Abstract

Care at the end of life is recognised as an important national priority in England. There are concerns about the quality of services offered and also about whether people’s preferences at the end of life are being met. Yet there is very little information on what types of care services people use – this is especially so for the use of social care at the end of life. This study describes work funded by the National End of Life Care Intelligence Network to track the use of both hospital and social care for large cohort of people during the last 12 months of life.

Data and methods: We received administrative data from health and local government organisations commissioning hospital or social care services in seven areas in England. The data drawn from a population of over 3.1m, spanning up to three years was linked via pseudonymous person identifiers and included 73,243 people who died. We analysed hospital and social care services received (including the costs of these services) in the final year of life for all individuals who died to describe factors associated with social care use and to look at the relative use of hospital and social care services.

Results: Overall, 28% of those who died had used a council funded social care service in the year prior to death, with 15% having spent some time in a residential or nursing care home. A similar proportion had received home care services. There were significant differences between areas in the use of social care – ranging from 19% to 36%. A range of factors were associated with higher use of social care services including age, sex, area deprivation and diagnostic medical history. Hospital costs in the final year of life were almost twice those of social care services. While the costs of social care services increased gradually during the final year (by one quarter), hospital costs showed a very rapid rise in the final two months (representing an over 8-fold increase over the year).

Policy implications: This study demonstrates the scale and nature of social care use at this critical period and provides information that is important in planning and assessing needs for services. There is clear interest in attempts to identify whether alternative models of community- or social care-based end of life care services could offer benefits in terms of reduced hospital admissions and/or in terms of costs associated with those admissions. This work is an important step towards describing in detail the use and costs of hospital and social care services in the final year of life, and the interplay between these services.

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