Palliative Care at Home in Greenwich

Palliative care at home means arranging skilled support so that a person with a life-limiting illness can remain in familiar surroundings, with their symptoms managed well and their wishes respected. For families in Greenwich, that often means coordinating between a home care agency, the district nursing team, a GP, and sometimes Queen Elizabeth Hospital Woolwich or the broader Lewisham and Greenwich NHS Trust. It is practical work, and it matters enormously.

The goal is not simply to keep someone at home. It is to make sure that pain is controlled, that personal care is given with competence and consistency, that medication is administered safely, and that the people who love the patient are not left to manage clinical decisions alone. A good palliative care package at home includes all of that.

Families searching for this kind of support in Greenwich are usually doing so under pressure — often after a hospital admission, sometimes following a sudden deterioration, occasionally after a long period of uncertainty. There are roughly 110 CQC-registered home care agencies operating in this area ^[4], which means there is real choice, but also a real need to find the right fit quickly. CareAH exists to make that search manageable: a marketplace where you can compare agencies that are already registered, vetted by the regulator, and covering the Greenwich area. The platform does not deliver care itself; it connects families to agencies that do.

Queen Elizabeth Hospital Woolwich is the main acute hospital serving Greenwich residents and is managed by Lewisham and Greenwich NHS Trust. When a patient with a life-limiting illness is admitted there, the clinical team will typically begin discharge planning as soon as the person's condition is stable enough to consider it ^[8].

Hospital discharge for palliative patients in England operates under a structured pathway framework. Pathway 1 means the patient can return home with a package of community support — this is the route most relevant to families seeking palliative home care. Pathway 2 involves a short-term placement in a bed-based setting before returning home. Pathway 3 is for those who need ongoing inpatient care. Where a person is well enough to go home but needs assessment and support to be put in place, the Discharge to Assess (D2A) model may apply: care is arranged quickly to enable discharge, and a full needs assessment follows at home.

Once home, the NHS Continuing Healthcare (CHC) framework becomes important ^[2]. If a person's primary need is a health need — rather than a social care need — they may be eligible for NHS-funded care, assessed against the National Framework for NHS Continuing Healthcare ^[3]. The Lewisham and Greenwich NHS Trust integrated care teams and Royal Borough of Greenwich adult social care work alongside each other in these assessments.

District nurses attached to local GP practices carry clinical oversight of patients at home. A palliative home care agency works alongside them — not instead of them. The agency provides personal care, medication prompts, overnight support, and continuity of presence. Clinical decisions remain with the NHS clinical team. Getting clear on this boundary from the outset helps families avoid confusion when care needs change.

Palliative care at home requires a specific set of competencies. When assessing an agency, look beyond general statements and ask for evidence.

Regulatory status Under the Health and Social Care Act 2008 ^[6], it is a criminal offence for an organisation to provide regulated personal care in England without being registered with the Care Quality Commission ^[4]. Every agency listed on CareAH is CQC-registered. An unregistered provider is operating illegally — do not use one regardless of cost or convenience. You can check any agency's registration and inspection reports directly on the CQC website ^[4].

Staff training specific to palliative care Ask whether staff have completed end-of-life care training beyond basic mandatory courses. Ask specifically about training in recognising deterioration, supporting families in distress, and following advance care plans.

Continuity of carers Frequent carer changes are distressing for patients and families at this stage. Ask how many different carers would routinely visit, and what the handover process looks like.

Medication support Ask whether the agency can support with prescribed medication, including when and how they would escalate to a district nurse or GP if something changes.

Availability Palliative care needs do not follow business hours. Confirm whether the agency can provide overnight care, weekend cover, and 24-hour on-call support.

Communication with NHS teams Ask how the agency shares information with the district nursing team and GP. Good palliative care at home depends on that communication being consistent and timely.

Advance care planning Confirm the agency is familiar with documents such as an Advance Decision to Refuse Treatment (ADRT) or a DNACPR, and that staff know what to do if either is in place.

Funding for palliative home care in Greenwich can come from several sources, and it is worth understanding each before committing to an arrangement.

NHS Continuing Healthcare (CHC) If your relative's primary need is a health need, they may qualify for full NHS funding under the CHC framework ^[2][3]. A fast-track CHC assessment can be requested urgently for people who are deteriorating rapidly — ask the GP or hospital team at Queen Elizabeth Hospital Woolwich to initiate this if you believe it applies. Free, independent advice on CHC eligibility is available from Beacon ^[10].

Local authority funding Royal Borough of Greenwich has a duty under the Care Act 2014 ^[5] to carry out a needs assessment for anyone who may need care and support. If your relative qualifies for local authority funding, the amount they contribute depends on their finances. The current upper capital threshold is £23,250; below £14,250, no contribution is expected from capital ^[1]. For a Care Act 2014 needs assessment, search 'Royal Borough of Greenwich adult social care' for current contact details and opening hours.

Direct Payments If your relative is assessed as eligible for council funding, they can request a Direct Payment ^[9], which gives more control over how and from whom care is arranged.

Self-funding Families who fall above the capital threshold will initially fund care privately. CareAH allows you to compare agencies and their fee structures across domiciliary care agencies in Greenwich.