This page details the high level findings and outcomes for service users, staff and the wider south east London system from the implementation of a series of palliative and end of life care (PEoLC) staff interventions within the multi-morbidity model of care (MMMoC). This element of the programme helps renal teams to have confident conversations, improving service user decision-making.
To see our complete findings on the impact of PEoLC interventions on renal staff and service users with advanced kidney disease, click here to see our report.
Our challenge
- People with late-stage kidney disease often have many symptoms and frailty
- Care can feel fragmented, with many teams involved
- Individuals often access palliative care support very late
- There are many misconceptions and myths about what palliative and hospice care is
- Staff confidence, lack of awareness and knowledge, alongside system barriers can delay care planning talks
Our ambition
The PEoLC interventions aim to:
- Help people access palliative and end of life care support earlier in their journey
- Make “what matters to you?” a routine conversation in kidney care
- Build staff skills and confidence for sensitive talks and care planning
- Improve shared working and use of the Universal Care Plan
MMMoC: The wider programme of work
- Offered a comprehensive, holistic approach to LTC care across the whole pathway
- Enabled integrated, multidisciplinary working at scale
- Improved outcomes and experience for service users and staff
- Supported system sustainability and preventative transformation
Palliative and end of life care staff intervention: the approach
A targeted programme of activity from June to November 2025, for renal teams at Guy’s and St Thomas’ and King’s College Hospital, designed to build awareness, understanding, confidence and skills in palliative and end of life care.
- Hospice education visits (46 members of staff involved)
Tours of hospice settings, including services available, referral routes and what patients can expect, with time for open discussion and “ask me anything” with hospice staff - Staff webinar (16 members of staff participated)
An introduction to palliative care and local hospice support, helping staff understand when and how to involve services, with opportunity for questions and discussion - Ward-based awareness sessions (“tea trolley dashes”) (18 ward visits took place)
Informal, face-to-face conversations on wards, supported by campaign materials, to raise awareness and normalise conversations about palliative care in day-to-day practice - Skills workshops on sensitive conversations (62 members of staff joined)
Interactive sessions with actors to practise starting and responding to care planning conversations, with a focus on confidence, language and communication skills
Involvement across the south east London system
- Kidney staff at Guy’s and St Thomas’ and King’s College Hospital
- South East London Palliative and End of Life Care Programme
- Hospice partners (including St Christopher’s and the Community Hospice)
- Universal Care Plan leads and supportive care nurses
“The training gave me the space to reflect on my current practice and consider how I can approach these discussions with greater confidence and compassion.”
Value: Impact on service users
Key outcomes
- Earlier and more compassionate conversations about future care
- More support for symptoms and daily life, not only the final days
- Care more aligned with ‘what matters most’ to service users and families
- Better understanding that palliative care is support throughout life limiting illness, not just end of life
“More comfortable talking about palliative care as it is not just about end of life”
“Following the visit, I will be more mindful of the emotional and end of life needs of my patients and aim to have more open, compassionate conversations about their care preferences”
Outcomes: Workforce
This work primarily demonstrates workforce and culture change:
- Staff confidence rose across every area measured
- Confidence to discuss the Universal Care Plan rose by 36%
- Staff who never had care planning talks fell from 52% to 14%
- 81% rated the activities “excellent”
- Workshops led to a 70% rise in confidence for starting and responding to care planning talks
- Staff reported more empathy and better listening in talks with service users and families
I will be more confident in identifying when service users may benefit
Outcomes: Challenging misconceptions
100% of 93 evaluation survey respondents learnt something new about palliative care from the tea trolley dashes with 86% learning ‘a lot’.
The percentage of respondents who learnt the following facts for the first time through the campaign – demonstrating the previous breadth of misconceptions and lack of awareness:
- 73%: Palliative care can be episodic
- 64%: A hospice is not just an inpatient setting / place you go to die; it also provides care in the community
- 63%: The sooner palliative care starts, the better
- 58%: Palliative care can be given alongside other ongoing treatment, such as dialysis
- 58%: Hospice care is free
- 55%: Palliative care is not just for the last few days / weeks of life
- 49%: Palliative care isn’t just for cancer, it’s for any life limiting condition
Outcomes: System
- Better links between renal services, hospices and palliative care teams
- More routine use of care planning tools and shared records
- More staff readiness for earlier planning and shared decisions
- Earlier referral data to hospices showed no clear trends but future measurements would be useful
What next?
The palliative and end of life care work within the MMMoC has supported staff to feel more confident and proactively engage in sensitive conversations with service users and families.
The palliative and end of life care part of the model will aim to:
- Secure ongoing funding to keep this work in kidney services
- Spread the approach to other long-term conditions
- Continue linking the approach to integrated neighbourhood teams for joined-up local care
- Ensure further evaluation, with larger sample sizes and longer follow-ups
- Keep joint working across renal, hospice, community and primary care
What are we most proud of?
The palliative and end of life care approach:
- Helped renal teams feel more confident to ask ‘what matters to you?’ and plan care accordingly
- Challenged myths about palliative care and hospice support
- Built stronger links across services for better joined-up care
