Annual Report 2025-26
Contents:
Summary of the year
Welcome to our Annual Report for 2025-26
Introduction from Dr Rob Elias (Clinical Director) and Stephen Cass (Director)
Dr Rob Elias
LKN Clinical Director
Stephen Cass
LKN Director
The lifeblood of the London Kidney Network (LKN) is the strength and quality of trusted relationships with our partners. In 2025-26 we connected, collaborated, challenged and celebrated with a vast array of colleagues, friends and patients, through educational events, developmental workshops, and face-to-face and on-line meetings.
The 2025-26 Annual Report captures activities and outcomes we are proud to share. It highlights progress delivering our plans and looks towards our priorities for 2026-27. We have made progress across the full kidney pathway, from early identification of chronic kidney disease (CKD) patients in the community, to improvements in advanced kidney care clinics helping patients choose the right care.
The LKN strategic priorities set our course for the next 3 to 5 years. These are to:
- create balance between demand and capacity to deliver services across the kidney pathway
- continue to develop CKD/cardio-vascular renal metabolic (CVRM) prevention plans and interventions, and
- reduce inequalities and disparities in kidney services across London and Surrey.
We are confident our priorities align well with the 10-year Health Plan for England: Fit for the Future (HM Government 2025) which requires three shifts: hospital to community, analogue to digital, sickness to prevention.
Renal 3Ps Projects
2025-26 saw the third year of London ICBs funding £1m each for renal transformation (3Ps) projects. As local schemes reach maturity there is growing evidence of positive impact for example, CVRM primary care clinics in Harrow, and the integrated Multi Morbidity Model of Care activity in South East London. Plans that started as pilots three years ago are being embedded in ongoing, funded services, testament to the power of collaboration and a unified voice for kidney care in London.
Our Sharing and Learning event in July (2025) saw 120 partners and patients share the details of local projects through presentations, workshops and posters in our first conference style event. Feedback was incredibly positive and a boost to colleagues who have worked so hard to make the 3Ps projects a success. The content has helped shape our plans for 2026-27.
Dialysis and Capacity
We have continued work to better understand and plan for the rising demand for dialysis. Under the formal governance of the London Kidney Transformation Board, all London renal units and ICB commissioners meet regularly to review plans and share ideas to assure adequate dialysis capacity for the capital.
Development of the Kidney Dialysis Occupancy Measure (Kidney DOM) has continued to gather momentum, resulting in additional funding for renal units in North East and North Central London. Plans are in place to open more dialysis capacity in the next 18 months which is great news for patients and staff.
The Kidney DOM is now used in all England renal units and is on track to become a formally recognised NHS Indicator by April 2027.
Word of the Kidney DOM has spread further afield and the LKN team are supporting its introduction with NHS Scotland, and Health Boards across New Zealand.
Commissioning and Service Delivery Guidance
We led the co-creation of Kidney Commissioning and Service Delivery Guidance. As ICBs become the strategic commissioners responsible for the entire kidney pathway, the guidance will support ICBs to prioritise the most important aspects of kidney care in future funding plans. All ICBs in London and Surrey have confirmed they will include kidney care as a priority in strategic commissioning plans for the next 3-5 years. This is a great step forwards formalising commitment from the new commissioners. Patients and clinicians will see the benefit over years to come.
Collaboration and Partnership
To support improved CKD/CVRM prevention for local populations, the LKN has advocated development of an integrated approach to care which reflects the connections between heart health, kidneys and related metabolic conditions such as diabetes. This approach guides our collaborative work.
Throughout 2025-26, the LKN has been an active partner in the development of A Million Hearts and Minds, a 5-year campaign to improve heart health for Londoners. We will continue this throughout 2026-27, helping to ensure recognition of kidney health as a priority for London, and supporting a CVRM approach as the Cardiac Modern Service Framework is published in early summer 2026.
Our joint work with charity and industry partners goes from strength to strength including:
- Collaboration with Kidney Care UK supporting Peer Support across London and live educational webinars for people living with CKD stages 1-3 in London.
- Publication of the HIDDEN CKD Community Toolkit, co-created by Kidney Research UK, NHS partners in South East London and the LKN to engage and test for kidney disease in underserved populations.
