Home Dialysis Campaign Manifesto

Introduction 

The NKF is pleased to publish

 A Manifesto for Increasing Home Dialysis in England for the Benefit of Patients and the NHS

Report & Recommendations to the Secretary of State for Health and Social Care, the NHS and the Kidney Charities following the Home Dialysis Summit hosted by the All-Party Parliamentary Kidney Group 

The manifesto is the culmination of a 5 year campaign run by the NKF with the aim of increasing home dialysis rates across the country for the benefit of patients and the NHS. It's publication comes after the Home Dialysis Summit which was hosted by the All-Party Parliamentary Kidney Group in May 2025. 

Download the Manifesto

The report contains summary information gathered by the NKF which describes progress made and challenges still being felt. The full information from the responses can be found below.

View the Presentations

View the presentations used during the parliamentary summit.

Below, we have provided the collated responses from the NHS Regional Networks, Clinical Directors plans, and good practice responses.

Contents 

Click any of the below to be Directed To An Extended Response

Regional Network Responses

Clinical Director Responses

Government Responses

Regional Network Responses

All Responses from Regional Networks

North East and North Cumbria Network

Read Their Response

What is your network as a whole doing to improve Home Dialysis in your region?

Establishment of monthly meetings with home therapies teams from across the region to build a common sense of community and to share best practice. We have also made home therapies a focus topic at our regional showcase day and regularly support renal units in business case planning when they wish to expand their provision. We have also encouraged renal staff to increase awareness of the NKF phoneline peer support service. As a Network we update the management of units on the rate of their home therapies compared to national guidelines and encourage meeting and exceeding this level. In 2025 we hope to support home therapies patients in our region through charity supported home heating support initiatives which should improve experience of home dialysis care.

What progress has been made in increasing Home Dialysis in each of the units in your region?

Carlisle exceeds the 20% recommended rate of home therapies and achieved 31% in 2023 according to NHSE data. Sunderland has increased from 14% in 2018 to 15% in 2023 but is planning to expand further. Middlesbrough has raised its home therapies rate from 9% in 2009 to 12% in 2023 but remains far short of the 20% target, Network encouraging rectifying action. Newcastle currently on 18% and aiming to expand home dialysis further.

How are patients undertaking Home Dialysis in your region reimbursed for utility costs?

 Universal rate agreed across region following Network support and consultation, all units confirm reimbursement being carried out, some units using template forms provided by renal units. KPAs confirm patients in region receiving this money.

North West Network

Read Their Response

What is your network as a whole doing to improve Home Dialysis in your region?
The North West Kidney Network has a workstream focused on dialysis this workstream aims to optimise dialysis experience for all patients and reduce unwarranted variation. We have a vision to create a culture of confidence in home dialysis through clinical leadership and enhanced engagement. Objectives are to increase the uptake of home therapies across all units. Improve rates of medical PD Catheter insertion and Urgent-start PD and to establish regional QI metrics and establish data flow for us as a region.  

What progress has been made in increasing Home Dialysis in each of the units in your region?
Led by the leadership of a nephrologist based in Manchester five local QI projects have been stood up to improve home dialysis number, these have been decided locally at each provider organisation, they have also been supported by NWKQIP.

Regional metrics have been developed.


The Dialysis workstream has primarily focused on supporting the Home Therapies teams with their own Quality Improvement projects within each of their units. The units focused on two or three areas of improvement with a focus towards increasing home dialysis numbers. The workstream held a combined event with KQIP in November 2023 and November 2024. This event showcased the fabulous work undertaken by each of the units. With the assistance of KQIP we are currently supporting the units with sustainability tools to help keep momentum with their ongoing work. Numbers are slightly increasing.

How are patients undertaking Home Dialysis in your region reimbursed for utility costs?
Reimbursement process in place in adult five hub units across the region:


Liverpool University Hospitals NHS Trust (LUHFT) – Nephrology Department
Wirral University Teaching Hospital NHS Foundation Trust (WUTH) – Nephrology Department
Northern Care Alliance NHS Foundation Trust (NCA) – Nephrology Department
Manchester University NHS Foundation Trust (MFT) – Nephrology Department
Lancashire Teaching Hospital NHS Trust (LTH) – Nephrology Department
We are awaiting updates from the children's services at:
Alder Hey Children's Hospital Trust – Nephrology Department
(MFT) Royal Manchester Children’s Hospital – Nephrology Department

Yorkshire and Humber Network

Read Their Response

What is your network as a whole doing to improve Home Dialysis in your region?
The Yorkshire and Humber Kidney Network has appointed clinical leadership for dialysis to drive the development plans for dialysis. We have developed and will be monitoring our live data dashboard to track progress. We are building relationships with pre dialysis staff, promoting peer support and patient engagement. 

What progress has been made in increasing Home Dialysis in each of the units in your region?
Limited progress has been made in increasing home dialysis figures from UKRR show decreasing home dialysis rates in most areas:
Bradford 14% -13% (-1%) 
Doncaster 9% - 11% 2
Hull 17% - 15% -2
Leeds 11% - 11% -0 
Sheffield 19% - 16% - 3% 
York 24% -16% -8%

How are patients undertaking Home Dialysis in your region reimbursed for utility costs?
All units provide reimbursement for utility costs for patients on home dialysis, rates are reviewed annually and payments are made by bank transfer monthly or quarterly in arrears. 

Midlands Network

Read Their Response

What is your network as a whole doing to improve Home Dialysis in your region?
The Midlands Kidney Operational Delivery Network is performing well in meeting the 20% GIRFT National target for Home Dialysis and will launch the DAYLife Quality Improvement project in April 2025. This initiative aims to bring together units and patients to further improve home dialysis rates while maintaining high-quality care. The project will align with the Network's Peritonitis QI initiative. In May 2024, the Network hosted a Dialysis Study Day featuring educational sessions on patient/carer involvement, sustainability, managing challenging behaviours, new technologies, access to home dialysis in the Midlands, and caring for frail and vulnerable patients. Additionally, the Network has introduced the Dialysis Occupancy Measure (DOM), which focuses on In-Centre Haemodialysis but also highlights the need to increase home dialysis services. Home dialysis rates are regularly monitored at board meetings within the Network, and support is provided to units that require assistance.

What progress has been made in increasing Home Dialysis in each of the units in your region?


