Introduction Recognition that someone is entering the last year of life enables access to Palliative and End of Life Care (PEoLC) including advance care planning. There is currently under-identification of people in the last year of life. The NHS Community Trust covers a population of 1.1 million. Numbers of people identified as being in the last year of life have increased significantly since 2014, with strategies including staff education, use of the ‘surprise question’ and development and support of a PEoLC Champion in each service. However under-identification continued.

Aim To enable access to PEoLC through improved identification of the patients known to the Trust who are likely to be in the last year of life.

Method In May 2018 there was a ‘Hard Reset’ week: senior trust management required the PEoLC Champion in each service to lead a review of the Systm1 clinical record of every adult on the community caseload and inpatients, using the surprise question and document the outcome on Systm1. They were supported by locality managers, clinical leads and specialist palliative care nurses. Data was captured from Systm1.

Results In May there was a considerable increase in number of people newly identified as being in the last year of life (857) which was most noticeable in non-cancer services, such as heart failure service (171) and speech and language therapy service (55). Overall there was a 43% increase in people newly identified in the three months following the hard restart (1065) compared with the three months before (745).

Conclusion The Hard Reset method increased numbers of people identified as being in the last year of life which has been sustained several months later.

Next steps To sustain this improvement and ensure that those identified are able to access PEoLC.