The role and value of a hospice night support service in supporting out-of-hours domiciliary   care: A qualitative study of staff perspectives

<ns5:p>Background It is important to develop an adequate evidence base regarding the resources needed to meet the complex care needs of patients dying at home, and how care might best be resourced and coordinated. Currently, however, there is little information about the nature, extent and adequacy of local and national provision, particularly of out-of-hours care. The wide variation in service models in the UK makes it hard to establish their outcomes and effectiveness. Methods This paper presents qualitative findings from a mixed methods study of a Hospice Night Support Service (HNS) that was established to extend the support provided to and by Hospice at Home and other out-of-hours services, including District Nurses and GPs, where there was previously very little provision for home care at night. It reports staff perspectives and experience of working for the HNS, and its role and value in the provision of out-of-hours hospice services. Results Participants’ accounts indicate the great potential for further development of rapid response services such as the HNS through effective integration between local hospice, health and social care services to provide a more substantial, clearly defined and essential resource for patients and family members. Conclusion Greater clarity is needed regarding the remit of Hospice at Home services such as the HNS, their best fit within local networks of palliative care, whether they are intended specifically for dying patients or more generally for those who are frail and vulnerable, and the extent and sustainability of long- term family care for severely ill patients dying at home.</ns5:p>