Nottingham
Over the past 12 months, significant progress made in increasing the number of patients on peritoneal dialysis, largely due to the efforts of the DAYLife project. Unfortunately, home haemodialysis (HHD) progress has stalled, partly due to the removal of the Quanta machine from the UK market.

Birmingham QE
At Queen Elizabeth Hospital (QEH), the key development has been the expansion of our assisted programme, now extended across Worcester and Herefordshire. This has helped ensure parity of service across our catchment area, and we had hoped to see a rise in peritoneal dialysis (PD) numbers as a result; however, this has not yet materialised. The PD team is working closely with the Advanced Kidney Care Clinic in Worcester to collaborate and optimise this service.


Regarding HHD, there has been a recent leadership change, with a new HHD lead taking over. The new lead will focus on increasing home HD numbers and improving conversion rates from other units. Though it’s still early days, as the lead has only been in post for a month, we anticipate progress in 2025.

Heartlands
The AKCT team continues to promote home therapies, including offering direct starts to home HD where possible. The PD, HHD, and AKCT teams meet fortnightly to discuss all potential patients. We aim to improve shared care uptake, with the current home therapies rate at Heartlands standing at 25%.

Dudley
They have been working on a Quality Improvement project within the trust to increase the HHD population. As a result, we’ve secured a four-bed bay for HHD and self-care training. Also in the process of acquiring a second training machine. Due to financial constraints, we are unable to recruit additional staff until we increase our patient population. In the meantime, we are rotating staff into HHD to build the team and support the self-care programme.

Shrewsbury
Our approach is multi-faceted, starting with early patient identification and streamlined referral processes through the AKCC for those progressing. This multidisciplinary clinic places a strong emphasis on education and support at the first point of contact. The dedicated CKD team then provides patient education and counselling on renal replacement therapy (RRT) through home visits outside the clinical environment, where we can better assess suitability for home therapies and meet with families and carers.


Additionally, CKD seminars offer further education, and our Home Therapies Fayre—held every three months—provides potential patients with the opportunity to hear from consultants, meet current home dialysis patients, and make an informed decision on their dialysis modality. We also offer supportive care for patients opting for conservative care. These efforts, though starting early, have significantly improved patient confidence in our care, with high acceptance of home therapies.

Derby
We have been actively involved in several projects to maintain and improve home dialysis rates. Over the past 12 months, we’ve maintained a home therapy population of approximately 30%. Our PD population has increased, with 40 new patients starting, though 31 patients have dropped off due to deaths, transplants, recovery of kidney function, or a switch to in-centre dialysis. The HHD population has remained steady, with 16 new patients starting, while 15 patients have dropped off for various reasons.


Significant changes have been made to the Advanced Kidney Care setup, including monthly reviews of all patients without a decision in our MDT, redesigning information sessions, revitalising shared care, and creating a new starter area in our main unit to promote HHD from the beginning of HD treatment. We are also continuing to prioritise PD as the first option wherever possible in AKC and are exploring PD acute starts for crash landers.

Wolverhampton
Wolverhampton has directly responded to the NKF and is continuing to develop its home dialysis services.

How are patients undertaking Home Dialysis in your region reimbursed for utility costs?

Shrewsbury

£75 provided quarterly.


Stoke 

Electricity: 4hrs 1 hr machine clean x 3 days = 15 hrs per week. 
Machine uses 1.95KV x 15hrs = 29.25KV. 
This provides a payment of £6.201 per week x 13 weeks = £80.613. 

Water: Water used per week is 1.8 litres. 
Water used per quarter is 21.6 litres (based on 13 weeks) 
Cost of water is £1.86 x 21.6 = £40.176 
Drainage is also reimbursed: 
Cost of drainage is £1.22 x 21.6 litres = £26.352 
Water and Drainage reimbursement is £66.528 per 13 weeks.


Wolverhampton 

 Quarterly payment for electricity plus water meter.


Dudley 

 Every quarter direct into bank account.


Derby 

 Contribute to electricity and water if on a water meter.


Leicester 

 At cost.


Nottingham, Birmingham and Coventry 

 No information.

South West Network

Read Their Response

What is your network as a whole doing to improve Home Dialysis in your region?
The SW Network chairs regular regional home therapies meetings to link teams, share ideas and support each other to improve outcomes. The Network collects monthly data detailing progress in this area. In November the Network held a very well attended Home Therapies away day. There were presentations from each of the renal centres showcasing how they had expanded their home therapies and how they had supported patients to get home that weren’t the ‘typical’ home dialysis patient national data was also presented and direction for home therapies. This event will be repeated in the autumn. The core Network team are supporting renal centres with bespoke quality improvement projects, patient and wider advertising of home therapies and changing the culture towards home therapies being the first line dialysis treatment. The Network is working towards a road show throughout the region to promote home therapies and focus events with haemodialysis nurses to raise the profile of shared care. The Network is hosting a spring industry event to ensure that all renal teams are fully aware of the range of options available to patients, the value added services and the technology that is present and in development.  There is a strong culture of sharing learning in the SW and this can be seen in the spread of medical PD catheter insertions, acute PD and in offering more than one type of HHD option to patients. 

What progress has been made in increasing Home Dialysis in each of the units in your region?
Royal Cornwall has tripled the number of people on HHD and sustained the number on PD. We are now supporting the team to grow both types of Home Therapy.


North Bristol Trust are steadily growing their PD patient numbers and have innovative plans for HHD which is also steadily growing.


Dorset have doubled their PD patient numbers and are now consolidating this and have a steady growth in HHD which is expected to continue this year.


RDUH has sustained both PD and HHD in the context of a challenging year for both PD and HHD teams.


Gloucester has increased its PD patient group by a third and is working with patients to develop shared care in haemodialysis services to then progress to HHD


Plymouth has sustained its PD patient numbers and managed to support some patients with HHD despite not having a formal service.


Home therapies in the region are at the highest since the introduction of the SW Renal Network

How are patients undertaking Home Dialysis in your region reimbursed for utility costs?
All renal centres in the SW are reimbursing using a calculation of the energy/water the patients prescription and type of machine requires.

London Network

Read Their Response

What is your network as a whole doing to improve Home Dialysis in your region?

The Dialysis at Home workstream is a key part of the London Kidney Network (LKN).  This workstream is supported by a project manager and co-chaired by a kidney doctor and a dietician. The workstream is engaged in a collaborative and multidisciplinary network level approach across both HHD and PD, it includes strong representation from people with lived experience of home dialysis.

