Dying well at home: the case for integrated working

Accessing equipment and services

Equipment and community services needed in the home to enable people to be cared for until death

The most beneficial thing I found was having the drugs in the home, to be able to administer when you need to, instead of going through the OOH [out-of-hours] service and having to wait for drugs.

Community nurse [25]


Commissioners should:

  • Ensure that there are protocols in place to deal with the key issues in rolling out electronic palliative care coordination systems (EPaCCS) or their equivalent, including what information should be recorded, how it is collected, updated and quality assured, and who should have access to the data.
  • Assess the support available to people dying at home and their carers ‘around the clock’, and take steps to address the large gaps in service provision.
  • Ensure that there are agreed protocols (e.g. prescription of opiates) between out-of-hours locum GP services and with regular primary care.
  • Ensure that hospital discharge planning and case conferences include community staff, for example a district nurse.
  • Ensure that there is a single point of contact for carers through which they can arrange a home-based assessment for home-based equipment by a qualified professional, such as an occupational therapist, and be trained to use it as necessary.
  • Consider commissioning services that provide for blood transfusions and other intravenous procedures, which are available to people in their homes in order to avoid emergency hospital appointments and admissions.
  • Commission services that address the need for patients to have analgesia at all times, as poor pain relief is often responsible for emergency admissions. Ensure that equipment such as syringe drivers and palliative care kits are available.
  • Consider the provision of personal alarms for frail patients and carers and telecare.

Key points from research and policy

Electronic palliative care coordination systems (EPaCCS), also known as locality registers

Well-coordinated and out-of-hours services in the community

General needs for home equipment

Blood transfusion

Pain-relieving drugs and syringe drivers

Telecare and personal alarms

Practice examples

  • Practice example 5. The Partnership for Excellence in Palliative Support (PEPS) service in Bedfordshire illustrates a single access point, which aims to deliver expert advice and services ‘round the clock’.
  • Practice example 7 describes a London-wide initiative to build on the EPaCCS record and make it available to local authorities, hospital, primary and community care staff and the ambulance service.
  • Practice example 8. The Midhurst Macmillan Specialist Palliative Care Service offers a range of services in the home setting, including blood transfusions, intravenous antibiotics and analgesia. The service works collaboratively with generalist services.
  • Practice example 12 describes an intravenous therapy team, working in home settings.


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  • Dying well at home: the case for integrated working
  • Dying well at home: research evidence