- Development of a clinical planning tool, GRIP33 (Growing Incident Peritoneal Dialysis to 33%), to increase the number of patients starting peritoneal dialysis, in collaboration with industry partners.
At our core, the LKN creates a place for like-minded clinical and management colleagues to come together to learn from each other and improve the quality and experience of care for patients. We must thank our LKN team, and the hundreds of colleagues, partners and patients who come together under the flag of the LKN and give their time, energy and expertise so willingly for the benefit of others.
Much of our work together begins with small conversations as we nurture relationships and encourage each other to challenge our thinking and adapt our behaviours. This is not easy. We are incredibly grateful for each and every conversation and change, however small it seems at first, and for the people who make the LKN the vibrant and influential network we are so proud to be part of.
The London Kidney Network Team
Thank yous and goodbyes
We have been grateful for the time, hard work and commitment shown by the LKN Clinical Leads and core LKN team this year. Without this small group of clinical leaders and the programme team, work would not be possible.
We’d like to particularly thank those who have left their roles during 2025-26: Sarah Harwood (Patient Experience and Engagement Manager), Radhika Laksham (Project Coordinator), Donna Morgan (LKN Lead Nurse) and Katie Vinen (Supportive Care Co-Clinical Lead). We wish them all the best for the future.
Summary Workplans & Achievements for 2025-26
Demand And Capacity Group
Our plan for 2025-26
- Develop a Demand and Capacity Management sub-group of the London Kidney Board to oversee the delivery of the workplan across renal provider and commissioner teams in London
- Develop a Dialysis Commissioning Support Team to support the increase in capacity of RRT, with a particular focus on ICHD in 2025-28 in response to the forecast increase in demand
- Develop a flow model to predict growth in demand in the kidney pathway over the next 10 years to take account of CKD stages 1-4, general nephrology outpatients and AKCC populations
- Produce 10-year trajectories for each London renal trust for key ESKD modalities: ICHD, PD, HHD, Transplant, Supportive Care
- Develop a robust set of agreed data reporting and monitoring tools to track current state including operational, workforce, clinical, safety, and system flow
- Provide guidance and support to ICBs to take a “Once for London” approach to remove barriers to capacity mobilisation and develop service resilience
- Kidney DOM is used by renal units and ICBs to monitor progress with maintaining, and planning, management of demand and capacity to assure safe, high-quality service provision
What we achieved
- Agreed purpose, scope and governance for London Demand and Capacity Management Group
- Piloting use of the Midlands Kidney Network KSCOPE tool to support ICHD growth trajectory work in Royal London Hospital
- 10-year trajectories developed and will continue to be refined and reviewed throughout 2026-27
- UCL Partners commissioned to develop automated data solutions
- Kidney-Commissioning-Service-Delivery-Guidance-final-v1.pptx developed for London in partnership with renal clinical experts and ICB leaders
- Kidney DOM reportedly monthly by all London units and is used by Trusts to support decision making
Data
Our plan for 2025-26
- Collate data for priority workstreams using nationally & locally agreed key benchmarked metrics
- Growth Forecasting: Current and future growth within dialysis is forecast and embedded within planning conversations
- ICHD Capacity Utilisation (Kidney DOM): Current ICHD provision is known, evidenced and linked with dialysis growth forecasting
What we achieved
- All work streams have been supported to refine data reporting and utilisation e.g. supportive care audit, and more nuanced transplant metrics
- ICHD growth projections for 5 and 10 years remodelled and used to show when each unit will be operating at >90% Kidney DOM, and 100% estates and/or staffed capacity
- Incident new starter data scoped within the Clinical Information Group and will begin reporting on this from end March 2026
CKD / CVRM Prevention
Our plan for 2025-26
- Create an automatically pulled 2nd generation CKD specific report that can be included in the LKN ICS Dashboard and quarterly report
- Contribute towards developing an economic evaluation of the value of early detection and optimisation
- Develop practical guidelines i.e. a toolkit on setting up a CKD community outreach programme (based on the Hidden CKD model)
- Communicate and share the toolkit with London ICSs to encourage consideration of similar programmes
- Develop and host 3 live and interactive educational webinars as exemplars for what should be delivered locally for people with CKD stages 1-3 living in London or Surrey Heartlands
- Co-create and share a ‘Caring for your Kidneys’ patient resource
- Work collaboratively with the 3Ps renal evaluation team to support successful delivery of the evaluation of the 3Ps CKD/CRM projects
- Work with the London diabetes and cardiac networks to co-develop and deliver resources that support ICSs to develop CRM models of care
- Establish a pool of people to facilitate regular communications to support the workstreams aims and objectives