What progress has been made in increasing Home Dialysis in each of the units in your region?

The LKN and the seven units across London and Surrey Heartlands are committed to not only supporting a greater number of people to have access to dialysis at home but also to improve the quality of care and outcomes for people on home dialysis.  This is further informed by discussions with a broad and inclusive LKN patient engagement group.  


In reflecting how to improve access to home dialysis, a key message from both the patient engagement group but more widely has been the need for easy access to peer support. In light of this and in a collaboration between LKN and Kidney Care UK, a full-time peer support co-ordinator. This individual has been engaged in supporting the development of a London-wide, inclusive peer support network which is now available to support people considering home dialysis or already doing dialysis at home.


Access to PD catheter insertion can be a barrier to support people to start home dialysis. There are now opportunities to train in percutaneous catheter insertion between London units. This training resource is now being used by individuals working between units in London to develop these skills and ensure that across as many as units as needed there is access to percutaneous catheter pathways.


Focusing on quality of care, the workstream has worked closely to support units to focus on the results and findings of the Kidney PREM to support changes at a unit level. Peritonitis is a key marker of quality of care and in conjunction with the Midlands Kidney Network, the majority of units in London have engaged with developing and implementing a Root Cause Analysis approach to each and every peritonitis episode. This looks to reduce both the rates of peritonitis but also improve the outcomes from PD peritonitis.


More broadly the LKN has worked with fluid and dialysis providers to ensure quality of care to patients on dialysis at home across London. The LKN has also developed and pioneered the use of the Kidney Dialysis Occupancy Measure to help focus providers on the challenges faced around in-centre dialysis capacity and the need to provide equitable access to high-quality home dialysis. 

How are patients undertaking Home Dialysis in your region reimbursed for utility costs?

The LKN has previously developed a network-wide reimbursement policy which has been adopted by the seven units in London, this covers reimbursement for people doing both HHD and PD. This is a flat rate reimbursement varying only by dialysis modality, and has been developed to ensure that it is easy to administer, paid prospectively and applied without means testing. The underlying principle has been to make it as equitable and easy as possible for people to access this support. 

The policy has been revised again in the last 6 months. Firstly, to ensure reimbursement in line with national price cap for energy supplies. Secondly, after engagement with patients and charitable organisations the policy has revised to include a nocturnal HHD reimbursement rate.

East Of England Network

Read Their Response

The East of England Network has now been established for two years and over the last year has been working on addressing significant challenges with dialysis and staffing capacity that are major concerns across the region. Added to this, the cost of delivering dialysis has increased over the years and the dialysis tariff no longer meets the cost of delivering holistic dialysis care - there is work nationally to review this against a background of significant financial challenges in the NHS, and the network is contributing to this. At least three of the five providers in the area are facing severe challenges in dialysis estates. In the East of England, the average dialysis growth is 5%, with some as high as 8% - this compares to previous growth predictions of around 2% - bringing a need for investment and there are ongoing discussions between stakeholders, ICB’s and commissioners on initiating the necessary capital and revenue investments that can be achieved along, with the other strategies for managing dialysis growth over the next ten years.

Against this background the network has set up a working group to develop their renal strategy, this group includes commissioners, renal providers, ICB’s and will soon include patient groups. Recent changes announced in NHS structures may affect the longer term plans and there is an understanding that this may have to adapt in the light of these developments.

The Strategy group is working on three main themes


1.    The Prevention of Chronic Kidney Disease
There is close work underway with the CVDR (Cardio-vascular, Diabetes, Respiratory Renal and metabolic pathways) to improve awareness and coding of CKD. This should be the basis for improving education in interventions to prevent or reduce the rate of progression of CKD and the consequent need for renal replacement therapy (transplant or dialysis). Despite the prevention strategy there will be an increase in kidney disease due to ageing population, enhanced life expectancy and medical breakthroughs, but the aim is to slow, delay or prevent the onset of kidney failure requiring renal replacement therapy. There are a number of different projects across the communities and ICB’s in EOE, including links with primary and secondary care providers to improve the interface between them. There is also a range of workstreams including:-  increased CKD coding, increasing uptake of renal protective medications, along with blood pressure and diabetes control in the community; increased education for prevention of acute kidney injury in the community; collaborative working with pharmaceutical providers to provide education for health care professionals and the general public.

2.    Improving lives by increasing home based dialysis
The region has agreed the target of 20% of patients on home based dialysis. Of the 6 ICB’s in the region only one (MSE) has hit that target and all the others are working to get there. To achieve this a number of initiatives are underway:

2.1.    Investment in home dialysis units and in training and investigating various ways of working with training units to be closer to home for patients.


2.2.    Working with psycho-social teams on barriers to home dialysis e.g. space issues, connecting patients with providers such as social services or the local council to explore the possibility of adaptions to make the environment suitable for home dialysis.  


2.3.    Achieving parity of renumeration across the region for reimbursement of utility bills.


2.4.    Developing better access to surgical procedures (mainly PD catheter insertion)– this is variable across the region and there is mapping underway to determine how it is provided and whether there are areas in the region where there is capacity that could be utilised. Clearly the challenge is the distance that patients may have to travel, with the aim of providing services as close to home as possible.

3.    Improving transplantation rates pre-emptively and improving transplant work up
Aligning transplant pathways to improve transplant listing and work-up of pre-emptive transplantation so that all those suitable for this procedure have the opportunity to join the transplant list – this work is still in its infancy but is proceeding apace. One of the challenges is improving the timeline for the delivery of pre-transplant investigations to lead to earlier activation on the transplant list.

Other areas being worked on include improving education and awareness in a pre- dialysis pathway for both Home Therapies and transplantation as it has been found that earlier discussions increase Home Therapies uptake. One of the East of England units is part of the national transform AKC quality improvement project with the hope that this will translate into more patients taking up home based treatment/pre-emptive transplant.

The network is also working on patient transport having set up a task and finish group – if reimbursement was offered for self-transport, then this could reduce the pressure on the service. A framework for good practice based on pathway mapping and patient feedback has been carried out, along with a survey to provide more reliable economic modelling. However, the financial position of the ICB’s is causing concern, but we will continue to monitor the position and seek improvements.

South East Network

No Response.

