Pilots to provide more care and support in the home at the end of life

Categories: Care.

Based on a Swedish model of advanced home care, the Macmillan Specialist Care at Home model is led by a community-based consultant doctor working with a team of highly skilled doctors, nurses, support workers and other professionals to provide flexible and personalised care.

The model aims to provide a single point of access for patients and support more people with life-limiting conditions to remain at home, or wherever their preferred place of care is. It also aims to get people referred to services earlier and prevent unplanned hospital admissions.

Within the pilot regions, anyone affected by cancer or other life-limiting conditions will be referred for specialist care at the earliest opportunity, and offered as much medical treatment and support in the home as possible. The team will also collaborate with a range of local health and social care organisations to coordinate support for the individual and their family.

The six pilots – based in Hull, Isle of Wight, West Norfolk, Birmingham and Solihull, Dudley, and North London – will run from April 2014 until 2016.

The pilots follow the success of the Midhurst Macmillan Specialist Palliative Care service in Sussex. Evaluations of this service found that it enabled more people to be cared for and die in their preferred place, while reducing emergency hospital admissions and patient stays in hospital and reducing the total cost to the health and social care system of caring for people in the last year of life.

Hospices will be involved with all of the pilots – and leading on two – bringing long term experience and specialist knowledge of caring for people in community settings.

Highlighting the important role of hospices in meeting the future needs around end of life care, Heather Richardson, National Clinical Lead at Help the Hospices, said: “The Commission into the future of hospice care strongly recommends that the hospice sector collaborates, develops mechanisms to learn from each other and invests in evaluation to shape models of care that will meet future need and demand.

“It is pleasing to note the strong involvement of hospices in this new programme of work being led by Macmillan Cancer Support. Their inclusion provides opportunity for mutual learning, shared good practice and a joined up approach to the development of new or amended services to improve care at local level. Help the Hospices is keen to learn from their experience and the programme as a whole.”

The North London pilot will be led by North London Hospice. Pam McClinton, hospice Chief Executive, said: “North London Hospice has delivered specialist palliative care at home for almost three decades now. We are delighted to be working with Macmillan Cancer Support to explore ways that we can extend and enhance our specialist home service that benefits both patients and families. Our vision is that everyone in our diverse community affected by potentially life-threatening illness has equal access to the services and support they need to optimise their quality of life.” 

Dr Paul Howard, Consultant in Palliative Medicine, Earl Mountbatten Hospice (leading the Isle of Wight pilot), added: “Enhancing the resources available through the community palliative care service will enable us to extend more of the care currently delivered within the hospice to those with life-limiting illnesses who would prefer to remain at home. The Isle of Wight already benefits from well integrated and highly motivated health professionals both within the palliative care team and in the wider NHS. It is therefore an ideal place to demonstrate how much can be achieved together in the home setting.”

In Dudley the pilot is being run by Mary Stevens Hospice, NHS Dudley Clinical Commissioning Group and Dudley NHS Foundation Trust. Solihull CCG, Birmingham Cross City CCG and Birmingham South Central CCG are running the pilot in Birmingham and Solihull. In Hull the pilot is being led by City Health Care Partnership CIC and West Norfolk Clinical Commissioning Group is led the West Norfolk pilot.

Ciarán Devane, Chief Executive, Macmillan Cancer Support, said: “We know that three quarters of cancer patients would prefer to spend their final days in their own home with family and friends, but less than a third actually do. To allow people a real choice, we need health and social care services to be coordinated into a seamless package of care. We hope that by testing the Macmillan Specialist Care at Home approach we will further demonstrate a blueprint for the way end of life care is delivered in the future.”

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