Increasing early identification of Bangladeshi people at the end of their life in Tower Hamlets

By Sabeen Jabbar (Advance Care Planning Nurse) and Clarissa Sorlie (Improvement Advisor) 

The Advance Care Planning Team in Tower Hamlets Community Health Services supports people in the last year of their life with future planning, encompassing conversations about their physical, emotional, spiritual, and psychological needs. This includes discussions about preferred place of care, preferred place of death, and what holds significance for them in the final stage of their life.  

Sabeen Jabbar, Advanced Care Planning Nurse, recently made an unexpected discovery: fewer than 19% of the individuals on her caseload were Bangladeshi. Tower Hamlets has the largest Bangladeshi population in the entire country, accounting for 34.6% of its residents (according to the 2021 Census). Sabeen therefore believes that local services are not appropriately identifying patients of Bangladeshi origin in the last year of their lives.  

Without early identification, patients face increased hospital admissions and are deprived of specialist support such as palliative symptom management or physiotherapy and occupational therapy, which are essential for enhancing their quality of life. This also results in a patient’s death being responded to via emergency services, instead of a planned call to the out-of-hours service.   

Determined to understand the needs of this population and how best to support them, Sabeen formed a project team and registered for ELFT’s Pursuing Equity Programme to share learning with other teams undertaking similar work.  

The team are now undertaking a three-part data review to understand the needs and resources of the Bangladeshi population in Tower Hamlets. This involves:  

1. Learning from data on the population 
2. Understanding the perspectives of professionals and community partners who support the population (for example, holding listening forums at the East London Mosque and speaking with local funeral services) 
3. Interviewing service user/carers to understand their experiences and perspectives 

This review will support them to develop a driver diagram, which is a tool for capturing the team’s theory of what needs to change and specific change ideas to test, in order to achieve the aim.  

One of their initial change ideas is to offer drop-in end-of-life training sessions at the East London Mosque. They are working with two GPs who piloted a similar project with the Cambridge Mosque, to develop this training. The team have also recorded a podcast episode for local GPs, to increase awareness of their service and how to identify patients who should be referred to them using available tools.