Social care keeps people out of hospital at end of life, finds study

Nuffield Trust research finds higher social care spending associated with lower hospital costs for patients in last year of life, and boosts case for free care at end of life, say charities.

Investment in social care appears to keep people out of hospital at the end of life, highlighting the risks of care cuts to patient outcomes and NHS budgets, research has found.


About the research

The study, Understanding patterns of health and social care at the end of life, was commissioned by the government-funded National End of Life Care Intelligence Network.

It anonymously linked the individual health and social care records of 73,243 people who died across seven areas from 2007-10, and compared patterns of hospital and council-funded social care use in the last year of life.

Key findings:-

  • 27.8% of people used council-funded social care and 89.6% hospital care in the last year of life.
  • There were considerable variations in rates of social care use between areas.
  • Total hospital costs for the sample were double total social care costs.
  • But for those who use a service, unit social care costs were £12,500 in the last year compared with £7,400 for hospital care.
  • Hospital costs per person rose sharply in the last few months of life while social care costs rose gradually.

More research on end-of-life care use and costs is available from the intelligence network.


A government-funded Nuffield Trust study found a statistically significant inverse relationship between spending on social and hospital care for people in the last year of life: the higher the social care spending, in all age groups, the lower the spending on hospital care.

The same was true of measures of activity, with higher levels of social care use associated with lower inpatient admissions, inpatient bed-days, outpatient attendances and A&E visits. The results are significant because, while over half of annual deaths take place in hospitals, just 1% of palliative care patients would choose to die in hospital.

“Our study suggests how social care might be effectively substituting for hospital care for this group of people,” said report co-author and Nuffield Trust head of research Dr Martin Bardsley. “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 cost far more for the NHS.”

The report also found that, while hospital care costs per person rose sharply in the last months of life, social care costs only rose gradually, which it said meant the economic risks of introducing free end-of-life social care were not great.

Free social care

The government-commissioned Palliative Care Funding Review having recommended free social care for people nearing the end of life in its final report last year, but ministers are yet to commit to the policy.

The findings were welcomed by palliative care groups, who are campaigning for free social care at the end of life to be introduced.

“We only have one chance to get it right for people at the end of life and we should not expect them to go through the uncertainty and complexity of means testing before they are able to receive social care support in their own homes, which is why health and social care must be made freely available to people who are dying,” said Simon Chapman, director of policy and parliamentary affairs at the National Council for Palliative Care.

Ciarán Devane, chief executive of Macmillan Cancer Support, said: “The report chimes with what I have heard from Macmillan social care professionals about how it is often help with the small things, like washing, dressing or turning someone in bed, which can make a big difference for families affected by cancer and is crucial to keeping people out of hospital at the very end of life.”

Related articles

Social work ‘too often missing from end-of-life care’ 

How care home staff can gain the end-of-life care skills they need 

Labour backs free end-of-life social care – but does government?

End-of-life social care should be free, says review


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