Background: Promoting the choice to die at home is central to UK policies and strategies and supporting this are hospice at home services of which there are variations in service composition and intervention. A bespoke hospice at home service comprising three elements: accompanied transfer home; a multi-disciplinary (including doctors) crisis intervention team and a flexible sitting service was established in the North West of England and piloted for one year. The aim of this study was to evaluate the impact of the service including its establishment.

Methodology: The retrospective cohort study and stakeholder evaluation undertaken of the pilot phase, found that of the 201 patients who received the service, 73% (132) died at home. 75 healthcare professionals (general practitioners, district nurses, community specialist palliative care nurses and hospital discharge co-ordinator) participated in semi-structured interviews, focus groups and electronic open ended questionnaires to identify their views on the service, its establishment and impact.

Results: In regard to the establishment of the service, the healthcare professionals reported that they had initially been fearful of the new service and how it could take over their role with terminally ill patients. However, this fear was unfounded and they found the service to compliment the care they could provide. This paper describes the phases of planning and designing the service, introducing the service and the pilot evaluation. Examples of good practice and lessons learnt are discussed including the importance of good lines of communication.

Conclusions: This bespoke service provides different elements of a hospice at home service, provides a tailor made package to meet individual and local area needs. The approach taken by the hospice in the establishment of the service appears to have played a key factor in its success.

Implications for practice:

• The lessons from setting up this service could be transferred to other new services not just hospice at home
• Communication with all key stakeholders is vital at all stages of the design of the service
• Developing services that meet local needs is important

This article by Catherine R Baldry, Barbara A Jack, Karen E Groves, Helen Birch and Ann Shard is licensed under a Creative Commons Attribution Non-Commercial 3.0 License.