Clinical Director Responses

All Responses from Clinical Directors

Alder Hey Children's Hospital NHS Trust

Read Their Response

What area do you cover? 

North West

What percentage of your patients dialyse at home? 
45%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
No.

Have you developed further the initiatives detailed in your 2024 response? 
Our aim is to encourage as many patients as possible to have home therapy. Business case presented to secure home therapy Band 7 post; negotiations with Isle of man for patients to have home haemodialysis on the island with guidelines.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
No time in job plan for leadership post. 

Please list the projects or pathways you currently have in place to promote home dialysis.
Business case for band 7 home therapy nurse.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
No.

Berkshire Kidney Unit

Read Their Response

What area do you cover? 
South East

What percentage of your patients dialyse at home? 
15.2%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes. We are now able to offer aAPD as a first treatment option now we've recruited, previous had to suspend service no staff. Increased HHD from 9-19 pts. 2 WTE dedicated HHD nurses. The Vascular access team have also increased their numbers to two nurses, one of whom has responsibility for shared care, enabling supportive training of patients on their access before being transferred for their machine training. During the year, we began using the Physidia machine which is very easy to learn and patients are very keen to use. We have now established a training planner to book patients in for their training, they are on average trained for approx 3 - 4 weeks.

Have you developed further the initiatives detailed in your 2024 response? 
Dedicated geographical LCC team. Revised how we teach - additional medium eg online info. LCC revisit education of all acute presenters. Greater Involvement with the failing Tx cohort - Education earlier. For home HD we have had presented in all areas about the HHD strategy, enabling staff to talk with more confidence when discussing the subject with patients.  We continue to work with Accounts regarding the reimbursement programmes which we anticipate to be in place very soon.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes.

Please list the projects or pathways you currently have in place to promote home dialysis.
We have a bi-weekly meeting on HHD  - comprising of the HHD manager, Clinical Lead, Clinical Director, & HD lead nurse reviewing Clinical pathways and the strategic plan. LC have weekly audit meetings to identify home therapy patients. 

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Bristol Royal Hospital for Children

Read Their Response

What area do you cover?
South West

What percentage of your patients dialyse at home?  
60%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD, Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
No, in children we often have a high level of home dialysis. The introduction of HHD has increased our options. Patient choice remains an important factor in our process.

Have you developed further the initiatives detailed in your 2024 response?
HHD has evolved and we started our first patient on this treatment.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Not that I’m aware of.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
No.

Derby

Read Their Response

What area do you cover?
Midlands 

What percentage of your patients dialyse at home?  
30%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes, increasing presence of home therapies in AKC information sessions, increased home visits from home therapy teams prior to starting dialysis, increased shared care on the main dialysis unit with focus (where possible - hampered by increasing patient numbers). 

Have you developed further the initiatives detailed in your 2024 response?
Aiming to increase late choice to home therapy pathway.

Please list the projects or pathways you currently have in place to promote home dialysis.
1) AKC information sessions redesign

2) New starter on Haemodialysis initiative with everyone given opportunity to meet the home team

3) Planning late choice onto home therapies project.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Derby - Additional Response

Read Their Response

What area do you cover?
Midlands

What percentage of your patients dialyse at home?  
30%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes.

Have you developed further the initiatives detailed in your 2024 response?
Yes.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme?
Yes.

Please list the projects or pathways you currently have in place to promote home dialysis.
New information sessions, road shows, new starter bay on ICHD unit, home visits, 1:1 sessions with home therapies team before starting dialysis.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Doncaster and Bassetlaw NHS Foundation Trust

Read Their Response

What area do you cover?
North East and Yorkshire

What percentage of your patients dialyse at home?  
20%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Started addressing it, but not finished.

Have you developed further the initiatives detailed in your 2024 response?
Yes, by encouraging Peer Support group to speak to patients interested in HHD. Also, education on Home Therapies from pre-dialysis.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes.

Please list the projects or pathways you currently have in place to promote home dialysis.
Pre dialysis clinics and education, pre dialysis home visits, outpatients clinics, arranged meetings with pre dialysis patients, leaflets and posters on home therapies.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis?
No.

Evelina London Children's Hospital

Read Their Response

What area do you cover?
South East

What percentage of your patients dialyse at home?  
65%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
We always consider home dialysis first. We actively consider peritoneal dialysis and actively consider home haemodialysis.

Have you developed further the initiatives detailed in your 2024 response?
No.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
No.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
No.

Leeds Paediatrics

Read Their Response

What area do you cover?
North East and Yorkshire

What percentage of your patients dialyse at home?  
40%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage;

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes.

Have you developed further the initiatives detailed in your 2024 response?
But no resources - need more staff.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
No.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
No.

Mid and South Essex NHS Foundation Trust

Read Their Response

What area do you cover?
East of England

What percentage of your patients dialyse at home?  
20.2%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static

Have you updated your plans for increasing the proportion of patients dialysing at home? 
We are doing an advance kidney care project which aims to improve patient activation.

Have you developed further the initiatives detailed in your 2024 response?
We are trying to develop a standard policy on the offer and practice.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
I suspect not.

Please list the projects or pathways you currently have in place to promote home dialysis.
We will see the impact and link.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Don’t know.

NHS Grampian

Read Their Response

What area do you cover?
Scotland

What percentage of your patients dialyse at home?
10%  

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes. After some logistical issues we are now in a position to get 4 patients home HD, 2 have already transitioned, we already have 4 at home so our aim is to double numbers by February. Some have been transplanted though. Numbers of Home HD are very small but we are about to release a media story to boost the coverage of it. We are also still doing incremental PD in the hope to increase those numbers but our PD numbers have dwindled a lot over the past few years. 

Have you developed further the initiatives detailed in your 2024 response?
Nothing different to our previous response, I sent but have now managed to get more people Home HD trained. 

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Not registered before now.

Please list the projects or pathways you currently have in place to promote home dialysis.
Promoting Home therapies through our low clearance clinic after Transplant first.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
No.

NHS Lanarkshire / Airdrie

Read Their Response

What area do you cover?
Scotland

What percentage of your patients dialyse at home?  
14% (33 PD, 4 home HD (via Glasgow service), 219 hosp HD)

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD.

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Constantly under review and discussed at our weekly multidisciplinary team. PD nurses proactively go into the HD units to promote PD, particularly targeting those with vascular access difficulties or crash-landers who may have not been able to have PD initially. We have a self-care HD unit who promote referral to home HD unit at adjacent health board if patients are keen/suitable. 

