Policy Statements - PAYMENT FOR "AWAY FROM THE BASE UNIT DIALYSIS"

 

Passed by the NKF March 2002 (Amended 2008)

The NKF believes that all current and future NHS Trusts, and other renal NHS budget holders, should make adequate financial provision for away from the base unit dialysis for all patients (sometimes known as holiday dialysis). Holidays and other trips from home are an essential part of renal replacement therapy and the lack of this provision can have a detrimental effect on patient welfare and outcomes.


Note

The NKF views with concern the restrictions placed on payment for holiday dialysis by some NHS Trusts, said to be due to insufficient budgetary provision. Funding for four weeks should be available for each patient each year. Failing this, three weeks should be regarded as a minimum. Payments available for holidays in the UK should be extended to countries not covered by EHIC or reciprocal arrangements where patients have a family link and are often making a visit after many years away.

Whilst accepting the pressure on available NHS funds the current discrimination is unacceptable.

Note 2

Following an NKF petition concerned with dialysis away from the home unit, the Prime Minister (Gordon Brown MP) responded by saying via a reply from 10 Downing Street:-

'The National Service Framework (NSF) for Renal Services makes clear that the ability to dialyse away from home, for holidays or other reasons, is important to kidney patients. The Department of Health has published guidance Temporary haemodialysis away from home, which is available from the Department’s website at https://www.gov.uk/government/organisations/department-of-health (search for ‘haemodialysis’). This contains advice on dialysis away from home in England and overseas.

Many patients are able to travel on holiday or business and are able to arrange for their haemodialysis to take place away from their home unit. This includes patients who travel within the European Economic Area and are able to receive dialysis treatment under the European Health Insurance arrangements, and patients visiting Switzerland and Australia.

However, some patients experience difficulties arranging temporary dialysis away from home (TDAFH) in the UK, in popular holiday destinations and at peak holiday periods or in areas where the dialysis services are under particular pressure. To tackle this issue, the Department has set up a working group led by Bob Dunn, Regional Advocate for the National Kidney Federation and a member of the Department’s Renal Advisory Group, to consider and provide a good practice guide to facilitate improved holiday dialysis. Its terms of reference are to examine the restrictions and NHS working culture barriers that prevent renal patients from obtaining TDAFH, suggest ways of breaking down those working cultural barriers to effect change, and identify examples of good practice that can be spread more widely in order to improve the experience of TDAFH. The report is due in the autumn.

It will be possible to extend TDAFH in England by increasing haemodialysis capacity. The Government has taken several steps to do this. First, it provided £60million between 2000/1 and 2005/6 as a capital investment programme for renal services.

In December 2007, the Department of Health wrote to all Primary Care Trust and Strategic Health Authority (SHA) chief executives, reminding them to work through their Specialised Commissioning Groups (SCGs) to ensure that robust plans are in place to meet the rising dialysis demands of their populations. The National Clinical Director for Kidney Care, Donal O’Donoghue, offered his support to work with SHAs and SCGs to review regional dialysis capacity plans to ensure that expansion plans are based on sound assessment of local need and comprise a balanced portfolio of treatment options.

The Department has also written to the directors of SCGs, emphasising the priorities and planning guidance set out in the 2008/9 Operating Framework, which calls on SCGs to pay attention to areas where significant increases in demand are likely to lead to pressure on services. It gives the example of demand for renal replacement therapy (dialysis or transplantation), which is projected to rise by around five per cent a year until at least 2030, and states that SCGs will wish to consider options for expanding the provision of satellite dialysis centres and offering more people the option of home dialysis, as well as expanding traditional acute dialysis units. The Department is also revisiting national modelling assumptions used in the NSF to bring them up to date.

Part of the national Phase 2 Independent Sector Treatment Centre (ISTC) Electives programme, called the E16 Renal Scheme, focused on providing expanded haemodialysis capacity in new facilities at existing locations and new facilities at locations where no satellite haemodialysis units currently exist. The E16 Renal Scheme reached financial close on 20 December 2007. It is expected to deliver approximately 108,000 haemodialysis sessions per year over a seven year period, when all units are on stream. Schemes which form part of the ISTCs procurement are developed in line with the needs of the local communities in which they will operate, and, to this end, the Department has worked closely with the local NHS and key stakeholder groups, including the National Kidney Federation, throughout the procurement to ensure that the scheme will be seamlessly integrated into existing NHS renal networks.

The Department of Health has also set up a unique project group of Trust finance managers, clinicians and commissioners to explore the issue of Payment by Results (PbR) for kidney services and to improve the quality of dialysis reference costs that are submitted as part of the process. The introduction of a tariff for dialysis in 2009/10 should make it easier to arrange care away from home because the tariff will smooth out the variation in costs between different providers.

These initiatives will in the long term help to alleviate the difficulties faced by patients and enable them to easily dialyse away from their home unit.'