How the Comfort Tracker is helping more people stay at home in their final months, weeks and days.

The majority of people want to die comfortably at home but are spending their final days in hospital settings that were not built for non-acute care at the end of life. They are in the wrong place, at the wrong time, receiving care in a setting that does not match what their preferred wishes are.

Nobody wants this. According to Marie Curie's 2023 research, 56% of people in the UK would choose to die at home, in an environment shaped by the people they love and routines that matter to them rather than a clinical one. Yet the system too often delivers something else: unmanaged symptoms at home, families not realising what is happening, resulting in unplanned admissions, and families and clinicians reaching crisis point before help can be arranged.

Home Monitoring for end-of-life care

The Comfort Tracker is a digital tool, for patient and carer symptom and wellbeing reporting, designed to address exactly this gap. It is a model, applied to palliative and end-of-life care, developed in Sussex to provide timely, responsive support in patients' own homes. It was co-created by Dr Rachel Melsom, Macmillan Palliative and End of Life Care Transformation Lead, alongside Dr Suzanne Ford-Dunn, Palliative Medicine Consultant and Lisa O'Hara, Nurse Consultant Palliative and End of Life Care, and is delivered in partnership with Doccla.

Through short, subjective questionnaires, patients and their carers share their symptoms, comfort levels, concerns and wellbeing needs, and Doccla's operational infrastructure ensures that information is actively reviewed and acted on by the local team managing the patient as part of the multidisciplinary team structure. What that means in practice is fewer gaps between what a patient is experiencing and what their clinical team knows, and more opportunities to intervene before symptoms escalate.

Importantly, the tool supports carers as well as patients. Families play a critical role at the end of life, and the Comfort Tracker gives them a structured way to communicate what they are seeing, raise concerns, and feel less alone in some of the most difficult moments of their lives.

The programme is currently live across Sussex Community NHS Foundation Trust and East Sussex Healthcare NHS Trust, with over 200 patients supported to date and planned rollout to 1,000 patients over the next 12 months.

What feedback is showing

Early feedback from patients and carers points to three consistent themes: reassurance that someone is actively keeping an eye on them without having to visit or call, clarity about what is happening and what to expect, and a sense of not being alone.

Those experiences matter in their own right, and they also translate into system outcomes. When families feel supported and clinicians have timely visibility, avoidable hospital admissions can be prevented and more people can receive better end-of-life care in the community, at a time when hospital capacity is under extreme pressure.

Why this matters to the system

End-of-life care is a clear example of where the NHS needs to shift, and where community-based Remote Monitoring and Virtual Wards deliver both better outcomes and better value. Hospital admissions in the final months of life are often avoidable, distressing and expensive. Preventing them is not only the kinder option, it is how the system sustains itself under the pressure it is facing.

As Dr Rachel Melsom puts it:

"The Comfort Tracker app helps to reduce unnecessary admissions, empowers patients and helps us deliver the best patient care at home. In addition, it improves carer understanding of what to expect when someone dies. All this ties into the NHS 10-Year Plan: using digital technology to improve patient care and move it out of the acute and into the community setting, where appropriate."

This is the direction every NHS system is being asked to move in: from hospital to community, from analogue to digital, from sickness to prevention. End-of-life care sits at the intersection of all three, and it is one of the most meaningful places that shift can happen.

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