Social care cash cuts could hit hospitals

If funding for social care is cut back, people may have no option but to use hospital care, a study by the Nuffield Trust has warned.

The study – which tracked how over 73,000 people used publicly funded health and social care services during the last months of their lives – also found “considerable variation” around the UK. 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. There were also notable differences in the use of social care between groups of people 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).
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The study also found that people with the highest social care costs had relatively low average hospital costs – this was broadly the case irrespective of age and suggested that use of social care may prevent the need for hospital care. This could become increasingly important if local authorities continue to restrict funding of care services to those people with the most critical needs only, the authors warned.

Another finding of the study was that people used social care well before the last few months of their lives but 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.

Finally, the costs of social care for people at the end of life were reasonably predictable which would suggest that the economic risk to the government of funding social care at the end of life – currently means-tested – would not be great.

Co-author of the report, the Nuffield Trust’s head of research Dr Martin Bardsley, said: “People are very vulnerable in the last months of their lives, and achieving appropriate and well co-ordinated 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 costing 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.”