Macmillan Specialist Care at Home
Macmillan Specialist Care at Home is a partnership approach to providing palliative care in the community. It’s based on the successful Midhurst Macmillan Specialist Palliative Care Service which began in 2006. People cared for at the Midhurst service have fewer A&E attendances, spend less days in hospital, and are more likely to die in their preferred place of care.
In Midhurst, the model has had a real impact on patients and services. An independent evaluation concluded that this improved patient and carer experience could be replicated in other areas and could even decrease the cost of care. This is currently being tested by Macmillan and partner organisations in six Innovation Centres in England.
The Macmillan Specialist Care at Home Model
This model of person-centred care, developed in Midhurst, has the following key principles:
- Consultant-led multi-disciplinary team
- Early referral to the team, often during active treatment. This allows enough time to build strong relationships, plan ahead and provide practical and emotional support when needed.
- Advance care planning is carried out routinely so everyone knows what is important for people and families.
- Clinical interventions (including blood/blood product transfusions, IV antibiotics or bisphosphonates, ultrasound, intrathecal analgesia) are provided at home or in a community setting.
- Coordination of each person’s care is a high priority
- Shared care between services and service providers – a key to a better experience of care.
- Flexible teamwork between specialists, generalists and trained volunteers in the community.
- Support for bereaved carers.
See our leaflet on Macmillan Specialist Care at Home [PDF] for more information.
We know this approach works in Midhurst – what we want to find out is whether it can be just as effective in different local contexts.
The Innovation Centres
Macmillan Specialist Care at Home is a two year initiative, supporting local services to work more effectively together and enhance the quality of care and treatment they provide for people at the end of their lives, and those around them.
Some of the key features of each centre are outlined below.
The Hull Innovation Centre is based in Hull City Healthcare Partnership CIC and works in partnership with many organisations across the city. The service is led by a community-based palliative care doctor who works within a team of nurses, palliative care pharmacist and other professionals. The doctor leads the team who assess the patient’s needs and make sure treatment and care is planned around each person’s requirements and personal choices.
The team has recently recruited a number of volunteers to help provide holistic support to people at the end of life. Read more about the service on their webpage.
The West Norfolk Centre is made up of teams from Norfolk Community Health & Care NHS Trust, Tapping House Hospice, The Queen Elizabeth Hospital King’s Lynn and Marie Curie. By working together this centre aims to deliver services that are easy to access wherever people live.
The team are currently working on effective roll-out of a patient-held advance care plan to ensure care is planned and coordinated according to people's wishes for their care.
The team are aiming to build a strong network of volunteers who will form part of the palliative care team and together deliver the best possible end of life care.
The North London Innovation Centre is based out of the North London Hospice. The team has established a Rapid Response Crisis Intervention Service which is now integrated into the existing Community Specialist Palliative Care service. Visits from two new support workers within the team have been welcomed by patients and their families as providing much needed support in the home. The team are working towards being able to provide this service seven days a week.
The team are looking to expand volunteering, building on their existing base of community volunteers, and supported by a new volunteer coordinator.
Isle of Wight
The Isle of Wight Innovation Centre is based at the Earl Mountbatten Hospice in Newport. They have increased their clinical team to support people to return home from the hospice or the hospital faster, avoiding unnecessary delays.
Their expanded team keeps in touch with people who have been assessed by a Clinical Nurse Specialist (CNS) and need regular follow-up at home. This additional contact helps to build relationships with the patient and family and helps avoid unplanned admissions hospital.
The two consultants working in the team provide welcome advice and support to patients and families and expertise to GPs and district nurses.
Birmingham and Solihull
The ethos in Birmingham and Solihull is person-centred care, developed by staff collaboration, education and responsiveness to the needs of their patients. As part of the project, some of the clinical interventions normally delivered in hospital such as blood transfusions and bisphosphonates will be offered at home, or from the Marie Curie Hospice, West Midlands, which is based in Solihull. The project will also work towards offering ultrasound scanning and paracentesis in hospices.
A new network of 20 GPs across Birmingham and Solihull are getting additional ongoing training on how they can provide the best possible quality of care for people at the end of their lives, when they need it most.
A joint initiative between the local NHS trust and Macmillan volunteer services align volunteers into health care teams to provide further support for people at the end of life. You can read more in the Birmingham and Solihull project leaflet [PDF] or on their Twitter page (@Macmillanathome).
Macmillan is working in partnership with Dudley CCG, The Dudley Group NHS Foundation Trust and Mary Stevens Hospice based in Stourbridge. The new single point of access hub at the hospice makes it quicker and easier for health professionals to refer patients to the specialist palliative care team in Dudley earlier, resulting in care that is better coordinated and puts the needs of patients first.
Macmillan and Dudley CCG have also provided funding for two new part-time consultants, who are based at the hub. The team are also supported by a wide range of existing voluntary organisation as well as some newly recruited volunteers. Read more about the Dudley Innovation Centre in their leaflet [PDF].
These enhanced services were launched in 2014 and an evaluation report will be available in 2016.
If you would like further information about Macmillan Specialist Care at Home, please contact Nicole Woodyatt, Macmillan Specialist Care at Home Programme Manager, or Becky Caicedo, Project Manager. Alternatively, please call Becky on 0207 8404734.