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Persistent inequalities in Hospice at Home provision
  1. Jackie Buck1,
  2. Liz Webb2,
  3. Lorraine Moth2,
  4. Lynn Morgan2 and
  5. Stephen Barclay3
  1. 1 Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
  2. 2 Arthur Rank Hospice Charity, Cambridge, UK
  3. 3 Primary Care Unit, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Jackie Buck, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK; J.Buck{at}


Objective To describe the nature and scope of a new Hospice at Home (H@H) service and to identify its equality of provision.

Methods Case note review of patients supported by a H@H service for 1 year from September 2012 to August 2013 (n=321). Descriptive analysis to report frequencies and proportions of quantitative data extracted from service logs, referral forms and care records; thematic analysis of qualitative data from care record free text.

Results Demand outstripped supply. Twice as many night care episodes were requested (n=1237) as were provided (n=613). Inequalities in access to the service related to underlying diagnosis and socioeconomic status. 75% of patients using the service had cancer (221/293 with documented diagnosis). Of those who died at home in the areas surrounding the hospice, 53% (163/311) of people with cancer and 11% (49/431) of those without cancer received H@H support. People who received H@H care were often more affluent than the population average for the area within which they lived. Roles of the service identified included: care planning/implementation, specialist end-of-life care assessment and advice, ‘holding’ complex patients until hospice beds become available and clinical nursing care.

Conclusion There is significant unmet need and potentially large latent demand for the H@H service. People without cancer or of lower socioeconomic status are less likely to access the service. Action is needed to ensure greater and more equitable service provision in this and similar services nationally and internationally.

  • primary health care
  • palliative care
  • home care services
  • hospice and palliative care nursing
  • health inequalities

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  • Contributors LMot, LMor, LW and SB conceived the study. All authors contributed to the study planning and design. JB contributed to data collection. JB analysed and interpreted the data with input from SB. JB wrote the manuscript with input and feedback from SB, LMot, LMor and LW.

  • Funding The study was jointly funded by the Arthur Rank Hospice Charity and the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care Cambridgeshire and Peterborough (CLAHRC CP) Programme, which was recommissioned as NIHR CLAHRC East of England in 2014.

  • Disclaimer The opinions expressed are those of the authors and not those of the NHS, the NIHR or Department of Health.

  • Competing interests This study was undertaken by the Palliative and End of Life Care Research Group of the University of Cambridge. It was part-funded by the Arthur Rank House Hospice Charity who part-fund the H@H service. LW, Mot and LMor are employed by the Arthur Rank Hospice Charity.

  • Ethics approval This study was approved by the Chair of a Local Research Ethics Committee (LREC) to be service evaluation and not to require LREC approval. The research team followed standard procedures for the ethical conduct of research involving the use of patient-identifiable information.

  • Provenance and peer review Not commissioned; externally peer reviewed.