These are the reviews published by the Kent, Surrey & Sussex Clinical Senate from 2013 to 2021.
The Kent, Surrey & Sussex Clinical Senate mergered with the Hampshire Thames Valley Clinical Senate in July 2022 to become the South East Clinical Senate.
Review of the pre-consultation business case for Ophthalmology Services for East Sussex CCG: September 2021
More than 1.5 million people in England have reduced vision. It is estimated that this figure will double by 2050. The population is ageing and one in five people aged over 75 and half of people aged over 90 live with sight loss.1 Lack of IT connectivity causes difficulties receiving referrals directly from optometrists and sharing information for advice, guidance and shared care.
Nevertheless, ophthalmology referrals to hospital eye services rose just over 12% from 2013/14 to 2017/18 and now account for 8.2% of outpatient appointments. More treatments for chronic ophthalmic disease are available that require regular, timely attendance to prevent permanent visual loss, contributing to capacity issues. The processes for the commissioning and provision of eye health services across pathways of care are fragmented, with fragmented solutions for different parts of a pathway of care operating in silos. This results in inconsistency, delays, waste and unwarranted service variations, with governance and quality assurance issues at boundary handovers between steps along the care pathway. To reduce variation in access and outcomes, systems are expected to implement whole pathway transformations and improve performance in Eye Care with support via the National Pathway Improvement Programme.
The East Sussex population has an elderly, multiply comorbid, demographic driving demand for ophthalmic services which include diagnosis, treatment and prevention of conditions that affect the eye and visual system. While there are many clinical conditions that can affect the eye and its surrounding structure in people of all ages, many eye conditions are age-related, making eye health (ophthalmology) services increasingly important as people get older. The prevalence of medical retinal disease (macular degeneration and diabetic retinopathy), glaucoma and cataracts are all significantly higher in the East Sussex population than the England average. East Sussex CCG
currently commissions ophthalmology services from the 3 hospital sites in East Sussex Hospitals Trust (ESHT) and through community and primary healthcare providers (optometrists and minor eye conditions services). The changing needs of the population, the changing nature of ophthalmology care and the associated challenges in providing ophthalmology services have made the redesign of ophthalmology a key priority for the East Sussex system.
Review of the pre-consultation business case for Cardiac Services for East Sussex CCG: August 2021
Cardiovascular Disease (CVD) has been highlighted in the NHS Long Term Plan as one of the 8 clinical priority areas and cardiac services was one of 14 areas identified for rapid establishment of networks to support emergency and urgent care during a pandemic surge as part of COVID-19 preparedness. The long-term vision for cardiac services in the South East region builds on the nationally identified optimum model of care for cardiac services, and on the national COVID-19 emergency preparedness networks. This vision aims to integrate cardiac care and embed collaborative cardiac systems of working, delivering on the ambitions of the NHS Long Term Plan.
Currently, acute cardiology services are focused around hospitals rather than care pathways. Moving to a network model, shaped by local need rather than geography, is aimed at delivering more equitable, accessible high-quality care and improved outcomes.
The East Sussex population has an elderly, multiply co-morbid, demographic driving demand for cardiac services. The changing needs of the population, the changing nature of cardiology care and the associated challenges in providing cardiology services have made the redesign of cardiology a key priority for the East Sussex system. The proposed transformation includes faster access to an expert opinion at the “front door”, recovery of services impacted by COVID-19, and improved outcomes for patients (including reduced hospital length of stay and reduced waiting times).
The strong recommendations from East Sussex Healthcare Trusts (ESHT) Getting It Right First Time (GIRFT) cardiology review were to consolidate cardiac laboratory services and inpatient beds onto one site and ensure they provide clearly defined chest pain and electrophysiology patient pathways for the provision of timely best quality emergency treatment.
The East Sussex Case For Change outlined the key drivers behind the need for the current service to change, providing a basis for local patient and clinician engagement which highlighted 4 key themes in provision of cardiac services: the care provided; equality and diversity; access and transport; and the clinical services themselves.
Access and provision of primary Percutaneous Coronary Intervention (pPCI) in Kent and Medway: May 2021
A discussion was held with the SE Clinical Senates’ Councils, South East Coast Ambulance service (SECAmb), specialised commissioning and the recently established cardiac network representatives about the inequalities in patient care in ST-elevation Myocardial Infarction (STEMI) across the part of the region that South East Coast Ambulance service cover in response to issues/concerns raised by SECAmb with respect to the primary Percutaneous Coronary Intervention pPCI pathway.
