How can we spot the difference between good and bad social care?

Within the research group of the Nuffield Trust we have a number of studies that use the anonymised linkage of health and social care records. The results of one study are due to be published in the Journal of Health Services Research and Policy (JHSRP) soon but they have left us with a puzzle.

We found that from a population of older people (aged 75+) in four local authority areas, 14 per cent used some form of local authority social care over a one year period, and 71 per cent of that group also used hospital care in that year. 

Hardly newsworthy – social care users go to hospital – though it is perhaps more surprising that studies of this type have not been undertaken much before.

A lot of our work looks at how to avoid people having emergency hospital care – on the basis that emergency admissions are not very pleasant for the patients, can be costly to the NHS and, in an ideal world, we should be finding ways to prevent health problems turning into crises.

So we looked at how frequently social care users went to hospital. We found that those in care homes tended to use less hospital care than people receiving intensive home care. The people in care homes had fewer emergency and elective admissions. They also had fewer outpatient attendances than people not receiving any local authority funded social care.

This wasn’t a result we particularly wanted to observe – like everybody else, we like the idea of independent older people being able to live in their own homes.

So for the past few months I have asked people who know more than me what they think of this observation. I should note that our carefully crafted empirical observation was no great surprise for some people, but how should we interpret it?

Is it a good thing? Is it that care homes are doing all the right things to avoid health crises?  Do they provide an environment that manages health problems with more prevention and support than care services in somebody’s home?

Or, is it a bad thing? Is it that for some people care homes are not helping get the access to hospital care that they should have? Are we seeing an example of discrimination against some older people living in care homes?

People have views on these but I have to admit I just don’t know. It’s probably a bit of both – it usually is. Maybe what’s important is to find out the things that prevent the need for hospital care rather than where they are delivered.

For me the significance of the observation is twofold.

Firstly, that reduction in social care budgets and access to care homes may put a positive 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.

This article has also been published on Community Care.