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NHS England commissions dialysis services at a national level as a specialised service, setting out what providers should have in place to deliver dialysis care, including at home, as part of its remit to deliver specialised services. National Commissioning supports equity of access to high quality dialysis care. The service delivery contract sets out that the principle should be that home haemodialysis should always be an option for patients and that solutions should be sought to overcoming barriers that might prevent this. Decisions should be made on an individual basis but in general, patients suitable for home haemodialysis will be those who:<\/p>
- have the ability and motivation to learn to carry out the process and the commitment to maintain treatment;<\/p>
- are stable on dialysis;<\/p>
- are free of complications and significant concomitant disease that would render home haemodialysis unsuitable or unsafe;<\/p>
- have good functioning vascular access;<\/p>
- have a carer who has (or carers who have) also made an informed decision to assist with the haemodialysis unless the individual is able to manage on his or her own; and<\/p>
- have suitable space and facilities or an area that could be adapted within their home environment.<\/p>
<\/strong><\/p> NHS England\u2019s renal services specifications can be found at the following link:<\/p> <\/p> www.england.nhs.uk/commissioning/spec-services/npc-crg/group-a/a06/<\/a><\/p> <\/p> NHS England Specialised Services use the Renal Registry Annual Report and data to support work with local dialysis services so they are aware where variation exists so this can be considered and addressed.<\/p> <\/p> The Atlas of variation, published by Public Health England in 2015, showed that for clinical commissioning groups (CCGs) in England, the percentage of dialysis patients who were receiving dialysis in the home (home haemodialysis and peritoneal dialysis combined) ranged from 4.1% to 44.0% (10.6-fold variation). When the seven CCGs with the highest percentages and the seven CCGs with the lowest percentages are excluded, the range is 7.6\u201333.7%, and the variation is 4.4-fold. Variation by parliamentary constituency is not available.<\/p> <\/p> Reasons for the degree of variation observed include differences in:<\/p> <\/p> - access to, and timely assessment by, a specialist kidney unit \u2013 working with patients to help them decide between treatments takes time, but in some areas 30% of patients are not known to their kidney team for even 90 days before they start renal replacement therapy;<\/p> - access to a multi-professional team, including staff who regularly support patients undertaking home dialysis; and<\/p> - levels of support for people undertaking home dialysis to help them maintain their independence, including access to respite in-centre dialysis.<\/p> <\/p> The Atlas can be found at the following link:<\/p> <\/p> https://fingertips.phe.org.uk/profile/atlas-of-variation<\/a><\/p> <\/strong><\/p> According to the latest data from the UK Renal Registry (UKRR), there were 1,195 patients receiving home dialysis in the United Kingdom in 2014, 1,175 patients in 2015; and 1,256 patients in 2016. The UKRR collects, analyses and reports on data from 71 adult and 13 paediatric renal centres. Participation is mandated in England, via the national services specification published by NHS England.<\/p> <\/p> The latest report from the UK Renal Registry can be found at the following link:<\/p> <\/p>