Marie Curie Nursing Service a leader in reducing end-of-life care emergency hospital admissions – Nuffield Trust findings
by Emily Garside Service Developer The Chancellor has announced the government’s spending plans for 2015-16. The NHS budget in England is forecast to rise by 0.1% after inflation, to £110bn, once again escaping drastic cuts. However, with increasing demands on emergency services and the government’s Quality, Innovation, Productivity and Prevention (QIPP) initiative asking the NHS to make £20 billion of efficiency savings by 2015, it is clear that the pace of change in the NHS needs to increase. One of the ways the NHS hopes to keep its head above water is by encouraging more innovative services which reduce expensive emergency hospital admissions especially for people with long-term and/or multiple conditions. The MCNS is one model of good practice which has been shown to achieve this shift. Particularly encouraged is the idea of integrated care. This essentially means to co-ordinate care around the needs of patients, as well as co-ordinating the work of professionals who deliver the services to patients. To fully meet the needs of patients this often involves moving care from an acute to a community setting. This week saw the closing date for applications for funding for the new health and social care integration ‘pioneer sites’ that will be chosen by the Department of Health in September 2013. The Nuffield Trust, an independent health and policy research charity, has evaluated over 30 existing community based interventions to assess whether they led to a change in service use – particularly a reduction in inpatient hospital activity. Their report on ‘Evaluating integrated and community-based care: how do we know what works’ took stock of all of the evaluations they had completed in the past five years and concluded: ‘The NHS is awash with service innovations, often based in the community, which attempt to tackle the challenge of delivering high-quality community-based care for increasing numbers of people with long-term conditions. We have been tasked with identifying whether service changes have led to a reduction in emergency admissions and the associated cost to the NHS. The results have been almost overwhelmingly negative. The one exception was Marie Curie Nursing Services (MCNS) for terminally ill patients.’ This statement builds on the positive results of the Nuffield Trust’s original report, published in October 2012, ‘Impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life.’ The study used innovative data linkage and matching methods to compare the patterns of care for 30,000 people receiving the MCNS with a similarly matched control group. The study found that home-based nursing care can improve outcomes at the end of life. 77 percent of those who received MCNS care died at home and eight percent died in hospital. In contrast, 35 per cent of a matched control group died at home and 42 per cent died in hospital. Moreover the average costs of all hospital services used by individuals receiving the MCNS was £1,140 per person lower than for matched controls. The fact that the 29 other community interventions evaluated by the Nuffield Trust have not yet been able to demonstrate an impact on emergency admissions (and the associated costs to the NHS) highlights just how difficult these impacts are to achieve. The review highlights that time is a crucial element in enabling change in health care; explaining successful transformative models ‘have been established for many years, if not decades.’ Since 2004, Marie Curie has been championing a whole-systems approach to end of life care provision through our pioneering Delivering Choice Programme. As part of this process we have developed, delivered and evaluated effective local solutions to end of life care for the last ten years across 18 sites in the UK. The Nuffield Trust hopes that its most recent paper will provide useful learning for the new health and social care integration ‘pioneer’ sites and it is encouraging to see that the MCNS is being held up as a ‘well-established’ example of effective community-based care.