Understanding end of life care: the challenge for commissioners

A new report from the Nuffield Trust indicates the potential savings which can be achieved by delivering community based end of life care.


In 2012, the Nuffield Trust published its evaluation of the Marie Curie Nursing Service.  It compared the experiences of almost 30,000 people who had received Marie Curie Nursing Service (MCNS) care with matched controls who were alike in every respect that could be measured, other than they had not received MCNS care. The study found that access to MCNS care had a profound impact for those at the end of life.  Put simply, those who received the service were significantly more likely to die at home and were much less likely to use all forms of hospital care in the last few months of life.  The result was that total hospital costs for people using the Marie Curie Nursing Service were £1,140 less per person. So, providing care via the Marie Curie Nursing Service means that hospital costs are lower. But this left some asking whether the money saved from reduced hospital costs would simply be eaten up by increased costs for other community based services as more people spend more time at home at the end of life?


Research reveals potential saving


The Nuffield Trust has now answered this question in its latest report – Exploring the cost of care at the end of life. Whilst clearly hampered by key data gaps, the Nuffield Trust has, for the first time, pieced together the estimated costs for different care services in order to calculate the overall costs of delivering end of life care in the community. Its conclusion is clear: "any increase in activity that might occur in primary care, community care and in social care activity as a result of reduced hospital bed days is likely to be very modest when considered against the entirety of care activity during the last months of life." Based on these calculations it is estimated that commissioners could be able to realise potential savings of ‘nearly £500 per person’. This is good news for both terminally ill people and for those commissioning services.  It means that terminally ill people are supported to die at home with high quality care and commissioners could make significant savings.  Given the challenges that health and social care faces from on-going austerity and an ageing population this appears a potentially irresistible combination. We believe that this analysis should encourage commissioners to think through how they move more care from hospitals into the community and give people more of what they want and the health and social care system needs.


For more information


To read a summary and download report, visit our impact pages. Marie Curie Chief Executive Dr Jane Collins explains why the latest research is important and how it is useful to commissioners. Marie Curie Head of Analytics Michael Cooke talks about why the study was commissioned and highlights some of the key findings.