put pressure on hospitals. Secondly, that we ought to be looking to use these data to understand something more about what constitutes good quality social care, and see if we can use information about the management of health problems, to help spot the difference between good and bad social care.'
Dr Jennifer Dixon, Chief Executive of the Nuffield Trust, added:
'Some of the main policy challenges right now, whether in respect of long term care funding, spreading the use of personal budgets or integration, are all critically dependent on understanding better the trade offs and interactions between social care and NHS usage. Yet surprisingly, studies of this type are few and far between.
'Further research is needed to understand the causes behind these phenomena but the results emphasise once again that changes in social care can have knock on effects in the NHS.'
- Overlap of hospital use and social care in older people in England by Martin Bardsley, Theo Georghiou, Ludovic Chassin, Geraint Lewis, Adam Steventon, and Jennifer Dixon is published in the spring 2012 edition of the Journal of Health Services Research and Policy.
- Records for a single year (2006-2007) were extracted from the operational information systems of four primary care trust areas and their corresponding local authority areas. People who died during the year were excluded, meaning that patterns of use were not affected by care in the final few weeks of life.
- The study demonstrates the power of linking data across the public sector to gain a deeper understanding of the costs and benefits of expenditure from tax funds. The research team acknowledges that there were methodological challenges. For example, the geographical areas examined in the study may have been unrepresentative of England as a whole; information from other health care services including NHS primary and community health services was not included, nor were the team able to identify people who paid for all of their own social care, estimated to be around 25 per cent of older people. Improvements to how data is collected and shared may allow these issues to be addressed.