The Social, Economic and Environmental Impact of North Wales Hospices
Research type
Research Study
Full title
What is the Social, Economic and Environmental impact of hospice related care? V2
IRAS ID
232423
Contact name
Nicole Hughes
Contact email
Sponsor organisation
Bangor University
Duration of Study in the UK
3 years, 5 months, 30 days
Research summary
Research Summary
Over a quarter of a million patients are cared for by hospices in the UK each year, either in a hospice setting or in their own home. Many hospices have charitable status and the majority of their funding is raised through community campaigns and events, along with business and social enterprise models. Around 20% of their funding is provided as a grant via NHS resources. Increased pressure from policy to demonstrate value for money and stretched funding streams have motivated the North Wales Hospice Group to seek ways to determine their wider impact. Hospices across North Wales have already formed an alliance to inform their strategic direction and maximize sustainability of Hospice related end of life care in the area. However, to strengthen their case for refunding, the hospices would like a clearer understanding and demonstration of the intangible effects of their activities and the impact they create on the wider community. Furthermore, the care provided encompasses not just the individual patient but also their carers, families and friends throughout the duration of the illness and during bereavement. This research project aims to understand the impact of hospices by utilizing a social return on investment framework to understand the impact (positive and negative) of hospice clinical and non-clinical activities. Secondary analysis using anonymised patient level data will be utilised in addition to the collection of hospice costs. The costs associated with running the hospice will help demonstrate the hospices economic contributions. 1-2-1 interviews with patients and carers will be utilised in order to gain their perceptions on the care provided by the hospice and how it impacts them.
Summary of Results
Due to structural differences in care models, the costs for Site D were calculated separately. The mean total cost of palliative care provision was £1,512,841 per year for Sites A–C and £1,034,927 per year for Site D. The average cost per patient admission to the inpatient unit was £446 (Sites A–C). The unit cost per at home visit was estimated as £190 per patient (Site D). The average cost per patient visit to the day therapy unit was £292 (Sites A–C) and £178 (Site D).
Based on an occupancy rate of 80%, the mean unit cost for the inpatient unit and day therapy units was £407 and £169 respectively.
Thirty-four studies highlighted that an amalgamation of hospice service components were valued by patients and family-caregivers. These generally remained consistent across studies; however, the overarching synthesis demonstrated disparities between what people valued and why.Seven principal outcomes were identified: improvements in relationships, physical and psychological symptomology, mobility, informedness, social isolation, and autonomy.
Within the inpatient unit, ‘poor mobility’, ‘appetite loss’, and ‘weakness’ were recognised as prevalent issues. Psychosocial items of care were generally well managed although there was limited data pertaining to this. Within the day therapy unit, ‘breathlessness, ‘patient anxiety’, ‘family anxiety’, ‘weakness’, and ‘pain’ were identified as prevalent issues. In contrast to the inpatient unit, psychosocial items of care were often presented as severe.
The inpatient unit returned a base case Social Return on Investment ratio of £2.77:£1, whilst the day therapy unit returned a base case ratio of £11.85:£1.REC name
Wales REC 4
REC reference
17/WA/0399
Date of REC Opinion
11 Dec 2017
REC opinion
Favourable Opinion