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A report agreed by the NKF Executive committee (29th November 2003) to encourage informed discussion and debate surrounding the publication of the Government’s Renal National Service Framework.
It is hoped that this document will assist Kidney Patient Associations, and Kidney Patients themselves, to form views about renal provision which can then be used to judge the effectiveness of the NSF when published.
The information is for debate and discussion only and does not represent NKF policy.
NKF Executive
29th November 2003
At the time this report was prepared (November 2003) it had already become clear that:-
There cannot be any doubt that renal patients are expensive to treat. 34,000 ESRF patients are not a large group by medical standards yet together they account for 2% of the NHS budget. Faced with a doubling of patient numbers over the next ten years it follows that renal will by 2013 swallow a full 4% of the NHS budget. Whilst nephrologists will argue that early detection and prevention might hold down the costs, politicians will know that preventative measures also have a cost. Although politicians would not admit to it, it is worth considering that faced with this runaway expenditure a decision may have been made to hold renal down to 2% of the NHS budget.
A 2% cap on existing patient numbers would mean that service provision will remain static, but on the growing patient numbers a 2% cap would have a devastating effect, meaning that either provision for patients would be halved or half of patients will not be treated.
The following chart shows that the current proportion of Dialysis versus Transplant patients will not be maintained over the next ten years:-
| Year | ESRF Patients | Dialysis | Transplantation |
|---|---|---|---|
| 2003 | 34,000 | 15,000 | 19,000 |
| 2013 | 68,000 | 30,000 | 38,000 |
|
However - UKTransplant agree that numbers likely to be Transplanted by 2013 are more likely to be around 24000 This leaves the table looking like this:- |
|||
| 2013 | 68,000 | 44,000 | 24,000 |
To Provide HaemoDialysis stations for the extra 29000 patients by 2013 would require Space, resource and staffing for a further 483 machines each and every year
What a renal patient costs the NHS will depend on many variables, however what is very clear from the chart below is that extending a renal patients life span increases the cost to the NHS. As can be seen from this chart – the cheapest patient is the patient who progresses in a vertical line from South to North without treatment. The more the treatment is successful, the longer the life span, the greater the cost to the NHS.
What becomes very evident from looking at this chart, is that the only cost effective way of treating a renal patient is to delay the onset of disability. The higher you can push the disability line, the smaller becomes the triangle of expenditure. Were this to be done it would have benefits in respect of patient quality of life and to the NHS budget.
It is evident looking at the above chart that any action to be taken should be in the large area below the disability line – but what is this area? What is it comprised of and how many people are in it? Can they be identified?
The diagram below shows the “whole renal community” including all those that would appear in the above graph – only this time they have been roughly grouped. The graph also depicts the relative volumes of patients.
Each of the five sections shown in the graph (below ESRF) consist of a body of people gradually or speedily progressing upwards into the next tier. The pyramid is smaller at the top than it is at the bottom because many die on route. Nephrologists are right to argue that proper, better management of the groups in each segment can delay or prevent progression upwards through the pyramid.
It must be right to identify and then treat at an early stage all patients in each of the above segments. It also follows that patients in the lower segments may be unaware of their own condition; and the only answer to this is to involve G.P.s in screening for creatinine clearance rates. Whilst as a nation we may not wish to embark on blanket screening of the population, there must be a case for screening those suffering from Anaemia, Diabetes, high blood pressure etc.
The NKF has since its inception only concerned itself with the top two layers of this pyramid, however, it is hoped (indeed the NKF has argued for) that within the NSF attention will be given to early prevention and detection of renal disease. It can be argued that the time is now approaching, when the NKF must seriously consider whether or not it should position itself to become the spokesman for and champion of, all people with renal disease wherever they exist within this pyramid. Such a change of emphasis cannot be undertaken lightly as the result would inevitably lead to a radically different organisation with different focus’s to those that exist today. It may be that the new role would be too large an undertaking and that members would not like the dilution of effort to support ESRF patients, but the NKF Executive committee is duty bound to consider this matter under rule 3 of its constitution.
If we reconsider the first chart:-
| Year | ESRF Patients | Dialysis | Transplantation |
|---|---|---|---|
| 2003 | 34,000 | 15,000 | 19,000 |
| 2013 | 68,000 | 30,000 | 38,000 |
|
However - UKTransplant agree that numbers likely to be Transplanted by 2013 are more likely to be around 24000 This leaves the table looking like this:- |
|||
| 2013 | 68,000 | 44,000 | 24,000 |
To Provide HaemoDialysis stations for the extra 29000 patients by 2013 would require Space, resource and staffing for a further 483 machines each and every year
Most would accept that however much we campaign, we are not going to get the huge increases needed to cope with the dialysis population, and that only leaves one option – to dramatically increase the numbers of Transplants carried out each year.
The NKF has now had exploratory talks with UKTransplant and with representatives of renal industries at the highest level. It would appear that there may be grounds to believe that under the umbrella of the NKF these major players could be brought together, and that several initiatives could be undertaken that would have the one aim of improving transplantation in the UK and generating a large increase in the volume of Transplants undertaken.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
Page created: 11 December 2003
Last updated: 22 April 2008
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