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Health: Self-care Dialysis

Volume 711: debated on Monday 1 June 2009


Asked By

To ask Her Majesty’s Government what steps they are taking to encourage the uptake of self-care dialysis, including home haemodialysis, by patients with kidney disease throughout the country.

My Lords, the Government’s policy High Quality Care for All reaffirmed the Government’s intention to offer patients the right choice of treatment. For kidney patients this includes choice of a range of renal replacement therapies provided at home, in hospital or at a satellite unit. We know we need to do more and are actively engaged in looking at ways in which we can improve provision and the take-up of home haemodialysis.

My Lords, I thank the Minister for her reply. As there are significant advantages for the patient in self-caring at home, why is there such a discrepancy between the 2002 NICE figure, which was anticipated to be 15 per cent, and the actual figure for home dialysis of 2 per cent? What is being done to increase home dialysis?

My Lords, the noble Baroness is quite correct to point out that the NICE report said that up to 15 per cent of dialysis patients might be suitable for home dialysis. Of course, for a variety of different reasons to do with their frailty or condition, not all kidney patients will be suitable for such care, but we are very concerned to increase the number from the existing 2 per cent. I would say three things. First, we know that clinical leadership is crucial. When that works well locally, those PCTs are hitting a level of 10 to 15 per cent take-up. Secondly, we are challenging commissioners to increase home dialysis. We are particularly concerned to concentrate on home dialysis for children, so we are also working with the Great Ormond Street Hospital on a project to provide home dialysis for them. Thirdly and most importantly, we have sponsored an information flow to patients to ensure that they have the right kind of verbal and written information to enable them to make the right choices for them.

My Lords, does the Minister agree that, important as that work is, it would be even better if we could increase the organ donation numbers? Organ donation gives a much better quality of life in the right circumstances. Does she not also agree that if the task force recommendations endorsed by our own EU Select Committee, which looked at organ donation, could be implemented, it would increase the quality of life for very many people, particularly children?

My Lords, the noble Baroness is absolutely right: the best quality of life for people with kidney failure is achieved through replacement kidneys. As the Prime Minister made clear when the task force made its report, we want to start that debate and explore every option available for increasing donation rates. It is important to get the right infrastructure in place, and our target is to increase donation rates by 50 per cent within five years. I am also pleased to say that due to the work of noble Lords in this House, particularly the noble Baroness, Lady Finlay, a policy change to enable the consideration of requests for the allocation of donations from deceased donors will help in the drive to increase the number of kidney donors.

My Lords, the UK National Kidney Federation has nevertheless estimated that the number of people needing dialysis or transplant will rise from 20,000 at the moment to about 40,000 in 2018. It is a huge number of patients to be dealt with. What plans do the Government have to ensure that there is enough dialysis available in hospital and at home—including peritoneal dialysis, which is very successful for some patients—to treat this huge number of patients while they are waiting for transplants?

My Lords, I have already outlined some of the issues. We are concerned to attack this on several fronts, the first of which is to increase the amount of home dialysis, which is actually more cost-effective. Not only is it cheaper to provide people with home dialysis, it is also much more flexible and convenient for them, and we are very concerned to drive it forward. We also want to increase innovation. This month, for example, a very small home-dialysis machine is coming on line which people will be able to transport in their cars. We are pushing these possibilities and putting resources into them. We have increased the amount of money going into it. We are determined that the facilities and the choice will be there.

My Lords, the Minister will no doubt know that a tariff is being developed for dialysis. She will also share my view that it is important to ensure that the tariff that is applicable to home haemodialysis is adequate to encourage patients who want to do so to take up that option without significant cost to themselves. Will steps be taken to ensure that the tariff covers reasonable set-up costs for home dialysis and thereby avoid cost to the patient?

My Lords, the noble Earl is right. Our objective is that by 2010-11 the different tariffs for each type of dialysis will reflect the differing costs. That will in fact help in our encouragement of home dialysis, the cost of which we know can be recouped within 14 months of it starting to be used. The intention is that all the costs will be included within the tariff for each of the different types of dialysis that should be available.

My Lords, of the measures being used, what kinds of checks are being put in place to ensure that the quality of services is being optimised? Are dieticians and counsellors included within these measures?

Yes, my Lords; dieticians and counsellors are included in these measures and will be included in the tariff when it is considered.