Offering people at the end stages of life the chance to die in their own homes is acknowledged good practice and can bring comfort to terminally ill people, but it can also be a hard choice to sustain. Carers may find it extremely difficult to cope with the emotional ordeal of losing a loved one and dealing with the medical problems that are involved but their voices are infrequently heard. This study reports an evaluation of an out-of-hours service operating in one primary care trust in north east England, and focuses on the use of a telephone support service, which backed up domiciliary visits by specialist palliative care nurses. Interviews, focus groups and an open-ended questionnaire were carried out with 27 participants. Results revealed that staff, patients and carers appreciated being able to telephone the service (reactive). In addition carers felt particularly well supported by the service staff who proactively telephoned them on an agreed basis as part of the highly individualized telephone monitoring scheme. Such services support the call for the creation of a whole system approach for both palliative care patients and their carers.