What we achieved
- CKD specific report for inclusion in LKN ICS Dashboard and quarterly data report being used by ICS’ to help monitor progress and identify areas for improvement
- Economic evaluation of early detection and optimisation in development with partners
- Hidden CKD Community Toolkit published. We will identify additional opportunities for integration in 2026-27
- Partnered with KCUK to develop, implement and evaluate an educational webinar programme. Will be repeated and expanded in 2026
- ‘Caring for your kidneys’ animated patient information resource, co-created with the Welsh Kidney Network
- Midlands and Lancashire CSU shared the 3Ps evaluation work
- Have agreed to work jointly with Cardiac and Diabetes Networks. Consulting on a pan-London CRM Education Framework
- Strong connections across London and UK created. This will be ongoing work
Advanced Kidney Care
Our plan for 2025-26
- Liaise with renal units involved to align with the national AKC transformation project
- Ensure patients’ input informs our work priorities and work content
- Define and create an AKC pathway that outlines key areas of multi-professional care that should be provided
- Define standards of care for each multi-professional intervention identified in the AKC pathway
- Engage with all London units, patient reps and relevant partners to determine how to best support pre-AKC patient education and timely referral
- Work with LKN workstreams to:
- Ensure alignment of messaging and collaborate where indicated
- Agree 5 priority metrics (across entire AKC pathway) that reflect AKC care provision
What we achieved
- Engaging and collaborating with national AKC Transformation lead and project manager
- AKC Pathway development completed
- Defined standards of care for each multi-professional intervention identified in the AKC pathway
- Scoped information units give to patients on 1) Pre-AKC education, 2) pre-emptive transplant work-up, and 3) living donation. Will be further developed in 2026-27
- Started in-depth review of AKC metrics that will also inform the LKN Data Dashboard and Report
- Acted as advisors for 3Ps Renal Evaluation Team on 3Ps supportive care (SC), AKC and frailty metrics, and LKN Supportive Care Audit
- Surveyed AKC staff at all renal units to understand education provided to staff across London
- Engaged with renal units to explore co-developing a pan-London AKC education programme for staff
- Exploring early thinking for the AKC Health Equities Project
Transplant Workplan
Our plan for 2025-26
- Develop and implement solutions to problem areas shown in 2024-25 pathway mapping; urology pathway, cardiac work-up, and nursing workforce
- Maximise use of UK LDSS and ABOi incompatible transplants across London
- Work collaboratively with charity partners to increase kidney donation rates from non-white British donors (living and deceased)
- Support the London Units to prepare for transition to the SCORE model of care in April 2026 Surgical workforce feel supported and empowered to implement changes in service provision
- Kidney patients with a BMI which excludes transplantation are offered a weight reduction programme utilising GLP1s and MPT intervention
- MPT interventions pre-and post- transplant are made explicit within the LKN transplant pathway
- Work with the CIG to ensure LKN transplant data is accurate and provides relevant data to identify and support change in service delivery
What we achieved
- Urology pathway agreed, awaiting publication of national cardiac work-up (LKN units already meeting National guidance). Nursing workforce work complete
- Current use of ABOi transplants in London scoped
- Working with units to identify barriers and opportunities to SCORE. Will continue to share learning, and respond, as the National programme develops
- Revised metrics agreed and reporting due to start. Mutual aid audit planned for 2026-27
Dialysis
Our plan for 2025-26
- Imperial and Epsom and St Helier kidney units become recognised as peritoneal dialysis (PD) percutaneous catheter insertion training hubs and a rolling programme of training developed to future-proof service continuity
- Ensure any appropriately qualified Health Care Professionals (HCPs) can access percutaneous catheter training
- Agree metrics to monitor impact of Home Therapies uptake, and report quarterly
- Influence home therapy commissioning decisions through collaborative working with the Demand and Capacity Group
- All units able to access home haemodialysis (HHD) machines and training within London agreed metric
- In-centre haemodialysis (ICHD) is offered as short-term respite from HHD enabling people to remain on HHD
- Unit level peritonitis root cause analysis completed and learning shared across LKN-units
- Monitor changes through the LKN data pack. Take action to address issues
- Co-develop and pilot a dialysis at home peer support pathway with the Peer Support Lead. Evaluate impact on uptake and patient experience of shared decision making and HHD/PD
- Assess current Supplier Landscape across London. Develop a commissioning support group (CSG), including ICBs, renal unit Operational leads, procurement leads, and finance leads, to define options and opportunities
- Develop a London Nursing training and education programme on vascular access (VA) management