Have you developed further the initiatives detailed in your 2024 response?
More buy-in from MDT. Taking on in-house assisted PD with a view to increasing PD for frail patients or those who may need more assistance. 

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Not sure.

Please list the projects or pathways you currently have in place to promote home dialysis.
KCPC improvement project ongoing, and engagement in Transform AKC to improve pre-dialysis care, education and choices. 

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
No.

Ninewells

Read Their Response

What area do you cover?
Scotland

What percentage of your patients dialyse at home? 
11% 

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes - planning to start Nx STAGE.

Have you developed further the initiatives detailed in your 2024 response?
Yes - discussing support for increasing Home HD numbers and optimise PD.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
No.

Please list the projects or pathways you currently have in place to promote home dialysis.
Promoting home dialysis as at the first step of dialysis pathway and preemptive transplants at AKCC.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis?
Yes. 

Norfolk and Norwich University Hospitals NHS Foundation Trust

Read Their Response

What area do you cover?
East of England

What percentage of your patients dialyse at home? 
22% 

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes. PD: New 'New Patients' clinic started Aug 2024 to encourage shared decision making, see the unit and the various home treatment options; Working with LCC (Advanced Kidney Care), pre-dialysis education and Nephrology colleagues to increase exposure to the idea of PD from an early stage and prevent defaulting to HD; Acute APD programme for inpatients/AKI/crash landers now well established; Self-care and shared-care in main HD unit being encouraged as a potential stepping stone to going home; Regular 'Home Huddle' coffee mornings for peer support and to increase the sense of community for home patients, combatting isolation; Further development of assisted APD and remote monitoring (ongoing).

Have you developed further the initiatives detailed in your 2024 response?
Yes. Creation of a formal, kidney-centre led assisted APD programme; other aspects as outlined above.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes, attended the DAYLife day in Aston earlier this year.

Please list the projects or pathways you currently have in place to promote home dialysis.
Local policies for Acute APD, referral for/insertion of PD catheters and initiation of dialysis, shared-care HD in-centre, pre-dialysis education and 'choice room' for patients/families/carers to explore options.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Nottingham

Read Their Response

What area do you cover?
Midlands

What percentage of your patients dialyse at home? 
27% 

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home?
We have been working with Midlands regional DAYLife team and have successfully increased home dialysis rates, especially peritoneal dialysis.

Have you developed further the initiatives detailed in your 2024 response?
We are going to be working with the DAYLife team to re-invigorate our Shared care programme  - selected as team to be mentored. We are also working to develop a peer support programme which lapsed several years ago.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes, recently selected for shared care mentoring programme.

Please list the projects or pathways you currently have in place to promote home dialysis.
Shared care, developing peer support, reducing peritonitis.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Royal Free London

Read Their Response

What area do you cover?
London

What percentage of your patients dialyse at home?  
16%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes we have an entire workstream dedicated to growing therapies with a dedicated CNS in post now. 

Have you developed further the initiatives detailed in your 2024 response?
Yes.

Who is the dedicated clinical lead for home dialysis at your unit?
Currently covered by our dialysis lead but we plan to make a separate home haemodialysis lead also.  

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
I wasn't aware of this but will check with them.

Please list the projects or pathways you currently have in place to promote home dialysis.
New dedicated home therapies nurse, in reach to low clearance and failing transplant services, new lease scheme for more user friendly home haemodialysis machines, patient education sessions, purchase of additional HD machine for training, increased support from therapies team available if required to facilitate a home therapy.  

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Sheffield

Read Their Response

What area do you cover?
North East and Yorkshire

What percentage of your patients dialyse at home? 
17% 

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
We are still trying to secure funding to develop a sustainable plan for home therapies growth which is made very difficult by the bloc contact.

Have you developed further the initiatives detailed in your 2024 response?
No.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes.

Please list the projects or pathways you currently have in place to promote home dialysis.
General predialysis education, and then dialysis education on wards as well as new starters.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Sheffield - Additional Response

Read Their Response

What area do you cover?

North East and Yorkshire

What percentage of your patients dialyse at home? 
18%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
We are currently submitting a business plan for more nursing and educational support to facilitate transition and training for home therapies.

Have you developed further the initiatives detailed in your 2024 response?
No.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes.

Please list the projects or pathways you currently have in place to promote home dialysis.
Unaware.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Shrewsbury

Read Their Response

What area do you cover?
Midlands

What percentage of your patients dialyse at home? 
33%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Home Therapies Fayres to increase patient interactions with peers. Ongoing education of colleagues in promoting home therapies. Sharing of outcomes and experiences.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

St Helier Hospital, Carshalton

Read Their Response

What area do you cover?
London

What percentage of your patients dialyse at home? 
15%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Promoting home therapies in AKCC. One of the senior nurses is participating in Daylife program. 2 senior nurses attended Home dialysis academy.

Have you developed further the initiatives detailed in your 2024 response?
Reducing loss of patients on PD - we managed reducing early loss (90 days) down to 0% for 3 consecutive quarters.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
One of the senior nurses has participated in the program and is sharing the learnings with the rest of the team.

Please list the projects or pathways you currently have in place to promote home dialysis.
1. Developing peer support group for home therapy - to empower more patients to take up home dialysis.

2. We are working to create a new joint renal service with St George's hospital and developing a service and pathway structure that creates an environment to facilitate patient's access to home therapies. 

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

Swansea Bay

Read Their Response

What area do you cover?
Wales

What percentage of your patients dialyse at home? 
18.2%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes.

Have you developed further the initiatives detailed in your 2024 response?
Yes.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Unsure.

Please list the projects or pathways you currently have in place to promote home dialysis.
Value in health care project.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

University Hospitals Derby and Burton NHS Foundation Trust 

Read Their Response

What area do you cover?
Midlands

What percentage of your patients dialyse at home? 
31%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes.

Have you developed further the initiatives detailed in your 2024 response?
Yes, Shared Care promotion in new starter bay on main HD unit. Home therapies teams visiting ICHD patients.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes.

Please list the projects or pathways you currently have in place to promote home dialysis.
In house information sessions with AKC and home therapies, shared care on haemodialysis, home therapy open days.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
Yes.

