Challenge how to sustain outstanding end-of-life care in a rural county dealing with rising demand, an ageing population, increased complex comorbidities, tightening funding and finances and a diminishing skilled workforce.

The review a controlled collaborative, system wide partnership, with open and democratic stakeholder engagement and review lasting over 12 months. A panel of key engaged committed members, including: patients, carers, MPs, health and social care services, charities, faith groups, commissioners, GPs, specialist practitioners and the wider workforce including volunteers.

Critical success factors:

• Keeping patients and carers as our focus

• Partner relationship building with early participation

• The creation of excitement and new thinking by being brave and challenging the status quo

• High quality project management and external support

• Sustainability.

Wide ranging evidence and data has come from: external speakers, clinicians, patients, carers and families, and the general public through structured stakeholder engagement events, focus groups and surveys and analysis through desk top research by external consultants.

Outcomes Key themes are emerging and being developed which will lead to a new sustainable model of care with a countywide, cross agency partnership approach, sharing resources and innovations, with patient care as the driver

• A blended solution, with the hospice as a central enabler, to facilitate a caring network that will provide secure "touchpoints" of professional care and support when and where it has the most impact

• New community-based solutions: supporting early and timely referral, care closer to home using

• Collaboration and interoperability with the wider community: macro partnerships with micro- enterprise solutions

  • Innovation and digital connectivity

  • The workforce including volunteers

• Fundraising including income growth, branding and marketing

Reinforced Learning: Collaborate… or deteriorate!