Monday, 28 September 2009

Q & A: Taking frequency & length of HD sessions into account

Q: Given what appears to be growing evidence that longer hours/more frequent HD produces better clinical and general quality of life outcomes, would you think it reasonable, even in the current financial situation, for patient and their representatives . to ask for this to be taken into account when planning the capacity of new units? Dr Simon Jenkins, North West Region KPA

A: Dear Simon, I think that it’s important that patient and their advocates continue to articulate the needs of service users. I am firmly of the opinion that high quality is value for money and what’s more usually costs less than if services are chaotic and inefficient. Doing the right thing at the right time, every time drives up quality, drives up safety, drives down complications and drives down costs.

Having said that, there are clear logistical issues with regard to extending hours and frequency for hospital based haemodialysis. What isn’t in doubt is that home based haemodialysis can be precisely tailored to the needs of the individual and definitely costs considerably less than hospital based haemodialysis. There are barriers to home haemodialysis – funds in the “wrong” budgets, cultural barriers, difficulties in supporting people who have become institutionalised to regain their confidence and manage their own conditions. Several units have overcome these barriers and home dialysis is growing in Manchester, in Derby and at Guys Hospital. I think efforts to question why units are not at 5, 10, 12 or 15% home haemodialysis should be a standing item on Network and renal unit/KPA agendas. In South Island New Zealand all patients are on home dialysis (some peritoneal dialysis of course).

If we can optimize modality of dialysis for the population by offering more choice, I am sure that would increase the numbers of people on both home haemodialysis and peritoneal dialysis – that in turn would free up capacity within hospital and satellite units They could then run with some leeway to offer dialysis away from base, more flexibility in changing slots or providing longer hours and for those that would benefit (eg those that find the long break really difficult because of fluid issues), 4 or even 5 times dialysis a week, could be accommodated.

The fiscal situation means that the “do nothing” option is untenable, the “lets cut back a little” option is also untenable so we have to transform NHS services and use the £100 billion plus to deliver real quality. Home dialysis offers quality for those who choose this option and costs less than hospital based therapy. Improving quality at the same time as reducing cost is possible .

I firmly believe we can do that but don’t minimise the challenges and difficulties that we will have along the way. Individuals like you, who sit on network groups, play a vital role in ensuring that those who are less advantaged continue to receive increasingly high quality of care