Dialysis Care Outcomes — [Sir George Howarth in the Chair]

Part of the debate – in Westminster Hall at 3:00 pm on 19th May 2022.

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Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 3:00 pm, 19th May 2022

I thank the hon. Lady for reminding us all of that. We often focus on the physical aspects of this condition, as we should, but we must also remember the mental health and anxiety issues that come alongside it. Patients suffer with uncertainty about how they are going to feel the next day, uncertainty about their future health, and uncertainty about their personal and financial issues and their family. The hon. Lady is right to remind us of that point.

By comparison, home dialysis therapies offer flexibility and have been shown to have a positive effect on a patient’s health. When patients dialyse more regularly, they are more effectively replicating the natural function of the kidneys. Studies have shown that longer, more frequent dialysis sessions, undertaken at a schedule of the patient’s own choosing, achieve better results than a thrice-weekly in-centre schedule. People doing alternate-day dialysis have been shown to experience fewer symptoms, such as shortness of breath, high blood pressure and left ventricular heart damage. People on home haemo- dialysis have an up to 13% lower risk of death than those on in-centre haemodialysis. That shows that if people can do more home treatment, we can improve their longevity. NHS England has acknowledged the limitations of standard in-centre haemodialysis, and in particular the increased risk of hospitalisation or death after the weekly two-day break between in-centre sessions.

Margaret Ferrier is right about the importance of mental health. Depression is the most prevalent psychiatric illness in patients with end-stage kidney disease, and she made that point powerfully. One study shows that rates within the dialysis population vary from 22.8% to 39.3%. Wow—those are big figures, and they show what the condition does. Studies have also shown that depression is a significant predictor of mortality in dialysis patients. That is particularly important for younger people on dialysis, who report a lower quality of life than young adults in general.

People who have the choice of dialysing for as long as they need and at a time of their choice have freedom and control. They can also better respond to their body’s reaction at that time, in the comfort of their home and with the reassurance of their family around them. Home treatment probably addresses some of the issues of depression and mental health issues as well. It enables patients to have a life outside their dialysis schedule and hold down a job. It allows them to have a normal life and pursue the dreams and ambitions that should be the right of any person, young or old. I can attest to that through my nephew, Peter Shannon, who has had an organ transplant. I have seen his life change. He bought his first house just last week, incidentally, at probably the highest time for house prices in the whole United Kingdom.

In the last 18 months, covid-19 has exaggerated the negative impact of differences in dialysis care, and heightened the need radically to increase home therapy provision. Analysis from the UK Renal Registry has demonstrated that the relative risk of death associated with covid-19 among in-centre dialysis patients was much higher than that of the general population in England, especially among those of a younger age.

The UK kidney community has been calling for patients to be provided with greater choice in their dialysis care, recognising the need for increased awareness and education around home therapies and greater equity of access across the country. In the UK, however, the overall percentage of dialysis patients receiving home therapies has increased only from 3.4% in 2011 to 7% in 2022. Although that has doubled, it is a long way off the figure of 15%. It needs to double again, and I think, respectfully, that the Government should set a higher target.

In 2021, the NHS’s Getting It Right First Time programme recommended that a minimum of 20% of patients in every dialysis centre should be on home dialysis. It set that target, and NHS England’s Renal Services Transformation Programme is working to increase the provision of and access to home therapies, in line with recommendations made by Getting It Right First Time.

Although there are dialysis centres exceeding the target, which we welcome—it is not all negative; many are trying to achieve those targets and goals—GIRFT’s own report highlighted that 33 out of 52 centres in England have not yet met the target. Again, I respectfully ask the Minister—she knows I do this constructively; I just want to get the stats so that we can understand the problems and how to do things better—to tell us what has been done to increase the number of those 33 out of 52 centres that have not yet reached the target. The Getting It Right First Time target of a 20% prevalence rate for home dialysis compared to in-centre care could be transformative for patients, and could deliver considerable cost savings for the NHS at a time when they are desperately needed. We can do the treatment better, deliver the medication and dialysis better, and we can do it for a better price. That seems to me to be good value.

To address adequately the low uptake of home care, a review of dialysis reimbursement should take place to ensure that training and educational needs can be met, and to incentivise higher frequency dialysis at home, such as alternate day treatments to support all dialysis centres to meet the 20% target. What steps are the Government taking to reach that 20% target? It is essential that clinicians are offered the tools needed for them to meet the GIRFT targets in an effective manner, such as providing staff and patients with detailed, unbiased education to empower them to make informed decisions about their dialysis. I see it—as I often do—as a partnership, with clinicians working alongside Government policy and patients to do better.

