Dying well at home: the case for integrated working
Practice example 8: Midhurst Macmillan Specialist Palliative Care Service
This innovative, flexible and community-based care model is managed by the Sussex Community NHS Trust. It consists of a multidisciplinary team of specialist palliative care professionals, who link well with members of the primary healthcare team, community services, social services, care agencies and voluntary organisations in the locality, to provide proactive specialist palliative care and support following early referral from either the hospital or GP.
Care is undertaken either at home or in the community and may include blood/blood product transfusions, parenteral treatments, intravenous antibiotics, fluids and analgesia. The service accepts referrals for any person over 18 years of age who is living within a specified area with cancer or any life-limiting chronic progressive disease and who is experiencing complex problems.
The advantages of the model are that it extends choice at the end of life for people and their families, enables an early referral to active specialist palliative care and leads to good clinical outcomes such as less frequent Accident & Emergency attendances and decreased hospital stays. The majority of people cared for by this team will die in their preferred place, which is normally their own home.
An economic and qualitative evaluation of the service commissioned by Macmillan Cancer Support, which is still to be published, suggests that the service is cost-effective as well as offering maximum choice to people at the end of life. In the meantime, a summary is available from Macmillan Cancer Support on request.
Adrienne Betteley, Programme Manager, Palliative and End of Life Care, Macmillan Cancer Support.