"I'm using the female side of my brain and multi-tasking," he joked to his colleague at the other end of the phone, as he opened the boot of his car and deposited all his medical equipment.

For this was no ordinary ward round. It was, in action, Dr Hargreaves' vision of treating people with serious and terminal illnesses in their own homes.

It is a pioneering health service unique in Britain, and from their headquarters at the Pearson Unit, Midhurst Community Hospital, Dr Hargreaves and his team are revolutionising the way palliative care is given to patients.

The new service was born out of the horror that was the closure of the King Edward VII hospital and its Macmillan unit.

Dr Hargreaves had arrived in West Sussex in 2002 charged with redesigning palliative medicine. And so it was that as the King Edward VII doors closed, another one opened when the Primary Care Trusts of West Sussex, Hampshire and Surrey got behind his passionate dream to regenerate the service.

A year down the line, 170 patients all over West Sussex are receiving treatment in the familiar surroundings of their own homes with their families around them, but Dr Hargreaves believes still more could be done.

"Sixty per cent of people in the United Kingdom die in acute hospitals," he said, "which is not where they want to be.

"Overall in the Uk only about 24 per cent die in their own homes and that is because we don't have enough community services to keep them at home."

The frustrating fact is that not only is it less stressful for patients to stay at home, it also looks likely to prove more economical for the national health service.

But a wall of politics and a complex system of financing makes progress slow.

"What has happened," said Dr Hargreaves, "is that cancer treatment has changed tremendously and people are living longer and longer."

But with patients undergoing this modern treatment, he said, it was vital for the health service to change to reflect new treatment.

His vision is to provide more treatments at home which are now given by nurses in hospital.

"Let's get patients out of hospitals and back at home. Doctors in hospitals are so overwhelmed by work, they don't realise how patients are feeling," he said.

"That's no way to treat them. We want to help them to come to terms with their illnesses as well as sort out their symptoms."

Now his day begins with a conference in the Pearson Unit. Alongside Macmillan specialist nurses and the clinical team of staff nurses and healthcare assistants, they plan the daily care of patients.

And then Dr Hargreaves is off on what he calls his 'virtual ward round'.
Today he is visiting 74-year-old Joan Spain, who lives in Pulborough with her 77-year-old husband David.

Joan was diagnosed with breast cancer 27 years ago. She thought she had beaten it, but it had lain dormant and seven years ago it returned and has now spread to her liver.

In the past three weeks her condition has deteriorated and the build-up of fluid in her legs has made it difficult for her to move. Fluid in her stomach has made breathing and eating difficult.

Today Dr Hargreaves is visiting with his ultra-sound machine to monitor her situation and plan the next steps of her care.

Joan is to have an electrical hospital bed delivered with a special mattress. Community nurse Mary-Anne Elliker has arrived to change her dressings and Dr Hargreaves decides it is time husband David has more back-up to dress and bathe Joan. He is arranging for daily visits from social carers.

"I get a visit from a nurse most days," said Joan, "and Peter (Dr Hargreaves) comes in to see me, too. This is so much better than how it used to be.

"We cannot speak highly enough of Peter and his team. I have got so much worse in the last fortnight and I can't explain in words the peace of mind it gives me, knowing I am staying at home."

Her husband David added: "This service is so wonderful because being able to die in your own home, with someone you love beside you, is lovely."

"Being able to deliver this care for people is one of the best things you can do in nursing," said Mary-Anne. "We feel it is a privilege."

Dr Hargreaves is confident the day is coming when chemotherapy will also be given at home and patients will have to make fewer painful and exhausting journeys to hospitals.

"This isn't about dying, it's about helping people live with serious illness and giving them as good a quality of life as possible – and not just cancer sufferers.

"There are increasing levels of liver disease and people with heart failure.

"It's about a spectrum of care earlier in patients' diseases, anticipating problems and having the right treatment in the right place at the right time."

Sadly, Joan died four days after speaking to the Observer, but she
and her family were keen for her story to be told to highlight the groundbreaking work of Dr Hargreaves and his team.