Joint Clinical Senate Review of Improving Health Together: Advice on proposals for consolidating acute renal services within South West London, Surrey Heartlands and Frimley ICSs Report: May 2021
The Improving Healthcare Together 2020 to 2030 programme (IHT) was set up by the predecessor bodies to NHS Surrey Heartlands and NHS South West London CCGs in January 2018 to find the best solutions for the long-standing issues facing Epsom and St Helier hospitals.
NHS Surrey Heartlands and NHS South West London CCGs asked the Clinical Senates of London and the South East (Kent Surrey and Sussex), to provide independent advice on their proposals to improve the future of acute services in the combined geographies of Sutton,
Merton and Surrey Downs CCGs. These services are provided by Epsom and St Helier University Hospitals NHS Trust.
The Clinical Senates have previously provided their advice in two stages:
• Stage 1: September 2018: Review of the issues paper and supporting technical annex (case for change for acute service reconfiguration, clinical model and solutions development) to ‘Improving Healthcare Together 2020-2030’
o A desktop review of the emerging content in parallel with public engagement to inform furtherdevelopment for the pre-consultation business case (PCBC).
• Stage 2: March 2019 Formal review of Draft PCBC
o The Senates reviewed the draft PCBC limited to shortlisted service configuration solutions inclusive of the clinical models for: A&E Urgent and Acute Care (inclusive of critical care, renal, acute medicine etc.), Planned Care, Maternity, Paediatrics.
As part of the acute service reconfiguration plans it was proposed that renal inpatient services provided by Epsom and St Helier would move from St Helier to Sutton, alongside other acute hospital inpatient services. This proposal formed part of the decision-making
business case presented to and agreed by South West London CCG and Surrey Heartlands CCG at a Committee in Common meeting in July 2020.
Subsequently, clinical and managerial leads at Epsom and St Helier and St George’s have made a statement of support for a joint specialist renal inpatient unit, to be located at St George’s hospital. NHS Surrey Heartlands, NHS South West London CCGs, NHS England specialised commissioning and North East Hants and Farnham CCG asked the Clinical Senates of London and the South East (Kent Surrey and Sussex), to provide a further independent review on their proposals and options therein to merge the acute renal inpatient services currently provided separately at St Helier Hospital and St George’s Hospital Tooting to the St George’s hospital site, rather than the scheduled transfer of renal inpatient services provided by St Helier Hospital to the new hospital site at Sutton.
Review of town centre primary care proposals for Eastbourne and Hastings: August 2019
The two CCGs of East Sussex, Hasting and Rother, and Eastbourne, Hailsham and Seaford, identified the need to develop a consistent networked model for urgent care, that is aligned with the requirements set out in key national documents, including the NHS Long Term Plan and the prior Five Year Forward View. This involves the establishment of urgent treatment centres (UTCs), and the NHS 111 service alongside a Clinical Advisory Service (CAS). There are agreed plans to establish a UTC on the site of the Conquest Hospital in Hastings, and at the Eastbourne District General Hospital.
In parallel, there are major changes being directed nationally to the way primary care and community services are delivered and better integrated, also outlined in the NHS Long Term Plan and the General Practice Forward View. This involves the establishment of Primary Care Networks, improved access, and integrated care hubs, that will ensure patient centred, coordinated and integrated care for the local population and ‘fully integrated community-based healthcare’.
This context has required the CCGs to review the status of their current ‘Walk-In Centres’ (WICs).
Whilst there is no standard definition of an NHS WIC, Monitor defined them as ‘a site that provides routine and urgent primary care for minor ailments and injuries with no requirement for patients to pre-book an appointment or to be registered at the centre or with any GP practice’.
WICs are classified as type 4 A&Es in the NHS Data Dictionary (though they are far from the normal understanding of A&E) and provide primarily a same day GP-based service to attendees.
Current NHS England guidance is that: ‘it is expected that 100% of Type 3 & 4 A&E services should either meet the UTC standards, become another alternative non-urgent primary or community based service, or close by December 2019. Any exceptions to achieving this timeframe should be signed off by the Regional Director.’
