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[The following article appeared on the front page of the May 2003 edition of ‘Kidney Life’ (the NKF magazine) - a list of questions for you to ask providers of Renal treatment is also available; click here to view]

Following reports received from the NKF Advocacy Officer, the NKF is very concerned at the PCT/commissioning situation where there is increasing evidence of PCTs (Primary Care Trusts) cutting back. The overspending that a great many have inherited from the previous Health Authority arrangements is the main cause of the problem. The inherited overspend varies greatly from Trust to Trust depending on how well the funding was previously managed.

The result is that some PCTs are cutting back seriously due to massive inherited problems where others have inherited well-managed situations. The effect on renal will probably be a reflection of the extent of overspending; some renal planning/ funding may be cut back heavily, others not so bad. Add to this the lack of understanding that is admitted to exist in the PCTs of specialised services in general, the removal of ring fencing of specialised funding, and the delays in the publication of the National Service Framework, then we fear renal is about to enter a period of decline.

The NSF is supposed to be the guidelines for the PCTs; with its delay PCTs have no guidelines to work with. Cutbacks are taking place without any real knowledge of the consequences for patients. PCTs, either through ignorance or as a deliberate measure, are cutting back, moving back the previously established benchmarks, we believe in some cases, in preparation for the NSF.

The removal of renal funding ring fencing allows the PCT to use its discretion in the use of that funding. We are not alone in the belief that this may mean for any purpose – not just renal. PCTs have some 160-target performance measures to address. It is openly admitted “they use their funding to attack these targets as a priority, sometimes after having achieved the target only to wonder if it was really significant and could the money have been better spent”.

In this environment and culture, renal could well become an also ran. Concerns are such that in the last few weeks direct questions have been raised with David Lammy in the House of Commons on ring fencing and commissioning of specialised services with little real clarity in the answers received. The departure of Lord Hunt from Government (over Iraq) has not helped.

The NKF wishes to get an urgent agreement in place with the DOH that they will recommend to PCTs responsible for commissioning renal services that they approach the NKF and KPAs for patient members of their renal services commissioning groups. If we do not act now we will have an uphill fight on our hands with no access to the areas taking the decisions.

There is now no really obvious method of national overview apparent for the PCT Consortia handling renal. If they do not have it, then the NKF must supply it. If we do not take action we fear we will see a return to postcode treatment. It may improve in the long term (next ten years) but without action now patients are going to suffer and possibly die. Some may think this is a Department of Health or Government problem, but the NKF cannot sit back and avoid the responsibility for looking after our patients’ interests.