Economic appraisal of an end-of-life care training initiative for care homes with dementia patients

An education and training initiative was developed by Greater Manchester Strategic Health Authority for care staff in four care homes (with nursing) and one NHS mental health ward. The aim was to improve the quality of end of life care received by older people with dementia, through the use of end of life care tools, such as the Gold Standards Framework and the Liverpool Care of the Dying Pathway. An evaluation, undertaken by LJMU, showed that there were many resultant quality benefits. The integral economic appraisal indicated that the proportion of patients who died in their preferred place of death increased following the initiative. But primary care trusts (PCTs) could not expect to make cash savings, to help fund such education and training programmes, unless there were associated reductions in the number of admissions to hospital, which is one of the main aims of the Gold Standards Framework. The paper sets out the key elements of the economic appraisal, and argues for a costbeneficial approach, which is necessary given the anticipated increase in the number of people with dementia who may require care home places in the future.