University Hospitals Plymouth 

Read Their Response

What area do you cover?
South West

What percentage of your patients dialyse at home? 
22%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
We have submitted a business case for a home haemodialysis nurse - still awaiting approval.

Have you developed further the initiatives detailed in your 2024 response?
We have no on-going projects.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Not applicable.

Please list the projects or pathways you currently have in place to promote home dialysis.
We have no projects currently under way.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis? 
No.

Wirral University Teaching Hospital

Read Their Response

What area do you cover?
North West

What percentage of your patients dialyse at home? 
16.5%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes, we have participated in a KQUIP / QI project looking at both HHD uptake and PD retention over past few years.

Have you developed further the initiatives detailed in your 2024 response?
Yes, we have developed an enhanced support programme for new starters to PD to prevent early loss to in centre HD.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes.

Please list the projects or pathways you currently have in place to promote home dialysis.
Shared HD / Enhanced PD support / Medical PDC Placement /Infectious Complications Competency Framework.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis?
Yes.

Wolverhampton

Read Their Response

What area do you cover?
Midlands

What percentage of your patients dialyse at home? 
19%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Yes, our dialysis population has been growing at a rate of 8% over the last 3 years. This growth has led to enormous pressures on dialysis slots, this has led to us updating our plans and requesting financial support from our regional renal network as well NHSE specialist commissioning.

Have you developed further the initiatives detailed in your 2024 response?
Yes, due to increased growth in dialysis population in our centre, we have developed a new business plan to expand our home therapies unit.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
Yes.

Please list the projects or pathways you currently have in place to promote home dialysis.
We are actively involved in projects developed by the DAYLife learning hub.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis?
Yes.

Wrexham

Read Their Response

What area do you cover?
Wales

What percentage of your patients dialyse at home? 
25%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static

Have you updated your plans for increasing the proportion of patients dialysing at home? 
No formal plan but we do have a drive to maximise uptake of home therapies which is having a demonstrable effect. The vast majority of CKD patients approaching RRT have a home therapy as preferred option.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
No. This is being led by our Low Clearance lead as this is where the patient education occurs.

Please list the projects or pathways you currently have in place to promote home dialysis.
Nil extra. We are anticipating reaching 30% within the next couple of years.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis?
No.

Lister Hospital Stevenage

Read Their Response

What area do you cover?
East of England

What percentage of your patients dialyse at home? 
12.6%

Do you offer PD, HD static machine, HD portable (e.g NxStage)?
PD, HD Static, HD Portable e.g NxStage

Have you updated your plans for increasing the proportion of patients dialysing at home? 
Focus remains growth in home HD and PD simultaneously through

(1). Expansion of home therapies training area (funding required-work in progress) 

(2). Changes to pre-dialysis pathway to ensure those choosing PD are more likely to end up on their chosen home therapy

(3) modifications to pre-dialysis education programme to provide greater education in home therapies

(4) Introducing patients to shared care dialysis within the home therapies training area

(5) expansion of home therapies team to assist in home visits and help reduce losses to programme.

Is the dedicated clinical lead for home dialysis at your unit engaging with the national DAYLife programme? 
We have opted not yet formally taken on the DayLife project as we are participating in a CKD project to change our pre-dialysis pathways that was felt to have considerable overlap. However, this is something we are likely to participate in very soon.

Please list the projects or pathways you currently have in place to promote home dialysis.
(1). Home dialysis education days through Advanced Kidney Care team started early 2024

(2). Home therapies annual events for established patients to promote retention in the programme and also facilitate interactions between home therapies patients

(3). Home therapies training area expansion project which has undergone detailed planning but is awaiting funding confirmation by the Trust.

Does the dedicated clinical lead have dedicated/allocated time to improve home dialysis?
Yes.

Central Manchester University Hospitals NHS Foundation Trust

Read Their Response

What area do you cover? 
Greater Manchester East Sector and East Cheshire. 

What percentage of patients dialyse at home? 
25% of all dialysis. 

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 
PD… YES  HD Static machine…YES  HD portable (e.g. NxStage)…YES

Have you updated your plans for increasing this proportion? 
Manchester has been one of the largest centres for provision of home dialysis over the past 15 years. Both HHD and PD uptake numbers have increased steadily over the years and continue to do so. Home dialysis remains the default modality where preferred by patients and clinically safe and feasible. In HHD we have achieved one of the lowest technique failure rates (published data NDT). In the past 3 years, there have been a number of new and ongoing initiatives to sustain and increase the proportion of patients on Home dialysis such as:


1. Default modality of choice in the advanced kidney care clinics. 
2. Development of new resources for patients (videos in PD, etc). 
3. Augmented Medical PD catheter insertion through Renal Daycase. 
4. Increase in no of Consultant workforce delivering PD catheter insertions. 
5. HD start up program (30% pts opting to train through DAU). 
6. Increased HHD training capacity. 
7. Newly recruited HHD training team in the past 3 years (Sustainable workforce). 
8. New Independent HD Self Care program where Home is not suitable. 
9. Highly experienced MFT Community support Team (Home Dialysis). 
10. Trialling of novel devices in Home-dialysis to improve uptake. 
11. Sharing successful initiatives with other centres. 
12. Research in less explored areas (e.g. Self cannulation).

Have you developed further the initiatives detailed in your last response? 
We have a continuous cycle of innovation in home dialysis to improve the offering to all patients who choose to take up this modality to sustain and improve the program.

(This Response is From 2024)

Salford, Northern Care Alliance NHS Foundation Trust

Read Their Response

What area do you cover? 
Greater Manchester North.

What percentage of patients dialyse at home? 
20%

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 
PD… YES  HD Static machine… YES  HD portable (e.g. NxStage)… YES

Have you updated your plans for increasing this proportion? 
Yes.

Have you developed further the initiatives detailed in your last response? 
Departmental quality improvement project with allocated clinical time in progress.

(This Response is From 2024)

King’s College Hospital NHS Foundation Trust

Read Their Response

What area do you cover? 
South-East London. 

What percentage of patients dialyse at home? 
15%

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 
PD… YES  HD Static machine… YES  HD portable (e.g. NxStage)… NO

PD TEAM  
PD Access  
Home visits available to help with decision making progress/ build confidence/ensure suitability.  

Ongoing to recruit unplanned start through acute PD program supported by nurse specialist and nephrologist inserted PD catheters.  

