1. Counting the cost of end of life care

    25 Sep 2014
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    Our health services are not just about our health. They are also heavily involved in our deaths.

    This year, for every 1,000 people in England, nine will die. Eight of those nine will have some hospital care during their final year of life. For four or five, a hospital bed will be their last.

    Unsurprisingly, people who are near to the end of their lives are disproportionately high users of hospital services. We estimate, that approximately 15% of all emergency hospital admissions in England belong to the 1% of people in their final year of life.

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  2. Social care and cancer: tracking care across service boundaries

    (Guest blogger)
    2 Jun 2014
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    A recently published Nuffield trust report offers a fascinating insight into the routes that cancer patients take through the care system. In an era that promotes integrated care we all accept that caring for a person extends beyond one organisation; and treatment for cancer may include primary, community and social care on top of acute hospital activities.

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  3. Reforming social care – the Japanese experience

    (Guest blogger)
    27 Nov 2013
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    How is the oldest population in the world – Japan – coping with the long-term health and social care needs of its population?

    That is the question that a new report published by the Nuffield Trust attempts to answer:Caring for an ageing population: points to consider from reform in Japan.

    I was one of a group who visited Japan as part of this project. In the report we describe how Japan introduced compulsory social care insurance to pay for care in older age.

    Briefly, everyone over the age...

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  4. Long-term care reform in the United States

    (Guest blogger)
    19 Jun 2013
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    Long-term services and support (LTSS) primarily refers to personal care services that include home help, care in nursing homes and assisted living, as well as day care.

    Of the 13 million Americans that need long-term care, only 13 per cent have received help in paying for these services. The situation is set to become even more challenging, as the proportion of Americans over the age of 65 is...

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  5. Do home palliative care services have an impact on where people die?

    (Guest blogger)
    18 Jun 2013
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    As in many other developed countries, the UK population is rapidly ageing. This has implications for the provision of health and social care, as older age and life-limiting, chronic conditions are closely linked. There is a growing need for palliative care.

    One of the key values of palliative care is to enable people to choose where to be cared for at the end of life. When asked for their...

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  6. Principles matter: reforming social care funding

    11 Feb 2013
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    There is almost universal agreement that the social care system needs urgent and fundamental reform. Despite this consensus the various attempts at reform over the last 20 years have all stalled.

    Against that background Andrew Dilnot could have been considered either brave or foolhardy to accept the Government’s request to head the latest commission on reforming social care funding in 2010. Last year when it looked like the Government was planning to kick funding reform into the long-grass once again, the evidence pointed towards...

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  7. Pursuing nirvana

    27 Nov 2012
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    At last! We found evidence of an intervention which improves quality and reduces hospital costs. Is it telehealth? No! Is it greater competition? No!

    It is care by Marie Curie at the end of life. People receiving the home-based Marie Curie Nursing Service were more likely than matched patients to die at home, according to their wishes, rather than in hospitals, and less likely to have unplanned hospital care.

    This was our first excursion into examining the impact of home-based care from the 'third' sector – hopefully the first of many.

    On...

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  8. How can more people be helped to die at home?

    14 Nov 2012
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    At the Nuffield Trust we’ve worked on evaluations of a wide range of schemes over the last few years – from telehealth to integrated care and virtual wards – many of which aim (at least in part) to reduce hospital use and to move care into other less expensive settings.

    We find that although many interventions claim to make significant impacts on emergency hospital use, most do not deliver. However, we have recently published an evaluation of a service that shows a clear impact and looks like it might work.

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  9. The cost of caring for people at the end of life

    (Guest blogger)
    16 Oct 2012
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    What role should social care play to support someone at the end of life to die in their own home? And how can health and social care services work together to make this choice a reality?

    Macmillan Cancer Support’s own research shows that, with the right support, 73 per cent of people with cancer would prefer to die at home – but only 27 per cent actually do. If people’s end of life wishes are to be respected, it is vital that we answer these two questions.

    Macmillan has been...

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  10. Does universalism have a future?

    17 Jul 2012
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    In these times of austerity, the future of universalism is uncertain. The question is: would it be a more prudent use of Government funds and taxpayers’ money to routinely restrict benefits solely to those in need?

    This was the topic of debate at our annual reception and debate, expertly explored by Chair Mark Easton of the BBC and panellists Rt Hon Frank Field MP, Polly Toynbee, Julia Unwin CBE and Rt Hon David Willets MP, with an introduction by Professor...

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  11. Securing future NHS funding: is a productivity boost enough?

    (Guest blogger)
    4 Jul 2012
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    Most developed countries have problems with the percentage of their gross domestic product (GDP) spent on health, so our problems are not unique.

    The theory goes that in order to meet the challenge of future health care demand due to changing demography, lifestyle and new technology innovation, resources must shift into more community, home-based and self-service provision.

    There appears to be consensus at the policy level that it is in the interest of patients and service users that a more integrated approach should be developed. Underpinning this is an assumption that...

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  12. Predictive risk – clinical scepticism, incentives and participation

    21 Jun 2012
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    Since the development of the original PARR and Combined Predictive Model tools, many PCTs have introduced these or similar case finding tools, to identify people at risk of unplanned hospital admissions.

    Our one-day conference for people interested in using predictive risk tools in health care took place last week. People from across the UK and further afield spoke about the ways in which these tools are being used, as well as highlighting some issues and cautionary tales that have come from experience in trying to introduce and use...

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  13. Low cost and high quality integrated care: what can we learn from Japan?

    11 Jun 2012
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    While changing demographics are putting considerable pressures on health and care systems in all Western countries, nowhere is it more acute than in Japan. A baby girl born today in Japan can expect to live to 86 and a baby boy to 79. By 2030, almost one in three people will be 65 or older.

    Meeting the needs of an ageing population, against a backdrop of a diminishing total population, presents an enormous challenge for its Government. Yet Japan manages to provide universal health care coverage for its population (albeit with some co-payments) while spending around 8.5 per cent of...

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  14. How can we spot the difference between good and bad social care?

    29 Mar 2012
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    Within the research group of the Nuffield Trust we have a number of studies that use the anonymised linkage of health and social care records. The results of one study are due to be published in the Journal of Health Services Research and Policy (JHSRP) soon but they have left us with a puzzle.

    We found that from a population of older people (aged 75+) in four local authority areas, 14 per cent used some form of local authority social care over a one year...

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  15. Unpicking the costs of end of life care

    6 Jul 2011
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    Last week saw the publication of the findings from the independent review of palliative care funding led by Tom Hughes-Hallet. 

    Here at the Nuffield Trust we have been doing work around social care use at the end of life and it is nice to see that work being used by the report team.

    We are also about to publish some work looking at the variation in hospital use in the last 12 months of life. One of the observations from this research is that to change the system...

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  16. Social care at the end of life

    8 Dec 2010
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    At the Nuffield Trust we have just published a report that uses routine information to offer a new perspective on care services at the end of life.  We were aware of the importance of end of life care, both in terms of problems in the quality of services and the costs of these services.  We also know it’s an area where there is limited information yet a lot of national interest.

    Following a meeting with Mike Richards, the National Clinical Director for End of Life Care, and the National End of Life Care Programme team, it became clear...

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