Aims To meet the needs of the increasingly aged frail population (projected to almost double by 2050), an integrated population-based end-of-life care service, founded on Gold Standards Framework (GSF) principles and the Ambitions Framework is using a collaborative approach to learn lessons, address inequity and build on its solid foundations.

Methods Mid-Notts End of Life Care Together Alliance (EOLCT) spread GSF to GP practices and care homes, mainstreaming a proactive approach, later spread to the wider Notts Integrated Care System/ICS population. Local hospices are working in partnership with community, third sector and acute sector organisations to lead development and expand capacity and flexibility of the service. The partners led on advance care planning, Respect implementation, a new ICS end of life strategy, a co-designed care-co-ordination service and regular interdisciplinary training for all care providers. Progress in population-based end-of-life care was assessed using robust comparative audits of digital record-sharing (EPaCCS) data against whole-system GSF end-of-life care metrics.

Results Nottinghamshire data shows (trend 2019- 2021)

• Earlier patient identification (0.22-0.66%).

• Earlier and increased advance care planning (ACP) discussions and improving quality Respect forms (audited).

• Those on register attaining preferred place of care/death (54.7-67%).

• Reduced hospitalisation and system resource savings (10%Quipp).

• Better outcomes for individuals (commendations, fewer complaints).

• Nottinghamshire’s use of GSF and ACP laid the foundations for a later robust, generalist-led response to the COVID-19 pandemic.

Conclusion A key challenge for our health/social care systems is responding to the increasing care needs of frail co-morbid patients. Our strong foundations enabled quick integrated responses for the most vulnerable during the COVID-19 pandemic, toolkits for primary and social care at the onset and increased resilience and sustainability thereafter.