Manchester is among the most socially deprived areas in the UK leading to increased comorbidities, hospital attendances, admissions and deaths.¹ Deaths will increase to the levels seen in the pandemic by 2040^{2 3} with 75–90% benefitting from palliative care^{4 5} and many more home deaths expected.⁶ In 2015, North Manchester successfully piloted the ‘Midhurst Model’ of community palliative care.^{7 8} In 2018 this was extended citywide with extra funding from Macmillan, co-produced with service users.⁹

Method A service evaluation using qualitative and quantitative data in order to see if the model was successful and met the original aims and objectives.

Results Aims and objectives were mainly achieved. Patients, carers and community staff valued the regular support, 7-day service, single point of access and rapid access to support by appropriate staff. Patients/carers felt supported, respected and listened to, with less need to call other services. GPs and external staff rated the care highly. More time is needed to embed the service for district nurses. A reduction in bed days and preventable admissions was shown, with 90% of admissions deemed appropriate. More patients on the caseload were able to die at home with 89% achieving their preferred place of death. Timely identification of patients, discharge from hospital and advance care planning was promoted. Numbers on the caseloads and contacts increased exponentially. Remote reviews helped protect vulnerable patients. Work with ‘hard to reach’ (e.g. homeless) groups was undertaken. Patients were given bisphosphonates at home for malignant hypercalcaemia. Gaps identified were spiritual and level three psychological support and over representation of cancer and ‘white British’ patients on caseloads.

Conclusion The model of care worked well despite the effects of the pandemic. Financial savings are likely. Investment in community care is required going forwards.

References

1. Build Back Fairer in Greater Manchester (2021) UCL Institute of Health Equity. Available at: https://www.instituteofhealthequity.org/resources-reports/build-back-fairer-in-greater-manchester-health-equity-and-dignified-lives/build-back-fairer-in-greater-manchester-main-report.pdf (Accessed 10th Aug 2021).

2. Raleigh Veena for the King’s Fund. Invisible deaths: understanding why deaths at home increased during the Covid-19 pandemic. [Online] June 5th, 2021. Available at: https://www.kingsfund.org.uk/blog/2021/06/understanding-why-deaths-home-increased-covid-19-pandemic (Accessed June 10th 2021).

3. ONS Mortality Data. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity (Accessed Aug 10th 2021).

4. Modelling Demand for Palliative Care Service in England (2021) Sue Ryder Available at: https://www.sueryder.org/sites/default/files/2021-03/Modelling_Demand_and_Costs_for_Palliative_Care_Services_in_England%20%281%29.pdf (Accessed Aug 10th 2021).

5. Etkind SN, Bone AE, Gomes B, et al. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med 2017;15:102. Available at: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0860-2#:~:text=Based%20on%20projection%20method%202,2040%20from%206465%20to%203891 (Accessed June 10th 2021).

6. Bone AE, Gomes B, Etkind SN, et al. What is the impact of population ageing on the future provision of end-of-life care? Population-based projections of place of death. Palliative Medicine 2018;32(2):329–336. Available at: https://journals.sagepub.com/doi/pdf/10.1177/0269216317734435 (Accessed 8th June 2021).

7. Noble B, King N, Hughes P, Winslow M, Melvin J, Brooks J, Bravington A, Ingleton C, Bath P. (2012) Evaluation of the midhurst macmillan specialist palliative care service (real choice project): a community consultant led palliative care service. Macmillan Cancer Support.

8. Yorke J, Prof. A Qualitative Evaluation Report regarding North Manchester Macmillan Palliative Care Support Service (2016). Available at: https://www.mhcc.nhs.uk/wp-content/uploads/2018/08/NMMPCSS-Qualitative_report_FINAL.pdf (Accessed 8th June 2021).

9. Atak, M. Macmillan Supportive and Palliative Care Programme. Service User Report 2019–21. Available at: https://www.manchesterlco.org/app/uploads/2020/08/MMSPCP-User-Involvement-Report-Mid-Programme.pdf (Accessed 8th June 2021).

10. National Palliative and End of Life Care Partnership. 2015. Ambitions for Palliative and End of Life Care: A national framework for local action 2015–2020 and 2021–2026. Available at: https://acpopc.csp.org.uk/system/files/documents/2021-05/FINAL_Ambitions-for-Palliative-and-End-of-Life-Care_2nd_edition.pdf (Accessed Aug 10th 2021).