The Macmillan–Scottish ambulance partnership: driving change in end-of-life care

TY - JOUR

T1 - The Macmillan–Scottish ambulance partnership

T2 - driving change in end-of-life care

AU - McFerran, Ethna

AU - Campbell, Sandra

AU - Stork, Madeline

AU - Mackinnon, Scott

AU - Buchanan, Deans

AU - Lawler, Mark

N1 - Copyright: © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

PY - 2025/12/10

Y1 - 2025/12/10

N2 - Objectives Unnecessary hospital admissions for palliative emergencies strain resources and may not meet patients’ end-of-life preferences. This study evaluates the impact of a 3-year partnership between Macmillan Cancer Support and the Scottish Ambulance Service (SAS), launched in 2022, to strengthen community-based palliative care and establish alternative referral pathways. Methods A retrospective comparative analysis of SAS call data linked to emergency department (ED) outcomes was conducted for 2022 and 2023. We assessed changes in key metrics: acute-care hospital admissions, ambulance conveyance rates and 7-day mortality using χ2 and two-proportion z-tests. Costs were estimated using NHS data and scenario modelling of patient length of stay. Results A statistically significant 5.47% reduction in hospital conveyances was observed, equating to over 1600 fewer incidents conveyed to hospital. Estimated ambulance service savings totalled £570 871, with ED-related cost reductions from £3.6 to £5.6 million. A modest increase in 7-day mortality was noted, consistent with increasing acuity of patients managed in the community. Conclusions The SAS–Macmillan collaboration demonstrates that targeted education, alternative referral pathways and integrated community care can reduce avoidable hospital admissions and improve efficiency. The initiative offers a scalable model to enhance patient-centred, community-based palliative and end-of-life care, aligned with patient preferences.

AB - Objectives Unnecessary hospital admissions for palliative emergencies strain resources and may not meet patients’ end-of-life preferences. This study evaluates the impact of a 3-year partnership between Macmillan Cancer Support and the Scottish Ambulance Service (SAS), launched in 2022, to strengthen community-based palliative care and establish alternative referral pathways. Methods A retrospective comparative analysis of SAS call data linked to emergency department (ED) outcomes was conducted for 2022 and 2023. We assessed changes in key metrics: acute-care hospital admissions, ambulance conveyance rates and 7-day mortality using χ2 and two-proportion z-tests. Costs were estimated using NHS data and scenario modelling of patient length of stay. Results A statistically significant 5.47% reduction in hospital conveyances was observed, equating to over 1600 fewer incidents conveyed to hospital. Estimated ambulance service savings totalled £570 871, with ED-related cost reductions from £3.6 to £5.6 million. A modest increase in 7-day mortality was noted, consistent with increasing acuity of patients managed in the community. Conclusions The SAS–Macmillan collaboration demonstrates that targeted education, alternative referral pathways and integrated community care can reduce avoidable hospital admissions and improve efficiency. The initiative offers a scalable model to enhance patient-centred, community-based palliative and end-of-life care, aligned with patient preferences.

KW - Communication

KW - Education and training

KW - End of life care

KW - Home Care

KW - Hospital care

KW - Palliative Care

UR - https://www.scopus.com/pages/publications/105024849609

U2 - 10.1136/spcare-2025-005772

DO - 10.1136/spcare-2025-005772

M3 - Article

C2 - 41371760

AN - SCOPUS:105024849609

SN - 2045-435X

JO - BMJ Supportive and Palliative Care

JF - BMJ Supportive and Palliative Care

ER -