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Public Private Partnerships for Satellite Dialysis
Please note, this page is a summary of the full conference speech (click here for the full transcript).
Dr
Nick Richards
Dr Richards trained at St Bartholomew's Hospital, London,and worked in research at St Thomas's Hospital before moving to Birmingham in 1989, where he is divisional director and consultant nephrologist at the University Hospital. The renal service at the hospital is one of the largest in the UK, caring for about 1000 dialysis patients and operating five satellite units in partnership with Fresenius Medical Care.
"A satellite dialysis programme in partnership with the private sector has allowed the service in Birmingham to be improved in the absence of any capital money", Dr Richards said.
"Back in the early 1990s we had a rapidly expanding dialysis population and a hopeless under-provision of haemodialysis facilities", he said.
"About a third of our patients were dialysing twice a week, which was totally inadequate, we had far too many patients on CAPD, many of them the wrong patients, and we were unable to offer patients any choice".
Faced with annual growth of ten per cent and no increase in facilities, they went to the regional commissioners who suggested they explored funding opportunities with the private sector for two units. In a lengthy process lasting two years, the hospital worked out a specification for the provider to design and build the units, and to run them as nurse-led units.
A seven-year contract was eventually let to National Medical Care of America, taken over by Fresenius in 1997. The first two were built in business parks, the next in a converted chip fryer factory. The last two were on hospital sites, in Kidderminster and at the city hospital itself. The contract with Fresenius was renewed, except for Kidderminster run by Baxter. Where patients lived had been the most important criterion, and every kind of patient was catered for, including holiday patients.
"So over the course of 13 years, back in 1990 we had 19 dialysis stations and we now have 120", said Dr Richards.
When the satellite units opened, the commissioners had accused the service of creating renal failure, and Dr Richards argued that the units were there because the patients were there. In 1991 they had been taking on 100 new patients per million of the population every year, now it was 180 ppm.
"This is far and away above the level we are supposed to be taking according to Renal Association guidelines", he said.
"There's no doubt that these patients exist, so I suggest the guidelines are probably wrong".
Before the satellites came on stream, there was no choice for new patients, and 70 per cent went on CAPD. Now 20 per cent started on PD and 80 per cent on haemodialysis. After patients had moved out to the satellites, 20 per cent had had to be readmitted to the main hospital because they were unwell, but this had now gone down to five to seven per cent.
A quality insurance system had been set up and each clinic and all its patients were reviewed every month, in a multidisciplinary meeting involving all the staff. These reviews had seen a year on year increase against Renal Association standards. Interestingly, the biggest increase was in the hospital unit, presumably because the patients there were now having adequate dialysis.
Patient surveys had shown greater patient satisfaction. There had also been a number of cost neutral service developments, paid for by the company, including high flux dialysis and new dialysers. The hospital had also paid for other improvements in techniques.
Please note, this page is a summary of the full conference speech (click here for the full transcript).
Austin
Donohoe - Patient Presentation 4
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