Joint Clinical Senate Review of the Improving Healthcare Together 2020-2030 Pre-Consultation Business Case for Surrey Downs, Sutton and Merton CCGs: March 2019
The South East (Kent, Surrey and Sussex) and London Clinical Senates were asked to jointly review the ‘Improving Health Together’ (IHT) pre-consultation business case (PCBC) and its proposals for health services in the three clinical commissioning groups (CCGs) of Surrey Downs in Surrey, and Sutton and Merton in South West London. The proposals underpin a substantial change programme to provide sustainable hospital services in South West London and Surrey Downs. A multi-disciplinary independent review panel of health and care professionals with a wide range of experience and representatives of service users and carers was brought together to review the PCBC.
Future Acute Stroke Services in Kent and Medway: A Clinical Senate review of the STP’s preferred option for Stroke Service Configuration: November 2018
The South East Clinical Senate has previously undertaken a number of independent clinical reviews of stroke care for Kent, Surrey and Sussex, and specifically for Kent and Medway it previously was invited to review the draft case for change, and more recently the pre-consultation business case before it went to public consultation. We were delighted to then be asked to provide this independent clinical review of the draft decision making business case, specifically the preferred option within it for three hyperacute and acute stroke units for Kent and Medway.
The stroke programme board, clinical reference group, commissioners, providers and other stakeholders have undertaken a very thorough, measured and collaborative approach to developing their proposals for future stroke care, with the goal of providing the highest quality care for stroke patients in the future, and this is reflected in the draft decision making business case, that was shared with us for review.
The clinical senate has taken both a broad pathway and population based perspective, and a detailed focus on specific elements of the pathway and service, and considered the impact on patients from across the county, and for those hospitals that would not have a stroke unit on site.
We have made recommendations around the prevention strategy, the acute period, post-stroke rehabilitation and implementation.
Joint Clinical Senate Review of the Case for Change and Clinical Models for Surrey Downs, Sutton and Merton CCGs: August 2018
At the request of the ‘acute sustainability programme’ (ASP) led by the three CCGs of Surrey Downs, Sutton and Merton, the South East and the London clinical senates undertook an independent clinical review of the case for change clinical models and potential solutions for hospital based healthcare in their geography. The purpose of the review was to aid the ASP in ensuring that the planned pre-consultation business case was robust, evidence based, sustainable, took account of the local, regional and national context and imperatives, and would maintain or improve patient outcomes as determined by the relevant standards and metrics.
In the time available to undertake this clinical senate review a ‘desktop’ approach was taken, where available members of each of the two clinical senate councils separately reviewed the document provided by the ASP, called ‘Improving Healthcare Together 2020-2030, Issues Paper Technical Annex: Case for Change, Clinical Model and Development of Potential Solutions, v1 draft for discussion. Surrey Downs, Sutton and Merton CCGs, June 2018’. Key lines of enquiry provided the framework for this review. The discussion and notes from both clinical senate councils were combined, and key themes were drawn out and presented in this report back to the ASP.
Helping Patients and Staff to Stop Smoking: The Essential Role of Acute Hospitals: January 2018
Future acute stroke services in Kent and Medway: A clinical senate review of the STP’s draft proposals prior to public consultation: January 2018
The CCGs of Kent and Medway (K&M) through their Sustainability and Transformation Partnership (STP) have agreed on the need to centralise acute stroke care in hyperacute stroke units (HASUs) and acute stroke units (ASUs), in order to achieve the significant improvement in patient outcomes seen in other parts of the country who have undertaken such service change. K&M have previously produced a strong case for change for stroke services, following a previous clinical senate review of the draft case for change from which a series of recommendations were incorporated into the final document. The Kent and Medway health system have undertaken a detailed and lengthy review of how the aims can be achieved, and have agreed on the need to move from the current configuration where six of the current seven acute hospitals provide acute stroke services without HASUs or ASUs, to one where there are three hospitals providing a combined HASU and ASU.
Through a well defined process, they have moved from a long list of 20 combinations of three acute hospitals, to a medium list of 13, and subsequently to a short list of five options, using various ‘hurdle criteria’.
Prior to progressing these shortlisted options to the regional investment committee and then to public consultation, the South East Clinical Senate was asked to provide an independent, clinical review of the proposals, to ensure that they and the underlying model for stroke care in K&M are clinically sound and sustainable.
Improving Clinical Communications Between Primary and Secondary Care Clinicians: A review and recommendations for the Sussex and East Surrey STP: December 2017
The way that clinicians work together in providing care to individual patients, and how they communicate with each other, is vital to providing an integrated, coordinated, patient-centred approach, and for delivering the best experience of care and outcomes for patients.
