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There are two parts to Johns question, I think, and we the patients would like to work on both of these with you!

Tarek, yes I know of some relevant research, and it would be great if you commission us local people to work with you , rather than just see this as buying in another clinical service.

On end of life care,

I really like the Conversation project, and would very much like to start the dialogue, with PPGs and Healthwatch, about how we can bring discussions about end of life choices , to be kitchen table discussions.I visited the IHI and heard about this:

- annoying, wont let me post link- but it's theconversationproject.org/

I have personal experience of knowing the end of life choices of a dear friend, and chasing the ambulance to St Thomas , after she had a third stroke, but arriving too late and they had already done things and admitted her and put up drips and lots of machinery.
Her written directive was eventually implemented, with assistance from the Chaplain, but would be good to work together to make sure people know they can have peace at the end if they wish.

AND on the cultural issues, yes again there is research, and would be great if the CCG would coproduce some work with local communities to make those communities active in promoting health and avoiding illness and admissions.