Social care and hospital use at the end of life

Supporting people at the end of their lives is a complex task – often requiring a patchwork of different services to be delivered. Information about care is important to help us assess how health and social services can be better coordinated in ways that translate into higher quality and more efficient care.

Despite the vast numbers of people that require care and support at the end of their lives, there is a shortage of information about the care that people receive at this critical time, and there are major gaps in our understanding of what services are appropriate.

The techniques used in this analysis mark a significant step forward in information about end of life care

The Nuffield Trust has been attempting to address this shortfall by investigating the use and estimated costs of hospital and social care services for large groups of individuals at the end of their lives.

Social care and hospital use at the end of life

The first published research from this project: Social care and hospital use at the end of life (Dec 2010), explains how we extracted and linked together anonymously (to protect patient’s identities) health and social care records to show the care history of people who died in three primary care trust/local authority areas.

From this we were able to examine the use and estimated costs of hospital and social care services for 16,479 people at the end of their lives. We believe this is the first time that such an estimate has been derived for large populations.

Our research found that on average 30 per cent of the group used some form of local authority-funded social care service in the 12 months before their death, and uptake was higher in older age groups. Use of local authority-funded social care increased gradually in the last year of life, whereas NHS-funded inpatient hospital care increased sharply, particularly in the final two months.

We found some evidence across all age groups that higher social care costs at the end of life tend to be associated with lower inpatient costs. While a direct causal link between high social care use and lower hospital use cannot be confirmed, our findings do suggest that any reductions in the availability of local authority-funded social care might increase demand for hospital services.

The techniques used in this analysis mark a significant step forward in terms of providing a better understanding of health and social care services used by people at the end of life. However, the analysis is partial.

The Nuffield Trust has now been commissioned by the National End of Life Care Intelligence Network to conduct a more detailed follow-up study. This study involves a wider range of local authorities, and an extended number of datasets.

Overlap of hospital use and social care in older people in England

By linking the normally separate health and social care records of more than 120,000 people aged 75 and over Nuffield Trust analysts have also examined how two systems of care – NHS funded health services and local authority funded social care – interact at the individual patient level. The results are available in the paper: Overlap of hospital use and social care in older people in England, 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.

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, for which further research is needed. However the results do suggest that the anonymised linkage of health and social care records potentially could form a useful tool for those trying to identify the difference between good and bad social care.

Further information about the findings of the study published in the Journal of Health Services Research and Policy, is available in a statement issued by the Nuffield Trust.