- Trial and embed use of needling Patient Reported Experience Measure (N-PREM) to monitor impact of training on patient experience
- Work with Peer Support Lead and Patient Experience Group (PEG) to develop accessible, multi-format patient information on VA
What we achieved
- PD percutaneous catheter training hubs now running as business as usual with ongoing reminders to units of training availability
- Developed a dialysis at home module for roll-out
- Developed a new metric (Growing Incident Peritoneal Dialysis to 33%- GRIP33) to show uptake and distance from target
- Home Therapies (HT) updated metrics now reported quarterly
- Data suggested increased numbers of HT and less peritonitis
- Developed standard re-housing referral letter templates to improve access to dialysis at home
- Updated ‘Utility Costs Reimbursement Guidelines’
- Developed and presented a dialysis at home module proposal to the AKC team to support shared decision-making through community education.
- Agreed data-sharing with industry partners and obtained home therapies data to support GRIP33
- Drafted set of service standards for home haemodialysis including baseline expectations for workforce, training access, machines, home modification, and data
- Submitted a response to the All Party Parliamentary Kidney Group (APPG) on home therapies work within London
Supportive Care
Our plan for 2025-26
- Support implementation and continued future funding of the 3Ps Frailty and Supportive Care projects by working with London ICS’ through a Community of Practice
- Create a unified, consistent data set across the 7 renal units to understand the relationship between identification of frailty and subsequent actions
- Promote and embed use of LKN patient information
- Integrate patients’ views into our work by obtaining feedback from a wide group of kidney patients to understand diverse views on supportive care, patients who are on the Supportive Care pathway and on dialysis, and frail patients who have geriatrician input at AKCC
- Develop guidelines for common symptom control in adults living with CKD5 in the community
- Develop Dialysis Withdrawal Guidelines that enable consistent and supportive care across London for when considering and/or enacting dialysis withdrawal
- Support primary care to manage frail patients with advanced CKD in the community
What we achieved
- Continuation of funding for a majority of 3Ps frailty projects. Work continues to support the others, and to secure funding across London for 2027-28
- Expanded data set, including use of ACP and PPC, finalised
- Patient booklet updated. Created a patient information video with the Welsh kidney network. Further development of the LKN website to host info in progress
- Symptom Control Guidelines for use in Primary Care written
- Withdrawal of Dialysis Protocol
- Completed a second London Supportive Care Audit, shared the results across London and at the National Renal Networks Enhanced Supportive Care Community of Care. Plans to publish in peer reviewed journals and at conference in 2026-27
Psychosocial and Rehabilitation
Our plan for 2025-26
- Develop the LKN Multi-Professional Team (MPT) forum to become a single point of access for expert opinion on how the MPT can support kidney patients and how that support can be embedded in pathways
- Develop MPT intervention pathways to support management of complications and common symptoms of kidney disease
- Each LKN priority work area has MPT interventions embedded within their priority objectives for 2025-26 and beyond
- Review the support available to help people live well with CKD, focusing on psychosocial support and physical function including rehabilitation and prehabilitation
What we achieved
- Two Community of Practices formed, one for psychosocial and one for rehabilitation and Allied Health Professionals (AHPs). Both delivered work in 2025-26
- Evidence-based pathways for multiple professions completed with AKC Workstream. Will continue into 2026-27
- Verbal mapping of available psychosocial support complete, with planned workshop for May 2026
Nurse Leads Group
Our plan for 2025-26
- Develop an audit tool to measure nursing workforce numbers, skill mix, and quality of care. Use existing tools to develop an LKN approach and gather data on nursing workforce capacity and quality in ICHD
- Refine the tool to gather data on current nursing workforce capacity and quality in other RRT areas i.e. home therapies and transplant
- Provide a forum for sharing best practice models, quality improvement (QI) projects, risks and solutions using a ‘hot topics’ approach
What we achieved
- The Forum meets regularly bringing together renal nurse leaders from across London to discuss ‘hot topics’ and to share solutions
- Focus on workforce development, safety, and service improvement
- Created a structured place for shared learning, and leadership development
- Enabled cross-London collaboration and alignment in nursing practice
- Strengthened the link between workforce discussions and system-wide improvement priorities
Measuring Progress: Data and metrics
The LKN values data and strives to be evidence led in defining the case for change and measuring the improvements in outcomes via our quarterly data pack and system dashboard. The core aims are to utilise data to highlight unwarranted variation, as well as evidencing dialysis growth data to help strategic planning.
