Case study:

16 August 2007

Renal palliative service development in St Thomas’ NHS Foundation Trust and Kings College NHS Trust

Key points

A renal palliative service for patients with chronic kidney disease (CKD) stage 5 is helping to control their symptoms, support families and carers and ensure they achieve a ‘good death’.

Patients have been allowed to make informed choices about where they would like to be at the end of life and avoid emergency admissions to hospital.

Controlling symptoms has been crucial in allowing them to stay at home.

The multi-professional renal palliative team operates across two NHS trusts, Guy’s and St Thomas’ NHS Foundation Trust and Kings College NHS Trust.

It oversees clinic and outreach services, run jointly by renal and specialist palliative care staff, which offer the specific palliative and end of life health care patients require.

The service, which is funded from the Guy’s and St Thomas’ Charity through the Modernisation Initiative, has now been extended to renal patients whose needs were not met by existing services – for example, those who have complex symptoms while on dialysis or with a functioning transplant, and those who discontinue dialysis.

Renal units have historically offered patients approaching CKD stage 5 three treatment options: haemodialysis, peritoneal dialysis and/or transplantation.

No specific services other than general nephrology care were provided to patients who refused or were unsuitable for renal replacement therapy.

However, clinical experience with these patients suggested they had palliative care needs that were not being addressed within the current, predominately disease-centred services.

It also became apparent that the range and complexity of their health needs would benefit from a multi-professional approach.

The development of the renal palliative service has dramatically improved the way staff are able to identify and control symptoms.

The team has developed a cohesive clinical pathway, improved advance planning and has been able to take into account wider psychological and social needs.

As a result of its positive impact on patient care, renal palliative care is now a core component of training for renal professionals.

The evaluation of the renal palliative service has also fed into the strategic planning of the renal workforce.

Phase 4 of the project will concentrate on embedding renal palliative skills within existing services.

The emphasis will be on developing a clear strategic plan for non-cancer palliative care, aimed at primary care trusts, commissioners and managers.