Phone calls and conventional letters have been the default means of communication for decades, whilst over time technological changes, increasing specialisation, the need for every greater efficiencies, changing organisational and professional boundaries, and changing patient expectations, have ceaselessly evolved.
In recognition of this, the Sussex and East Surrey STP sought a clinical senate review of how patient-related communications between clinicians could be optimised across its footprint.
The review’s focus was on three primary means of communicating about patient care: telephone, email, and shared access to integrated health care records (formerly known as electronic patient records). Many of the findings and recommendations in this report relate
simply to the better use of existing modes of communication, more reliable processes, and greater transparency and ease of access to each other. In addition, the importance of clear and timely discharge summaries and clinic letters, co-development of patient pathways, and
more opportunities for GPs and consultants (in particular) to interact face to face, will result in higher quality care, a better understanding of each other’s ways of working and needs, and a reduction in avoidable and time consuming supplementary requests for advice.
Whilst the review focussed on the inter-professional communications between primary and secondary care clinicians, many of the findings would equally apply to communications with community health care and social care professionals. Furthermore, whilst this review was undertaken for a specific STP, the issues identified, and the recommendations, can equally apply to other STPs across the country, though recognising that different areas and organisations have evolved their own ways of working, and may require different solutions and focus from others: one size certainly does not fit all. The benefits of STP-wide solutions and approaches to this issue should be emphasised, and would contribute to the shared clinical culture and practice that STPs can foster.
South East Clinical Senate Emphasising Quality, Delivering Value: July 2017
The concept of ‘value’ in health care is taking centre stage as one of the keys to sustainable health services in 21st century. Thanks to the pioneering work of Michael Porter and Robert Kaplan in the USA, and the vision, inspiration and influence of Professor Sir Muir Gray in the UK, there is increasing recognition that what health services now need to focus on is delivering value for patients and the population, defined as the achievement of the best patient-defined outcomes for the expended resources.
We are only at the early stages of developing methodologies to assess value, which requires a re-definition of meaningful outcomes from health care interventions (prevention, diagnostics and treatments), enablement of more active participation of patients in deciding on their best treatment through shared decision making, and having a better health economic understanding of the full pathway costs of the different treatment options available.
The South East Clinical Senate recognised that there is a low level of awareness of this value paradigm amongst health care professionals, and undertook to produce this briefing document to enhance understanding of the benefits of the value-based approach to healthcare, and make recommendations as to how clinicians in the region can take this forward in partnership with their patients and population, and managerial colleagues. It is hoped that this briefing document will help clinicians in taking forward the understanding and promotion of
value in to their own practice and areas of influence.
Reducing avoidable hospital based care: re-thinking out of hospital clinical pathways: November 2016
Improving health outcomes, preventing serious illness, providing convenient, timely and cost effective care, and avoiding the unnecessary use of acute hospitals, is a shared goal across the NHS, and requires a radical re-think about how and where care is delivered, for both acute and long term conditions. The design and implementation of high quality community-focused clinical pathways now requires the full range of health and social care professionals and their organisations to work together, alongside patient and public partners. New ways of working are required that maximise the impact of available staff, facilities and resources, and creative and innovative but realistic models of care need to be implemented. This report is intended as a guide for all stakeholders to improve clinical pathways and develop models of care that are less dependent on acute hospitals. Its recommendations are relevant to both acute and long term condition pathways. The report provides a detailed guide to managing acute symptoms and acute conditions out of hospital where safe and appropriate to do so. It also provides detailed guidance on effective common city based pathways for three common long term conditions: heart failure, respiratory conditions and patients living with and beyond cancer. The key requirements for and potential of community based clinical hubs are also described. This report complements the Urgent and Emergency Care Review and its ‘Safer, Faster, Better’ report, and anticipates some of the learning expected from the national Five Year Forward View vanguard sites that relate to joined up working between primary, community and hospital care.
Hospitals without acute stroke units - implications and recommendations: January 2016
The South East Clinical Senate review for Surrey CCGs which addresses the generic question of how high quality, safe and appropriate care can be ensured for patients developing a stroke in populations where their local hospital does not have both a hyper-acute and acute stroke unit.
