Introduction The pilot service delivered tailored care and support at home for terminally ill people and their families. Locally coordinated support included nursing care, personal care, emotional support and practical information delivered by a team of registered nurses, healthcare assistants, health and personal care assistants and trained volunteers. An anticipated benefit was a changed pattern of use across health and social care, reducing the use of acute services and increasing the number of patients able to die at home.

Aim The evaluation aimed to address patient and carer experience, quality and costs of the service.

Methods A mixed-methods methodology was used to analyse service use and outcomes across the pilot. Stakeholder, healthcare professional and service user surveys and interviews were carried out to create case studies and analyse service quality. Data linkage was carried out between 153 patients supported by the pilot and their matched controls (who died before the start of the pilot service) to assess the impact of the integrated service on hospital use and place of death. Finally, economic analysis used cost per activity from NHS Scotland Health Services to estimate potential savings.

Results The evaluation evidenced improved quality outcomes for patients and a changed pattern of hospital use. Significantly fewer patients in the pilot group experienced a hospital admission (27%), compared to their matched controls (40%) with a shorter average stay in hospital (2.5 days less per admission) and more time in the community (15.8%). Furthermore, significantly more patients in the pilot group (73.7%) died at home, compared to their matched controls (29.1%). The economic analysis showed a potential annual reduction in the costs of end-of-life care in Fife of £182,283.

Conclusion The integrated service model demonstrates that investment in coordinated palliative care services delivers positive outcomes in quality of care and health economics.