Started interventional radiology guided catheter insertion with ultrasound & fluroscopy guidance to expand pool of patients able to have local anaesthesia insertion.
We are working to formalise pathway for patients needing adjunct procedures e.g. hernia repair at the time of GA PD catheter insertion to enable these patients to have timely peritoneal access.  

PD retention 
Implemented incremental PD to reduce therapy burden / burnout.  

Focus on peritonitis reduction with root cause analysis of cases, regular retraining program and integration of microbiologist into weekly MDT to ensure effective treatment plans/minimise unplanned transfers to HD. 

We continue with a program of local anaesthetic procedures to enable rescue of dysfunctional catheters or infected external cuffs to extend technique survival.  

Assisted APD team to enable broad range of patients to benefit from the technique.

Home-Home transfer: 
Discussion on planned PD-HD transfer re continuation of home therapy via home HD.

Home HD TEAM 

Changes to programme since 2022. 

Improved Facilities & Increased Staffing 
Procurement of 25 HHDx machines with ROs. 
Procurement of additional vehicles for community support of HHDx patients. 
Recruitment of another Consultant to look after the Home Haemodialysis programme. 
Recruitment of 2 additional nurses with resource for a further nurse. 
Recruitment of further technical staff. 
Upscaling of use of training room- now with nursing provision to provide training of 8pts/wk with additional respite provision for patients currently at home. Currently 8 patients training each week. 

Actions to Improve Recruitment of Patients/Awareness 
Local Home HDx roadshow held this year on main hospital site with encouragement of patients to attend with existing patients present to provide peer support/real experience. 

Greater education from our Advanced Kidney Care Team about the Home Haemodialysis option to those patients with declining kidney function. 

Greater referral rate from our Consultant team reviewing new starters to Haemodialysis (planned and unplanned starters) providing a “Home Haemodialysis First” approach (as opposed to satellite HDx).

Weekly meetings with dialysis staff at our Main Starter unit to highlight potential patients who want to do Home HDx or are considered good candidates to approach prior to their transfer to satellite units. 

Visits by our Home Haemodialysis Team to the satellite dialysis units to introduce the concept to already established patients. 

A more proactive approach regarding the criteria required for what is required for a suitable Home Haemodialysis patient. Patients can now come for a taster fortnight to the training area where they can learn more about Home HDx and where they can be assessed re their capability by the Home HDx team at the same time without losing their existing satellite dialysis slot. 

Participation in the newly created Home Haemodialysis forum in the London Kidney Network so to share ideas of success and highlight challenges. 

Ongoing Retention of Established patients 
Monthly community reviews now established by the Home HDx nursing team for review of set up, refresher training, review of aseptic technique, needling review and assessment of AVF. 

Respite slots created as required if patients/relatives needing a break or access issues so to try to delay/ prevent home dialysis fatigue. 

Advanced Kidney Care Clinic (AKCC) 
Add home therapies suitability as one of top headlines at top of AKCC letter (along with RRT plan/hep B /Tx status) - if not suitable try to add reason so if modifiable eg currently in unsuitable housing point of potential could be identified. 

Make more use of offered home visits by PD team to anyone flagged as potential for PD. 

Plan to use a new home haemodialysis leaflet with all patients who might be suitable. 

Development of existing strong peer support service to optimise support to help people confidently choose or remain on home therapy.  

Earlier referral (in AKC) of people who may be able to do home haemodialysis to the specialist nurses who then provide additional information and support.

(This Response is From 2024)

Royal Cornwall Hospitals NHS Trust

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What area do you cover? 
Cornwall. 

What percentage of patients dialyse at home? 
10.7% and rising fast 

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 
PD… YES  HD Static machine… YES  HD portable (e.g. NxStage)… YES Physidia 

Have you updated your plans for increasing this proportion? 

Now has Physidia and plan to train 17 people on it – already done 10 and future patients identified.

Concerted effort to increase PD, main new activity is home dialysis team sit in with ckd nurse discussing RRT options. 

Increased home dialysis staff – which will enable assisted PD. 

Patient who have chosen PD for the future RRT has increased markedly. 

Target 20% – aim to achieve in 2024. 

Have you developed further the initiatives detailed in your last response? 
As detailed above. 

KQUIP have been a major driver and support.

(This Response is From 2024)

Lancashire Teaching Hospitals NHS Foundation Trust

Read Their Response

What area do you cover? 
Lancashire and South Cumbria which also includes the catchment areas of neighbouring hospital trusts: Blackpool Teaching Hospitals NHS Foundation trust to the West, East Lancashire Teaching Hospitals NHS trust and University Hospitals of Morecambe Bay NHS Foundation Trust to the North. 

What percentage of patients dialyse at home? 
15% 
Current numbers: PD 56; HHD numbers 39 (although some fluctuations on a monthly basis depending on new starters and transition of modality). 

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 
PD: Fresenius and Baxter Systems, HD Static machine: 5008s, HD portable: NxStage

Have you updated your plans for increasing this proportion? 
Considering our expansive geographical catchment area, a new Home Dialysis Training Facility has now been opened at Westmorland General Hospital facilitating the provision of a more equitable service to patients with End Stage Renal Disease within South Cumbria and Morecambe Bay area. This allows the delivery of Home Therapy Dialysis Training nearer to home, whereby previously these patients had to travel to Chorley District Hospital. Our longer-term goal would be to offer an Assisted APD (aAPD) Service in this area. Recent attempts to recruit staff for this have proved challenging. 

We have a Home Therapy Dialysis Co-Ordinator in post that guides the patient though their pathway to our service and who liaise closely with our Kidney Choices Team. Our advanced kidney care clinics have expanded with the goal of having an advanced kidney care clinic at each of our renal centres. 

Where possible we provide home based training for PD and on occasions, we have been able to deliver NxStage training at home. 

Recent PD developments have been the introduction of a laparoscopic surgical PD catheter insertion and salvage service locally as well as collaboration with the Manchester Royal Infirmary Transplant Surgical Team for support as we develop the service to offer laparoscopic insertion of Tenckhoff Catheters in patients with significant previous abdominal surgeries, where medical insertions are not an option or have been unsuccessful. 

We are also examining our acute PD pathway and expanding our catheter insertion list to twice weekly in order to offer PD as a viable option for patients presenting acutely with end-stage renal failure. 

