Number Of Patients On Dialysis Set To Double In Next Ten Years, But Already The NHS Can't Cope, UK

Main Category: Urology / Nephrology
Also Included In: Public Health
Article Date: 07 Oct 2008 - 2:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

"Many dialysis services and renal clinicians are currently overstretched with insufficient capacity to cope with the number of patients they care for, possibly due to differences in opinion on the effectiveness of services between healthcare professionals and commissioners. Consequently over half of all kidney disease patients die within the first five years of receiving dialysis, in part due to late identification and access to services. Strategic investment and improved planning of renal services are absolutely essential if we are going to be able to provide better patient care and cope with future demand."
Tim Statham
Chief Executive, National Kidney Federation (NKF)

The number of patients requiring dialysis is set to more than double over the next 10 years1 creating a huge demand on the NHS to provide adequate dialysis services.
Ineffective planning for the provision of care and lack of choice offered in renal services could be at the root of the current issues in dialysis services. A recent survey of commissioners and providers of renal care in the UK showed that while nearly all commissioners (93%) considered they had an effective and responsive commissioning process for renal services, less than half (47%) of all healthcare professionals agreed.2

A 10 point action plan* launched this week by The National Kidney Federation (NKF) and All Party Parliamentary Kidney Group (APPKG) is calling for urgent improvements to dialysis services that could help to extend the lives of many kidney disease patients and allow the NHS to treat more patients within current budget constraints. The report 'Better Dialysis Services, Saving Lives and Improving the Quality of Lives', sets out the key actions that must be taken by the Government and renal specialists to increase dialysis services to match patient numbers, improve the choice of dialysis for patients and give all patients a planned pathway of care.

"It is important that patients with end-stage kidney disease can be educated to choose their type of treatment to suit their lifestyle. Ideally a clinician would want around a year to prepare a patient for dialysis however, around one-third of patients present less than a month before requiring treatment. The outcomes for these patients are much poorer than those who present earlier, requiring longer hospital admissions and intensive input from the renal team.

It is therefore important that healthcare professionals are educated to recognise potential kidney problems and refer them appropriately to renal units, and that renal units enable patients to be involved in the decision about which treatment would suit them best," explained Professor Edwina Brown, Consultant Nephrologist, Hammersmith Hospital, London.

The Renal National Service Framework (NSF) published in 2004 set out that all renal units should have the capacity to offer patients a choice of dialysis treatments whether daily at home, or three times a week or more, in hospital if needed. However, a review of renal services shows more than one quarter of providers cannot provide a home haemodialysis service.2

"Proper forward planning is required at Strategic Health Authority and specialist commissioning group level, and it is vital this process involves both clinicians and patients. Current dialysis services lack the capacity to provide optimal treatment and choice to patients, adversely affecting their health and quality of life", said Dr Evan Harris MP, APPKG co-chairman. "This report identifies many of the current challenges facing dialysis service provision and the steps the Government and NHS need to take to ensure that patients are provided with the best possible care now and in the future."

The report urges the Government to address the 10 key actions in a comprehensive strategy for kidney services, which updates the National Service Framework and ensures that recent NHS reforms, like the Darzi report, are effectively applied to improving services available to all kidney patients.

* Ten Actions

1. Increase dialysis provision to match patient numbers and plan for the expected increases in prevalence
2. Enable choice of dialysis for every patient
3. Improve early recognition of patients who will need dialysis
4. Consider pre-emptive transplantation for all patients before dialysis
5. Provide vascular access and PD catheter access surgery early
6. Ensure every patient has an individualised care plan
7. Use the Renal Registry to plan and audit dialysis services
8. Improve the provision of 'away from unit' dialysis
9. Implement free car parking at hospitals for all people using dialysis services
10. Maintain the commissioning status of dialysis services as specialised services.

About the APPKG and Dialysis Manifesto

The APPKG consists of 174 members from the Houses of Parliament and the Lords. It was established in 1997. The registered purpose is: "To improve understanding in parliament of kidney disease and transplant medicine and promote improvements in the health and care services that are available to improve the health of people with renal failure." The NKF serves as the secretariat for the APPKG.

The recommendations in the report are based on the results of discussions from an APPKG hosted summit, at which key experts from across the dialysis communities identified the current problems. The production of the report was supported by Roche Products Ltd and Baxter Healthcare. Editorial control belongs to the APPKG.

About the National Kidney Federation

The National Kidney Federation is the only national kidney charity actually run by kidney patients for kidney patients. The NKF has two roles, campaigning for improvements to renal provision and treatment, and national patient support services. The NKF also acts as an umbrella organisation for 69 regional Kidney Patient Associations (KPA). KPAs are both the ears and eyes of the NKF and its controlling force. Apart from six members of staff, all other personnel are either kidney patients or carers of kidney patients. http://www.kidney.org.uk

References

1. The National Services Framework for Renal Services - Part One: Dialysis and Transplantation. 2004
2. Blank L, Lumsdon A et al, Adult renal dialysis services in the UK: a questionnaire survey to examine providers and commissioners approaches to this service. The Internet Journal of Nephrology 2005, Volume 2, Number 2

National Kidney Federation