Background In recognition of the growing demand for palliative care (Etkind, Bone, Gomes, et al. BMC Med. 2017;15(1):102), a need was identified for a rehabilitative service. We piloted a new multi-disciplinary ‘Living Well’ service, with input offered based on holistic assessment. Interventions included group work, drop-in sessions and one-to-one professional appointments dependent on identified need. People are discharged upon meeting their goals. Response to the service has been varied. Our hospice is based in a socially deprived area.

Aims To explore the barriers to delivering a holistic rehabilitative approach to palliative care.

Methods Qualitative methods were used including staff surveys and questionnaires gathering feedback about our service.

Results Service users reported difficulty in attending sessions (at the hospice or at our second rented location). Neither location is accessible via bus route and many of our service users rely on public transport. Following the pandemic we have had difficulty in recruiting volunteer drivers, so are unable to offer transport to services. Historically we provided domiciliary care irrespective of a person’s ability to attend, so an expectation was set that this was an option. Staff surveys identified themes of fear of discharging a stable patient in case they become unstable, and a sense of responsibility as we have greater knowledge of illness trajectories. Building stronger relationships with primary care colleagues was identified as a further theme. Certain staff groups found it hard to accept a person’s choice to be discharged, despite the person acknowledging they would potentially require our services again.

Conclusions We need to address the location of service delivery, and consider other community bases with better transport access. Recruitment of volunteer drivers is essential. To support staff through this change we need to provide further education about person-centred care, and the benefits of working outside the traditional medical model (Moore, Britten, Lydahl, et al. Scand J Caring Sci. 2017; 31(4):662–673).