This article describes a service development in palliative care which aims to offer practical support and caring skills to patients and their families at home. The concept of home care in the UK distinguishes between health-care and social-care needs and workers are allocated from different departments to provide that care. Such a distinction is not always clear and there is much debate about how needs are split. The continued allocation of funding from separate health and social services resources exacerbates the issue. The Macmillan Carer Scheme, which offers both health and social care to patients and their families, is an important and significant step in the move towards needs-based service development.