Case study: How community social care can save on health budgets

Blog Post: 25 September 2017


One of the many issues on the care circuit is the single budget proposal for health and social care. Economists and accountants often see the world in market terms or balance sheets, while carers generally take a view of the human condition.


In 2014 The King’s Fund produced an interim report on single-pot finance that was motivated by “human stories of anguish and distress.”

The issues are clear, the report said: There is a great contrast between healthcare – largely provided free at the point of use with a ring-fenced budget – and social care – funded through local authorities and means.

“These different systems do not work well together and are failing to rise to the challenges of an ageing population within which there are more people with long-term conditions,” Kate Barker, Commission chair on the future of health and social care, wrote.

For me, the argument for large-scale investment in community social care is overwhelming because the savings on health are potentially far greater than any outlay.

If there were ever a case study that supported such a premise, the one outlined the recent WMCA Salvaging Home Care Together conference is one of the most convincing I’ve heard.

We heard from John Nash, our media/PR man, whose wife has been an MS patient for more than 30 years.

Speaking to community care provider delegates he opened with these words:

  • What you do has the potential to change lives for the better
  • What you do can reimagine living for clients and their families
  • What you do can help recover lost hopes and inspire new dreams
  • What you do has a value far beyond what many of you will ever realise
  • And if we can work harmoniously with health the financial gains for the NHS are nothing short of strident

He went on to explain how a complex evolution of care and health resulted in a multi-disciplined ‘togetherness’ finally working.

Clearly an emotional journey for this speaker, he related how his and his wife’s lives were “exceptionally blessed” with a successful business, new job and a musical son.

On a summer’s afternoon their world was shaken with the MS diagnosis. The disease was aggressive, cruel and future plans to live out a dream in a Cornish village were in tatters.

John, responding to a plea from his wife ­ – “don’t put me in a home” – agreed to care for her at their home.

“Often have been the times when social services and other health providers would have seen it as the best clinical outcome, but stubbornly I held to my promise to try to care for her at home,” he told us.

As clinical needs became more complex, so the care packages grew, but John was forever frustrated that district nurses, carers from agencies and the local authority, and other more specialised help, never seemed to know what anyone else was doing outside their own immediate scope of practice.

A catalogue of care disasters ensued around an initial care package consisting of four calls a day with two carers:

  • 45 minutes to get up
  • 30 minutes to feed at lunch
  • 15 minutes afternoon call
  • 30 minutes tuck-up
  • And a night call (anyone remember them?)

In addition John’s wife was receiving three nursing calls X2 clinicians weekly. On a bad week those nursing calls could double – the record being ten in eight days.

The cost to health (the figures were leaked to the speaker and are not verified) was allegedly up to £44.00 per single nurse face-to-face home encounter.

Assuming that’s true (personally I think the unit cost is a little low), the nursing care would present a cost to health of £13,728 per annum if the care model were predictable. But it wasn’t and the nursing costs soared, we heard.

Based on the original care plan, excellence in social care is now saving health at community level a whopping £13,000-plus per year as the patient is now receiving only a nursing call (x1) once every three months to change a catheter.

How did John get there?

! Assessed with a nursing lead and consultant Jilly’s community care needs to include personal care, feeding, bowel management, catheter care, and social engagement/interaction

2 Called a care review with social services and presented the ‘needs’

3 With the social worker, the service user and nursing lead drafted a monthly plan of clinical and social care calls

4 Social worker negotiated budget based on evidence. (She won the bet)

5 Found a team that could deliver

Today this brave woman’s overall health has astounded her consultants. She’s brighter, better nourished, well hydrated, rarely does she see a district nurse or MS nurse and a stunning example of how potentially community social care can save on health budgets while improving the lives of those most in need of it.

Note: John Nash’s wife has given permission for WMCA to publish this blog and has approved the content.