Reducing inequalities for ‘at risk’ patients has been the focus of numerous service improvement projects/strategic input over my carer pathway and no more so than over the last 3 years. Over the last four years I led the building of the Derbyshire ambition the ‘Dementia Palliative Care Service’ which focuses on the development of dementia-specific palliative care strategies which would knit together dementia care expertise with palliative care expertise integrating approaches across health, care, voluntary sectors and into communities.