The South East Clinical Senate review of future stroke services in Sussex: December 2015
Sussex Collaborative sought advice from the South East Clinical Senate (SECS) about their plans for future stroke services in Sussex. Sussex Collaborative sought advice from the South East Clinical Senate (SECS) about their plans for future stroke services in Sussex. The review ensures that current proposals reflect best practice, are sustainable and fit for the future, and have appropriately considered the clinical relationships with adjacent stroke and other clinical services. The SECS report includes a review of the methodology used by the Sussex Stroke Clinical Reference Group (SSCRG) to date. The review provides a number of key recommendations that have a wider application in relation to similar change programmes.
Kent and Medway Vascular Surgery Services Review Report: June 2015
The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) 2005 called for a reorganisation of vascular services for emergency and elective care to optimise outcomes for patients in their 2005 report. In 2008, the European Society for Vascular Surgery’s Second Vascular Surgery Database Report showed that the UK had the highest mortality rates in Western Europe following elective abdominal aortic aneurysm surgery (UK 7.9%, best in Europe 2%) with a poor uptake of new endovascular technology.
Since then, there has been a major national drive to reconfigure vascular services across the country in order to achieve sustainable services and improved outcomes. The Vascular Society of Great Britain & Ireland (VSGBI) in 2012 published recommendations for the
configuration of major vascular centres, and these were adopted as part of NHS England’s ‘National Service Specification’ (NSS) for specialised vascular services. They set out the requirement for a centralisation of vascular surgery in specialist centres, with
appropriately configured staffing levels, rotas and facilities, and with a minimum catchment area of 800,000. This population requirement is considered to be an evidence based minimum volume necessary, to enable high quality outcomes.
The specialist vascular hubs, termed ‘arterial centres’ (ACs) cannot and should not provide all elements of vascular care for their network, and need to work in partnership with spoke units in associated hospitals in their network, termed ‘non-arterial centres’ (NACs). The
detailed functions and requirements of these NACs was subsequently provided in further VSGBI guidance published in 2014.
At present there are three providers of these services for Kent and Medway patients:
• East Kent Hospitals University Foundation Trust (EKHUFT), with the AC based at the Kent and Canterbury Hospital. Its current catchment population is 682,000.
• Medway Foundation Trust (MFT), whose current catchment population is 505,000.
• Guys and St Thomas’ Foundation Trust (GSTT), whose AC currently serves Tunbridge Wells/Pembury hospitals, and Darent Valley Hospital, between which the population served is 456,000.
Consequently both EKHUFT and MFT ACs are considered currently to be of insufficient size and undertaking insufficient or borderline levels of activity for sustainable future high performing ACs. In addition they both do not comply with a range of requirements as set out
in the NSS. Consequently, Kent and Medway commissioners have set up a programme board to develop:
a) A ‘case for change’, which will recommend how vascular services in Kent and Medway can provide safe and sustainable services and meet nationally agreed requirements in the future.
b) A decision making process and criteria to be used, for deciding on the preferred option(s) to progress.
A draft Case for Change, together with outline decision making criteria, have been developed by the programme board, but to provide an independent clinical review of these, the South East Clinical Senate was approached. This document describes the methodology
used for this independent review, and provides detailed recommendations for how the Case for Change could be enhanced, and from those, some of the decision making criteria that could be employed.
Kent and Medway Stroke Services Review Report: June 2015
Stroke affects around 110,000 people each year (with many more experiencing the warning condition of a TIA), is the third highest cause of death in England, and is the single largest cause of severe adult disability. Many strokes are considered preventable (particularly by better identification and treatment of high blood pressure and atrial fibrillation, and through other cardiovascular risk reduction measures). For those who sustain a stroke or TIA, there is a large body of evidence that the ready availability and provision of a wide range of multidisciplinary interventions (medical, nursing and therapies), in the context of appropriately constituted specialist stroke units, reduces mortality and long term disability.
Whilst there are no nationally mandated specifications for hospital-based stroke services (unlike many NHS England-commissioned specialised services), the recommended infrastructure is laid out in the National Stroke Strategy 2007, which provided a national quality framework to improve services across the stroke pathway. Clinical standards for stroke care and its provision are incorporated in the national stroke audit programme (SSNAP), and most recently, NHS England has commissioned a ‘Configuration Decision Support Guide’ to configuring stroke services, which will provide important guidance applicable to the whole stroke pathway (publication imminent).
