Thursday, 16 August 2007

Q & A Haemodialysis Capacity - ISTC?

Q: Dear Donal, I wonder whether you can provide me with some clarity regarding the state of play of securing ISTC procurement for the expansion of satellite haemodialysis facilities.

Over the last 10 years at St Helier we were able to develop 5 (6 in all as the last one replaced one of our old ones) satellite units through a mixture of Renal Modernisation monies, charitable funding and working in partnership with commercial providers. Up until now we were able to keep abreast with the needs but no longer!

We in SW London are about to hit another predicted dialysis capacity buffer iminently. I was going to consider drafting a tentative submission to the DH Commercial Directorate to see whether the ISTC route is one route I can pursue as all of the NHS organisations (Acute Trusts and PCTs) locally in SW London are in official turnaround with no spare capital in the system. Yesterday, I read in the press that Alan Johnson has reported to have said there will be no further waves of ISTC being introduced by the DH.

Before I start a wild goose chase, I wonder whether you can give me some clarity of the current situation. Your early response would be appreciated.
Dr Jonathan Kwan, Medical Lead for Renal Services, S W Thames Renal & Transplantation Unit

A: Dear Jonathan, thanks for the question. Capacity, unit and satellite haemodialysis capacity in particular remains a major concern of mine. At Hope Hospital people are being admitted and waiting months, not weeks, for regular dialysis slots!

I have recently written to Chief Executive Officers of the provider units in England emphasising that starting individuals on twice, rather than thrice weekly, regimes is not appropriate as it comprises patient safety. I am also awaiting details of the ten SHA renal strategy plans from our specialist commissioner colleagues so as to get a clearer national picture.

Several colleagues, well two to be precise, have mentioned that HD capacity is not a current issue - in one of these areas I know there are agreed plans for next three to five years already - ahead of 2008-2011 local delivery planning exercise! Aren't they ahead of the game!! The other colleague commented that their more pressing concern, at present, was organisation and funding of supportive and palliatitive care for those who elect for the no RRT option. I appreciate that they are probably the exception but it does demonstrate that 'we' can get planning for haemodialysis right - and when we do there will be other things that require our attention.

Turning directly to your question. Yes there has been a change in tone and emphasis since the new Prime Minister and Secretary of State came in to post. In short its not a 'wild goose chase' but its worth having some detailed discussions at this stage. I don't think there have been any specific comments on Renal Services, but we are of course part of the whole. The current projects will progress as planned. The E16 scheme - that includes renal facilities in Cheshire and Merseyside, South Yorkshire and Hull is now nearing financial close.

The recent comments made by the Secretary of State were in relation to centrally - driven procurements of independent sector capacity analogous that have been implemented until 2002. It remains possible for any NHS bodies to procure services from the independent sector and it may be possible for the Department of Health Commercial Directorate to work with renal networks to support them in the procurement of IS capacity. Such a procurement would be 'owned' locally but the commercial directorate at the Department of Health might be able to assist by bringing the knowledge accumulated during the recent haemodialysis procurement exercise.

I will arrange for you and the South West London network to discuss your local options more fully with our collagues in the Central Clinical Procurement Programme section of the Commercial Directorate. I would of course be happy to do the same for others who wish to explore the independent sector option.