The consultant-led multidisciplinary team in Midhurst aim to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes.
Specific elements of the model include:
- early referral
- the breadth of clinical interventions delivered at home
- strong partnerships with other local services and voluntary organisations
- role flexibility of staff and volunteers (the evaluators emphasised the non-hierarchical and flexible working relationships, and the willingness to learn from each other).
The evaluation comprised:
- a retrospective analysis of secondary-care use in the last year of life
- financial evaluation of the Midhurst Service using an Activity Based Costing approach
- qualitative interviews with patients, carers, health and social care staff and Midhurst staff and volunteers
- a postal survey of General Practices
- a postal survey of bereaved caregivers using the Midhurst Service.
The service received 389 referrals in 2010/11 (about 85% for cancer) from a population of 155,000.
The average cost per patient was £3,000, with the mean cost of interventions for cancer patients in the last year of life £1,900. Post-referral, overall costs to the system were similar for Midhurst and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life.
Patients and carers reported positive experiences of support, linked to the flexible way the service worked. 71% of patients died at home.
Evaluators commented: “Given the likely increased demand for specialist palliative care, the Midhurst model may represent an efficient way of expanding capacity without incurring significant capital cost.
“Our suggestion is that it is likely that the Midhurst model could be established in other areas. To achieve this we would draw attention to the features of the service which our study has identified as having an impact on the success in delivering good-quality palliative care at home, and enabling a high proportion of patients to die at home.”
As previously reported on ehospice, Macmillan is currently working with local hospices and other partner organisations across England to test this model in different demographic settings and expand the evidence base for palliative care in the community, known as Macmillan Specialist Care at Home.
The evaluation paper “Can comprehensive specialised end of life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK”, published in the European Journal of Cancer Care, Volume 23, can be accessed for free on the journal’s website.
If you are interested in sharing expertise and learning you can contact Nicole at email@example.com