Rachel Elliott and Matthew Franklin are reporting on behalf of the Medical Crises in Older People (MCOP) research team at the University of Nottingham.
As part of a programme developing and evaluating care in older people, our team wanted to know the distribution of health and social care costs of older adults discharged from Acute Medical Units (AMU) in England across six care services (primary care, hospitals, intermediate care, mental healthcare, social care, and the ambulance service). This is the first study to do this in England.
Our study published in Age and Ageing reports that over a three month period for older people discharged from AMUs, 76.1% of the cost was incurred by hospital care, followed by: primary care (10.9%); social care (10.0%); mental healthcare (2.1%); ambulance services (0.7%); and intermediate care (0.2%). The results suggest that older people are still relatively high resource users of secondary care compared to any other care service. Despite interventions to alleviate pressure on secondary care, these results suggest that there is still potential to reallocate care out of hospitals and into services such as social care, which may be cheaper for the NHS and preferred by patients.
The mean (95% CI) cost per patient for hospital care over the 3 month period was £1448 (£1146 – £1851). Inpatient care incurred the majority of hospital costs (mean, 95%: £952, £680 – £1350) and the top 10% of costliest patients accounted for 50% of overall care costs, mainly due to long and complex inpatient hospitals stays. Compared to the costs incurred by primary care (£218, £194 – £251) and social care (£201, £119-£334), these mean costs are approximately 14-15% of the cost for hospital care. These costs suggest very little about how to allocate patients between services, but are very informative from an economic perspective in relation to patient care alongside a finite NHS budget. Hospital care generally costs more than social care, and prevention (such as home care) is better than the cure (hospital care); but how do we move care away from hospitals and into other services?
Campaigns such as the “Where should you be?” campaign associated with relieving pressure on emergency departments (ED) suggests alternative services people should attend based on patients’ need. The issue is that there are still complications when providing alternative care for older people when it is easier to send them to the hospital. There is not enough communication or professional education among healthcare professionals for referrals to appropriate alternative services (there is also a lack of alternative services, partly due to the lack of research or evidence proving their worth) to be provided in real-time. We know, or assume, that there are ways to alleviate pressure on hospitals and that social care may offer a possible solution, but due to the lack of research (social care is a largely under-researched area in terms of its use alongside healthcare services) and communication between services, how we invest and then offer this alternative care as part of the NHS is just not known.