Peter Wilson, LKN Business Intelligence Manager and the Clinical Information Group members continue to refine and develop these to distil the complex Kidney Pathway for our units and patients across London.
You can find our data packs here https://londonkidneynetwork.nhs.uk/data/
If you would like to see the dashboard, please email us at lkn.londonkidneynetwork@nhs.net
Data in action: A case study
The Kidney Dialysis Occupancy Measure (DOM) for London and England.
With clinical consensus and agreement from the London renal unit Clinical Directors and Clinical Leads, the LKN developed a standard and consistent measure of ICHD capacity – the Kidney DOM. It is intended to be simple to use, easy to measure, and easy to report proxy indicators of clinical safety, patient experience and service resilience.
We consolidated our Kidney DOM work in 2024 – 2025 within London and began working with our teams to scope key quality metrics to sit alongside the headline Kidney DOM. We also collaborated with our fellow renal networks in the other regions to establish a national Kidney DOM summary.
In 2025-2026 work continued to evolve the Kidney DOM as a national metric. Quarterly reporting at a national and regional level was established giving valuable insight into ICHD capacity pressures around the country.
Work has begun to establish this as a recognised mandated national metric. Working with the national Demand Capacity Community of Practice to refine the Kidney DOM and standardise the reporting to allow for consistent reporting while highlighting the varied challenges that teams face in delivering high quality, patient focused ICHD while managing estates and staffing capacity pressures.
Education and Events
1 in-person event
6 Leadership Fora
9 National Webinars
1300 Participants
69 Presenters
65+ hours of learning
During 2025–26 we expanded our education and engagement work, combining large-scale events, workforce development forums, leadership sessions, and patient education.
Presenters and participants included clinicians, patients, commissioners, NHS England, ICS leads, charities, and industry partners, with strong multi-professional representation across London.
Our events:
-
- Strengthened system-wide collaboration and shared learning culture
- Supported transition from pilot projects to sustainable service models
- Increased focus on data-driven improvement and patient experience
- Built workforce capability and leadership across clinical and operational roles
Key Highlights
Learning & Sharing Event (April 2025)
-
- 120 attendees | 30 speakers | 24 posters
- Showcased high-impact pilots and system-wide improvement
- Strong focus on prevention, primary care management, and slowing CKD progression
- Clear shift towards scaling and commissioning successful interventions
CKD Patient Webinars (with Kidney Care UK)
-
- 3 public webinars focused on early CKD education and self-management
- Strengthened patient awareness and engagement
Leadership Forum Series (2025)
471 attendees across 6 sessions and 22 speakers
-
- January 2025: Research – 3 speakers – 95 attendees
- February 2025: Social Prescribing – 3 speakers – 60 attendees
- April 2025: Emerging Renal Challenges – 5 speakers – 91 attendees
- May 2025: Advancing Equity in Renal Care – 3 speakers – 86 attendees
- October 2025: Strengthening Patient Involvement Through PREMS and Peer Support – 4 speakers – 71 attendees
- December 2025: Integrating CKD Care Across Systems – 4 speakers – 68 attendees
- Strengthened system leadership, shared learning, and cross-sector alignment
Peer Support
What is peer support?
When patients are diagnosed or starting on new treatments, speaking to someone who has been through the same journey can provide comfort, information, hope, and prepare patients for meeting the challenges with a positive approach. This is peer support.
