Macmillan specialist care at home

Macmillan Specialist Care at Home is a partnership approach to providing palliative care in community settings. 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 (see full report below).

In 2014 Macmillan launched six innovation centres in England (map below) to see if the outcomes from Midhurst could be replicated in different contexts. Investment was focused on working with local service providers to build on existing services for people at the end of life, and their carers.

Macmillan Specialist Care at Home services follow the same core principles as those piloted at Midhurst:

  • A community-based consultant leading a multi-disciplinary team with a mix of different skills to match the needs of the people they support. This could include nurses, healthcare assistants, an education role, occupational therapist, physiotherapist, counsellor, volunteer coordination and volunteers etc, depending on the needs in your locality.
  • Early referral to the team, often during active treatment allowing time to build strong relationships and plan ahead.
  • Coordination of care across service providers, often through being co-located in a centralised ‘hub’ using a virtual ward system.
  • Providing high quality care in the community to enable people to remain in their preferred place of care. Some of our centres have also trialled delivering complex interventions at home such as blood transfusions, IV antibiotics and bisphosphonates.
  • Flexible teamwork between specialists, generalists and trained volunteers in the community working in different ways to meet the needs of individual patients.
  • The ability to respond rapidly in the community to manage crisis situations and reduce inappropriate hospital admissions.

Where was Macmillan Specialist Care at Home piloted?

The Macmillan Specialist Care at Home approach was piloted in six different centres in England (see map). These centres have been evaluated throughout the project and findings from 2014-2016 are available in this report [PDF]. All centres have been successful in bringing together existing local services, enhancing their offer and enabling people to be cared for in their preferred place.

Specialist care at home innovation centres
Specialist care at home innovation centres

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I had the feeling that somewhere behind the scenes it was all superbly coordinated...it gave me the reassurance, that people who were looking after my interests were working as a team...it all seems to have been put together so that at the end of the day we’ve got a jigsaw puzzle with five hundred pieces in place.

Patient in West Norfolk

How is the Macmillan Specialist Care at Home Model improving care?

In Midhurst, this approach had a real impact on patients and services.

An independent evaluation of the Midhurst approach [PDF] concluded that this improved patient and carer experience could be replicated in other areas and could even decrease the cost of care.

Initial findings from the Macmillan Specialist Care at Home innovation centres include:

  • All centres changed their patterns of referral with most people referred to the service before their symptoms were severe. This enabled support to be put in place before a crisis occurred.
  • Co-location of teams into a ‘coordination hub’ was highlighted as instrumental to building good working relationships, ensuring continuity of care for patients, and avoiding duplication of services. 
  • Coordination of care across teams sped up response times, for example, the Specialist Palliative care hub in Dudley processed 2,949 referrals and responded to over 99% of these within five working days, with urgent referrals being seen within 24 hours.
  • Centres identified education and training as a crucial element in supporting their workforce and increasing palliative care knowledge amongst generalists.
  • Consultants in the community increased response times for patients and improved the confidence of other professionals in making effective clinical decisions at the point of need. 
  • Volunteers played an important role for patients with additional support needs that did not require clinical input. Most of volunteers’ time was spent on ‘befriending’ activities.
  • Rapid response teams played a significant role in enabling patients to stay in their preferred place of care and avoiding unplanned hospital admissions.
  • Where a preference for place of death was known, 79% of people died in that preferred place. 
  • 88% of bereaved carers felt that the person they had cared for died in the right place.
  • Nearly three quarters of carers felt that the person they had cared for had enough choice about where they died, and 77% of carers thought the person they cared for had received the help and support they needed at the time of death.

Watch Nigel and Alice's story

Nigel talks about the support he and his wife Alice received from the Midhurst service.

Further information

If you would like further information about Macmillan Specialist Care at Home, please email the End of Life Care team.