Specialist palliative care has the potential to reduce costs by up to £8,000 per person and improve quality of life.
The new study, published by researchers at King's College London in the National Institute for Health and Research (NIHR) Policy Research Unit in Palliative and end of life care, Hull York Medical School, University of Hull and University of Leeds, considered two modes of care: for those living at home and for those in acute hospital settings.
As well as significantly reducing overall cost of care per person, specialist palliative care delivered at home and in the hospital was found to be associated with an increased quality of life for patients in their final months.
In high-income countries, about 1% of people die annually but this group accounts for 8-10% of all healthcare spending. This high cost is largely due to unplanned hospital admissions which can lead to fragmented and less satisfactory care. In these countries, people with serious medical illnesses largely prefer to be given care at home if possible but many end up dying in hospital.
This new study used economic modelling to evaluate the potential savings to the NHS that specialist palliative care provides. By combining the best available evidence from other research and government statistics, researchers estimated the cost savings from reducing unplanned hospital care, which is better for patients and the NHS. Quality of life was measured by assessing five dimensions of patient health: mobility, self-care, usual activities, pain and anxiety or depression.
Home-based specialist palliative care was associated with reduced costs of £7,908 per person who died, while hospital specialist palliative care reduced costs by £6,480 per person.
Specialist palliative care refers to care for those with more complex needs at the end of their life whose care cannot be delivered by a primary or core healthcare team. It requires a workforce with specialist skills who are experienced in delivering palliative care as their main role.
The researchers found that in 2022 in England, specialist palliative care supported over 20,000 people to die outside of hospital which saved approximately 1.5m hospital bed days and reduced healthcare expenditures by £817m. Many people are missing out on receiving quality palliative care—if any at all—and there are growing needs for increased palliative care from hospices, community teams and in hospitals. This new study shows the value and cost-effectiveness of specialist palliative care at helping to solve key system problems in the NHS.
Peter May, Senior Lecturer in Health Economics at King's College London and lead author on the paper said: "Previous studies showed that specialist palliative care supports people with serious illness to be at home. This is the first study to estimate the economic impact for England. About half of people who might benefit from specialist palliative care receive it, and this is highly cost-effective for both patients and the NHS. We must now turn our attention to understanding how and why people who might benefit do not yet receive palliative care."
Professor Fliss Murtagh at Hull York Medical School said: "Many people may be reluctant to ask for palliative care, believing that it might accelerate their decline and impose additional pressure on the health service. The reverse is true. This study shows good quality care in appropriate settings can improve their quality of life, lessen symptoms and other concerns, and reduce NHS pressures – everyone with serious medical illness should be asking for it."
"Specialist palliative care improves patient experience, reduces bed days and saves money: An economic modelling study of home- and hospital-based care" (Peter May et al.) (https://doi.org/10.1177/02692163261423755) is published in Palliative Medicine.
