Background Our statistics showed that the average length of time from referral to death in March 2017 was 1–2 months. This represented too many patients missing out on support and planned end of life care. We hypothesised that by engaging with more people, earlier we might reduce the stigma around engagement with hospice services.

Aims Our aim was to increase the number of people accessing the Living Well Services over a six-month period.

Methods After considering which activities attracted more referrals and listening to our users we relaunched our original day services as ‘Living Well Services’. The programme of activities offered was enhanced to offer more of our popular activities such as physiotherapy supervised exercise groups, Fatigue and breathlessness courses, Creative Cafes, singing and Tai Chi. We used community collaborations to deliver some of these activities. We also complemented our day service with a support group for patients with complex neurodegenerative conditions. We presented our new service to community colleagues, targeting disease specific groups such as pulmonary rehab courses where we delivered education on ‘Living with Long Term Conditions’, the Heart Failure CNS team at the acute trusts, as well as pre-established links with the local Navigator for Complex Neuro. We also opened all our Living Well services to self-referrals and improved our website to encourage engagement.

Results Over the period October 2017 to March 2018 the total number of attendances at the Living Well services increased from 340 to 667 representing a 96% increase. This included seven self-referrals. The caseload increased from 131 to 186, a 42% increase. Our non -cancer referrals increased from 38% in October 2017 to 48% in March 2018.

Conclusions We will review first referral to death times in a year to confirm that the significant increase in earlier engagement carries through.