Dying at home the Midhurst way.

Ensuring high quality of care for dying patients and their families is a challenge for both primary and specialist palliative care services throughout the UK. A model of a consultant-led palliative care community team was set up following the closure of a specialist palliative care inpatient unit in Midhurst, with the aim of providing that same level of care to patients in their own homes, care homes and community hospitals. It works closely with primary care to enhance community services and with secondary care to enable rapid discharge from hospital to the community. Anticipatory prescribing, advanced care planning and education of social care and nursing home staff are also key aspects of the service. The Macmillan Midhurst Service costs an average of less than £3,000 per patient and enables 85% of referred patients to die in their preferred place. Evaluations of the service have highlighted benefits to patients and families as well as cost reductions to the NHS of around 20% when patients are referred early.