Have you developed further the initiatives detailed in your last response? 

We work closely with the Kidney Choices Team (KCT) to further align our pathway to promote Home Therapies. 

We are looking into staffing to help support the Dialysis Co-Ordinator to be able to visit our Satellite Dialysis Units to re-evaluate dialysis decisions in some patients who are considering a Home Therapy. 

We hold a quarterly Patient Dialysis Education day where we get to showcase and promote Home Therapies which is popular and well attended. Patient feedback from these events are consistently high. We are exploring options to make these events available at other venues to improve accessibility. We would like to increase our home-based training for the NxStage machine. 

Further development of our laparoscopic surgical PD Pathway, as this is relatively new service.

(This Response is From 2024)

Kent & Canterbury Hospital University NHS Foundation Trust

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What area do you cover? 
Kent. 

What percentage of patients dialyse at home? 
14% Jan 2024 

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 
PD… YES  HD Static machine… YES  HD portable (e.g. NxStage)… NO

Have you updated your plans for increasing this proportion? 
• DAYLife – Has allowed opportunity to refocus on our shared care aspect of service. 

1. Patients perspective, introduced levels of shared care and launched a 2-week upskilling course with HHD staff. 
2. Staffs perspective – introduced a bespoke training update for the champion nurses and plans to introduce a new training programme for all HD staff to better understand all aspects of shared care.


• Business case developed to increase both home dialysis staff and resources – however competing with other Trust service changes and the necessary finances required. 

Aspects of the business case proposed: 

1. Establish the current assisted PD programme internally. 
2. Alter our approach with HHD resources – by leasing machines rather than purchase. 
3. Consider opportunity to provide assisted HHD – dependant on success of localised PD programme.

 4. We had identified the need for a smaller model of machine – offering versatility for those homes who cannot accommodate the larger model of machine – but this is currently on hold.

(This Response is From 2024)

Addenbrookes / Cambridge University Hospitals Foundation Trust

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What area do you cover? 
East Anglia - Cambs, Norfolk, Suffolk, Essex, Beds and sometimes Lincs. 

What percentage of patients dialyse at home? 
16.2% 

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 
PD… YES  HD Static machine… YES  HD portable (e.g. NxStage)… YES 

Have you updated your plans for increasing this proportion? 
YES 

Have you developed further the initiatives detailed in your last response? 
We are re-launching the Shared-Care programme. We are in the process of educating staff on the Shared Care initiative and liaising/networking with other units to helps us promote its uptake.

(This Response is From 2024)

Monklands Hospital, Airdrie, NHS Lanarkshire

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What area do you cover? 
NHS Lanarkshire. 

What percentage of patients dialyse at home? 
9.5% 

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 
PD… YES HD Static machine… * HD portable (e.g. NxStage)… * 
*Our home haemo training and care falls under the remit of our neighbours, Greater Glasgow and Clyde. I think at present there are 5 patients from NHS Lanarkshire on Home HD through this service but have counted them in our numbers as we have referred for/pay for this service. 

Have you updated your plans for increasing this proportion? 
In light of new technologies e.g. Nx stage, we plan to survey the current hospital HD population to explore barriers to home HD – particularly whether travelling to Glasgow for training etc is a barrier and we should be considering setting up a local service. 

We have been proactive in encouraging PD in our low clearance clinics (for suitable patients), are exploring funding for setting up an assisted PD service (currently outsourced to Baxter) and undertake regular review of hospital HD patients to see if they would wish to consider a switch of therapy. 

Have you developed further the initiatives detailed in your last response? 
Unsure. Workforce has been a major barrier to our progressing/auditing our current practice but we have had some successful recruitment recently and hope to make some progress (or at least have more detail of barriers to progress) in the near future.

(This Response is From 2024)

Queen Elizabeth University Hospital Glasgow

Read Their Response

What area do you cover? 
Greater Glasgow & Clyde and Forth Valley Healthboards for PD and Home HD, and NHS Lanarkshire for Home HD only.

What percentage of patients dialyse at home? 
7%

Do you offer PD, HD static machine, HD portable (e.g. NxStage)? 

PD… YES  HD Static machine… YES  HD portable (e.g. NxStage)… YES

1. Home therapies updates presented at internal meetings to highlight these modalities to colleagues – wide audience with senior nurses from all areas of renal medicine specifically invited. 

2. For PD, home training (as opposed to in-centre) now offered routinely which might make it more attractive to patients when deciding. 

3. PD technique reviewed at set intervals and after every PD peritonitis episode. This was ad hoc before but the hope is this might help reduce recurrent infection and prolong time on the modality. 

4. Home HD – we have addressed potential sources of patients. 
A. Pre-dialysis patients: we looked through all patients attending Stobhill Hospital General Renal Clinics with eGFR <18ml/min and remotely reviewed their records to see if there was anyone who might have been referred for home treatment – patients were then flagged on our EPR OPC screen and consultants at their next clinic were notified. The impending arrival of a ‘low clearance’ clinic at Stobhill should focus our efforts on home RRT better
B. Patients starting haemodialysis: we have set up an automatic email sent out to any clinician referring a patient for a hospital haemodialysis space asking if the patient would be suitable for home dialysis.
C. Patients already using Hospital HD – senior nurses in each of the dialysis units were encouraged to consider whether any of their group of patients would be suitable and our most senior Home HD nurse and one of our registrars have visited the units to provide encouragement and further information.

5. Self-care HD – we have started self-care training in the Home HD training room and encouraged it across other sites as a means of increasing patients’ independence. This has been shown to encourage patients in NHS Lanarkshire to consider home HD training.

6. Peer support/education - we have patients who offer to provide information and peer support for those considering Home HD. One of our more recent patients has made a video outlining his dialysis journey (PD and Home HD) which we hope will help others considering home RRT.

7. Home HD – informal discussions with our surgical dialysis access team to encourage them to refer any patients they think would be suitable.

8. I think we should also be considering PD and Home HD with a portable machine for those who need a short period of dialysis prior to transplantation. The Physidia is a pay-per-treatment modality and this more costly, but with a cassette system, and without the need for conversion, it is much quicker to train and get home (i.e. 2-3 weeks – much closer to times for PD).

(This Response is From 2024)

Response From the English Government 

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Response From the Scottish Government

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Response From the Welsh Government 

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Response From the Northern Ireland Government 

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Author: Joe Rutter

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