Stroke services and outcomes in Kent and Medway have been reviewed by the clinical commissioners against these core standards and recommendations, and found to show marked variability in performance, and overall a level of performance that must be improved, as well as insufficient case numbers in each centre (noting that some units perform significantly better in the SSNAP audit than others).
A programme board for stroke services in Kent and Medway, informed by a clinical advisory board, has therefore been set up by the Kent and Medway commissioners, and has produced a draft Case for Change and outline criteria for deciding on options for future models of care across the county.
The Clinical Co-dependencies of Acute Hospital Services: A Clinical Senate Review: December 2014
This clinical senate report provides a comprehensive clinical overview of the inter-dependencies of a wide range of acute hospital-based clinical services, and some of the key factors that should be taken in to account. Given the current intense national focus on the future shape and function of hospitals, stakeholders in health care systems have to consider the most appropriate configuration of their hospitals so that their clinical services are adequately supported by other specialties, are fit for purpose, sustainable, accessible and deliver the highest possible quality of care. The clinical relationships and dependencies of hospital-based services on each other is key, but the evidence base to guide an understanding of these dependencies is uncertain. On this basis, the seven Sussex CCGs (through their Collaborative) sought from the South East Clinical Senate (SECS) generic, evidence-supported clinical advice on the necessary relationships between acute hospital services, to inform their future local discussions and planning. The remit of the review was to provide generic advice, not region or locality-specific, and to identify evidence where it exists, or clinical consensus where it did not, to describe what services needed to be provided in the same hospital (either based there, or inreaching), and what could be provided on a networked basis. A clinical reference group was established, a literature review undertaken, and a clinical senate summit convened, and SECS worked closely with the four strategic clinical networks in the region. The dependencies of eleven major acute hospital services were reviewed: A&E (emergency medicine), the acute medical take, the acute surgical take, critical care (ITU), trauma, vascular surgery, cardiac, stroke, renal, consultant-led obstetric services and acute general paediatrics. The clinical dependencies of these services on a wide range of acute hospital based services was reviewed, and a four-level system for describing the strength of the dependencies was developed, and a co-dependency grid constructed. From the completed grid, it was possible to identify core groupings of services required to be based on the same hospital site, and delineate what an emergency hospital should provide on-site as a minimum, and the needs of the more specialist acute services reviewed. The report contains important reviews of addition broad themes that must be taken account of in considering service change. These include the public and patient perspective, ambulance service issues and opportunities, workforce issues, the teaching, training and research issue, the provision of liaison psychiatry support to acute hospitals, and the potential for telemedicine to enable better networking or services. This report is intended to be a useful clinical reference point to commissioners, providers and clinicians in the future planning of their acute hospital services.
Advance Care Planning: April 2014
Advance Care Planning in Kent, Surrey and Sussex: A Report and Recommendations from the South East Clinical Senate. South East Clinical Senate (SECS) has launched an important publication entitled ‘Improving Advance Care Planning in Kent, Surrey and Sussex’. This publication has been written for a wide audience, including, health and social care professionals, organisations responsible for education and training of health and care staff, commissioners, the community and voluntary sector, and public and patient engagement organisations. Advance Care Planning (ACP) is a vital component of end of life care planning, and is appropriate to consider for a wide range of patients (particularly those with progressive chronic conditions or at risk of acute deteriorations in health) as well as the public. It is the process of discussion to help a person decide on their future care whilst they have the mental capacity to do so. Our publication summarises the benefits of ACP, explores the current barriers to its greater uptake, and provides a wide range of recommendations to enable its greater use, and has been informed by a literature review, a clinical senate working group and a regional summit held in May 2014, which was attended by a wide range of stakeholders including patients and the public. Our publication endeavours to provide a clear and pragmatic guide as to how this can be achieved. There is a real opportunity to increase the use of ACP to ensure that it is fully integrated into high quality, patient-centered care across Kent, Surrey and Sussex. Simon Chapman, Director of Policy, Intelligence and Public Affairs at the National Council for Palliative Care said: “Too many people still aren’t talking about or getting their end of life wishes met, which is why we welcome this important new publication. Planning ahead makes it more likely you will be able to get the care and support that is right for you, and we fully support the emphasis that the South East Clinical Senate are putting on raising awareness about the importance of Advance Care Planning. There needs to be radical change so that everyone approaching the end of life is offered Advance Care Planning as an integral part of their care.” If you would like to discuss the document or require any further information, please contact Ali Parsons, Clinical Senate Manager at aliparsons@nhs.net.