Background: Specialist Hospice at Home (HAH) services play an important role in the provision of care for people who choose to die at home. Methods: A pilot evaluation of a new HAH scheme in East Midlands, UK was carried out between January and December 2003, in which routine data were collected and analysed. Results: In 2003, 155 people received the HAH service. Most patients (83%) were over the age of 60 and had a cancer diagnosis (92%). Almost one-third of patients waited for 2 days or longer to receive care from the HAH scheme. These patients were around three times as likely to be in an inpatient hospice (RR = 3.27; 95% CI = 1.19?8.95) or an acute hospital (RR = 2.85; 95% CI = 1.33?6.09) when they were referred. The median length of service use was 4 days. Conclusions: The HAH service enabled people to die at home in the last days of life. Given the aging population, we would expect the demand for such services to further increase. Shortcomings identified included delay in receiving care for people moving to home from hospices and acute hospitals.