What does the Kidney Care UK & London Kidney Network Peer Support Service offer?
An opportunity for people living in London with kidney disease, their family members, carers and/or donors to be personally matched to someone (i.e. a peer supporter) who can support them and has lived experience of kidney disease.
Who are the peer supporters?
Volunteers with lived experience who are trained in-house within Kidney Care UK, using a UK Kidney Association programme to ensure safeguarding and robust support for both volunteers and service users.
How do patients access the service?
Over 20 healthcare professionals actively promote the service across 7 London NHS trusts as peer support champions. They engage with patients, carers, donors and colleagues, and provide information on how our service offers support and how to access it. Since launching in July 2024, there have been 312 referrals for peer support from patients themselves and from kidney care staff.
What next?
The pilot service has been hugely successful and well received across London. Due to demand from patients, carers and kidney health professionals, there are plans to extend the service nationally.
Feedback on the Peer Support Service
Patient feedback
Thank you so much … [the peer supporter] was truly an excellent listener … we got on very well … I just needed to talk and [he] empathised with me. He was able to explain in more personal detail how home haemodialysis works and what the drawbacks and positive parts were to it.
What was especially important to me is having someone non-judgemental and understanding of what worries me. The chance to actually talk about things properly in “non-doctor speak” was so rewarding and was extremely helpful.
We will hopefully catch up again … which I think will be of great benefit to me on my journey and it is a great comfort to have someone as good as [the peer supporter] who listened to me.
Thank you so much once again …
Peer supporter feedback
Over the years I’ve experienced everything associated with CKD that you could imagine, and each stage is filled with more questions than answers, resulting in a fear of the unknown. I signed up as a member of the London Kidney Peer Network as I wanted to help people who are in the same position to be unafraid of what the future might hold.
LKN Finances in 2025-26
In 2025-26, the LKN used our limited funding wisely to support delivery of our aims and objectives focussing on:
-
- The multi-professional clinical leadership of workstreams through ten pan-London clinical leads
- A Programme Team providing project management, business intelligence and system convening expertise
- An ongoing collaboration with Kidney Care UK to co-fund patient-centred Peer Support
- Supporting communication of LKN activities and joint working with commercial partners to support events and training
| Summary | LKN 2025/26 Budget |
LKN 2025/26 Actual |
LKN 2025/26 Variance |
|---|---|---|---|
| Income | (830,881) | (830,881) | - |
| Expenditure - Pay | 792,966 | 724,747 | (68,219) |
| Expenditure - Non-Pay | 27,814 | 26,200 | (1,614) |
| Total Expenditure | |||
| Total net underspend | (10,101) | (79,934) | (69,833) |
Looking forwards to 2026-27
Transforming kidney care through an integrated approach to population health improvement across London and Surrey
Connecting | Collaborating | Challenging
Our agreed aims set our intentions for the 3 years to April 2028, and so continue into 2026-27.
We are keeping a sharp focus on the fundamentals of the kidney service in London in areas where the LKN can make a positive impact:
-
- Demand and capacity: improving the balance between demand for kidney services and our capacity to deliver the volume and quality required
- Prevention: continuing to work with ICB transformation pilots to develop services to prevent or slow progression of CKD
- Health Equity: a relentless focus on reducing health inequalities, particularly for vulnerable populations
Within our three priority areas, we will continue to drive and support improvements in our key workstreams, i.e.
-
- CKD and Cardiovascular Renal Metabolic Prevention
- Advanced Kidney Care
- Dialysis, including Vascular Access and Dialysis at Home
- Transplantation
- Supportive Care
- Psychosocial support and rehabilitation
These priorities and workstreams are supported by our continued development of data reporting and analytics.
The voices and real-world experiences of patients, families and carers will also continue to influence our work across the entire kidney pathway including transplantation, dialysis and supportive care. We will maintain our regular conversations with people with lived experience, e.g. through our regular Patient Engagement Group meetings throughout the coming year.
The LKN Workplan for 2026-27 includes summary aims, objectives and outcomes for each area.
Workplan 2026-27
View PDF
Communication
LKN email: lkn.londonkidneynetwork@nhs.net
LKN Newsletters: Website: https://londonkidneynetwork.nhs.uk/news/