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One of the biggest challenges today for both councils and primary care trusts is how to provide the best acute care possible, while at the same time, preventing hospital overcrowding. A partnership between Rotherham MBC, Rotherham PCT and Macmillan Cancer Support is providing an integrated health and social care team to care for people, who are at the end of their lives, in their own homes. The Hospice at Home Service in Rotherham ensures all palliative care patients receive high-quality and co-ordinated care, 24 hours a day, seven days a week. Macmillan's regional development manager, Paul McCavana, says the charity has funded the scheme with £430,000 over a three-year period, which started last year. The scheme was launched after local public health figures revealed mortality and chronic illness in Rotherham was far higher than the national average, with a disproportionate number of people from ethnic minority groups, or those with learning disabilities or mental health problems having palliative care needs. The philosophy behind the scheme was to help family and loved-ones care for patients at home, in a supportive environment. Mr McCavana says there are an estimated 30,000 carers in Rotherham, out of a total population of around 252,000. ‘Often, people don't recognise they are carers,' he says. ‘Nationally, one in five people are carers, but they don't often perceive themselves to be one. ‘This service originated at Rotherham Hospice,' he adds. ‘It came up because there was a real need for people at the end of their lives to get the right support and prevent them from going back to hospital.' Emotional and social support is given to the patient, their family and carers. ‘There's an emotional side to this as well,' says Mr McCavana. ‘Often, people just want to tell their story, so having somebody there to listen can be quite a useful thing. ‘We are hoping we can prove the worth of this service,' he adds. ‘From an economic point of view, it should avoid unnecessary hospital admissions, so we are reducing costs.' He hopes the PCT will carry on funding the scheme once the initial money from Macmillan has run out, in two years time. Mr McCavana says the charity is also involved in 40 similar schemes across the country, with the Crossroads Partnership. The scheme offers six hours of care a week, at any point between 8am and 10pm, to suit individual needs, and according to staff availability, for a period of six weeks. If a patient or carer prefer, one or two nights a week can be offered instead, and the service is completely free of charge. A district nurse retains overall responsibility for the patient, and visits regularly. With the help of funding from the charity and Rotherham PCT, there are six generic support workers as part of a supporting carers scheme, which will allow people to live and die at home. Funding has also been agreed for an equalities link worker, who will focus on the palliative care needs of black and ethnic minority groups. A steering group also meets monthly to discuss project development, outcomes and measures. Macmillan Cancer Support also works in partnership with other councils. Two full-time welfare rights advisors have been employed by Barnsley MBC to give benefits advice to residents diagnosed with cancer, following a grant of £160,000 from Macmillan Cancer Support. It is estimated that £126.5m in disability benefits go unclaimed every year in the UK by people with a terminal illness. ‘Studies by Macmillan show that financial concerns are second only to physical pain as a cause of stress for people with cancer and their families, so we are very pleased that Barnsley has recognised local need by supporting these posts,' says Mr McCavana. ‘The financial pressures are huge. We have done some research which shows that one in 17 people will lose their homes because of cancer, and one in six will get into mortgage arrears.' Mr McCavana says the charity is also talking to Rotherham MBC about launching a similar service there. And the charity is already running similar advice services in Doncaster and Derbyshire. ‘We see our role as getting these services off the ground, and being the starting point,' he says.

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WHITEHALL

Allowing a dignified exit

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