Guide for commissioners on end of life care for adults
This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg42
6 The commissioning and benchmarking tool
- 6.1 Identify indicative local service needs
- 6.2 Length of hospital stay for admissions ending in death
- 6.3 Investment in end of life care services
- 6.4 Potential savings
Use the commissioning and benchmarking tool for end of life care to determine the volume of service that may be needed locally, to consider the costs of commissioning some elements of end of life care services and to provide estimates for potential cost savings.
There are two indicative benchmark rates used in the tool:
The indicative benchmark for total deaths per annum is 1.12% or 1120 per 100,000 population aged 18 years and older.
The indicative benchmark of people who may need end of life care per annum is 0.83% or 830 per 100,000 population aged 18 years and older.
The commissioning and benchmarking tool helps you to assess local service needs using the indicative benchmarks as a starting point. With knowledge of your local population and its demographic, you can amend the benchmarks to better reflect your local circumstances. For example, if your population is significantly younger or older than the average population you may need to provide services for fewer or more people.
HES data were used in the tool to allow users to benchmark length of hospital stay for admissions ending in death by primary care trust against the national average. This should be used to help inform users about their current position relative to the national average. It is not intended to be used as a judge of performance or services in any area as there are many different factors which can influence the length of hospital stay. However, it may give commissioners data about local services and give information about local data analysis to inform local needs assessments.
Use the commissioning and benchmarking tool to give an indicative cost of certain aspects of end of life care services. Commissioners should be clear that each locality has specific needs and new services need to be compatible with the existing services in an area. No one type of service will be needed in every locality. Similarly, the costs of a given service will vary significantly depending on local conditions and needs.
The tool allows users to add data on the potential cost elements that may need to be considered in future service planning. The tool also shows the average costs per 100,000 population of investments made by PCTs in 2010/11 which can help inform decisions about the levels of investment that may be required. It should be noted that this is additional investment on top of current spend on services, and not the full investment in end of life care services.
It should be noted that primary care trusts are not the only commissioners of end of life care related services and funding comes from many other sources (as seen in figure 1 of this commissioning guide).
Commissioning decisions should consider both the clinical and economic viability of the service, and take into account the views of local people. Commissioning plans should also take into account the costs of monitoring the quality of the services commissioned.
You can use the commissioning and benchmarking tool to calculate the potential savings from reduced hospital admissions and reduced length of stay that may come about because of improved commissioning of end of life care services across the whole pathway.
Service redesign and investment in the whole end of life care pathway may increase the proportion of people who die in their own home. This may decrease the number of hospital admissions and the lengths of stay experienced in the last weeks and months of their life. These savings may offset some of the investment made in the rest of the pathway, and could potentially provide an overall cost saving.
Reduced hospital activity leads to a direct saving to a commissioner via reduced charges through the national tariff. However, for a hospital provider, only the costs of consumables will be saved in the short term and overheads will be unchanged. A step change needs to be brought about so capacity can be released if savings are to be reflected in hospital expenditure.
An average unit cost of a hospital bed day and example reductions of 1%, 5% or 10% are modelled in the tool. Users should amend these figures to reflect local expectations.
The tool does not look at stays not ending in death in the last weeks and months of life due to a lack of robust data. If end of life care commissioning leads to any reduction in such admissions, further savings may be possible.