One of the most pressing issues facing people who receive treatment at home rather than in hospital is the rising cost of fuel and energy. I referred to that at the beginning, and there are three points that I wanted to make. People receiving dialysis at home are at particular risk from rising energy costs. The figures that I cited, and the question asked by the Leader of the Opposition at yesterday’s PMQs, gives an indication of the issue. There seems to be an uncertainty, and perhaps a postcode lottery, as to where there is help for energy costs, but the figure that I gave of £118 per month for a child, or whatever it is, but that now costs £350, indicates that there is a way to go yet. Dialysis machines, with their high energy consumption, keep people alive. Dialysis treatment at home adds between £593 and £1,454 to utility costs per year, and that is before this year’s 54% energy bill rise.

One effect of dialysis treatment is that many patients frequently feel cold due to the associated anaemia and the process of dialysis, so they need to heat their homes more often and for longer during the year. When we feel warm, they feel cold. When we feel exceedingly warm, they might feel normal. There are not many times in the year in this great United Kingdom of Great Britain and Northern Ireland when we have Mediterranean heatwaves, so for the dialysis patient, feeling cold is almost an everyday occurrence. We do not want people to have to decide between giving up the freedom and independence that home dialysis gives them, and going into a hospital setting just to save costs. Again, I ask the Minister urgently to address that matter, because the barriers to employment for people on dialysis, posed by frequency and length of treatment, and the physical toll and intense fatigue, already compound financial insecurity for home dialysis patients.

The NHS service specification advises that NHS trusts reimburse the additional costs of home dialysis, but reimbursement is inconsistent across the country, and many patients receive no or very little financial support to pay for the additional costs of treatment. For most home dialysis patients, the £200 repayable relief on energy bills and council tax deduction will simply not be enough, and a special, specific provision is needed. It is regrettable that the spring statement was a missed opportunity for the UK dialysis community. Consistent reimbursement, longer-term capped tariffs for vulnerable groups and immediate financial support are urgently needed. Again, I look to the Health Minister and the discussions that she has with her Secretary of State for Health, and ultimately with the Chancellor, to ensure that we can deliver extra, specific financial help for those on dialysis treatment.

Many in the kidney community feel that their voices have been unheard in Westminster for too long, and when a friend from the kidney charity asked me to secure this debate, I was very pleased to do so. I think that today’s debate does two things. It raises awareness—that is No. 1—but it also directly asks the Minister to become involved and address some of the anomalies. I welcome the re-establishment of the all-party kidney group. Its work, led by Brendan Clarke-Smith, aims to promote improvements in the health and care services that are available to improve the health of people with renal failure.

I call on the Minister to respond to calls from voices in the renal community to support them, and ensure that a straightforward, accessible system is in place to enable people on home dialysis to be reimbursed for the additional cost of utilities, as set out in the UK Kidney Association guidance. Would the Minister perhaps be agreeable to that request? If I may, I would ask for a meeting on behalf of the APPG—perhaps the chair of the APPG, our friend and colleague, would do that—because then we could look at some of those issues. Those who are involved in this debate might wish to attend that meeting as well. NHS tariff payments for home dialysis must be sufficient to cover all associated costs, including reimbursement for additional utilities usage that should and must reflect current price increases. Again, I look to the Minister to pledge to work with energy companies, and the Chancellor to develop capped tariffs for people on medical treatments at home, such as dialysis.

Renal units should proactively offer support to all patients undergoing dialysis, to build their confidence and ensure that they are dialysing in the right way for them at the time. Again, Minister, we need to address the low uptake of home dialysis by implementing a review of the dialysis reimbursement tariff—I think we referred to that in the discussion that we had outside the Chamber, and I look forward very much to the Minister’s response. We must also ensure that training and educational needs can be met, and incentivise higher-frequency dialysis at home, such as alternate-day treatments, to support all dialysis centres to meet the 20% target. Let us meet that target. Let us do it here and back home as well, and achieve the significant cost savings that home dialysis can bring.

I will close with this comment: it is vital that all renal unit staff receive updated training to build their home dialysis knowledge, in order to help find solutions to the issues facing patients, and so that information for patients about transitioning to home therapies is standardised and includes details on the practical and financial support available. I place on the record my thanks to all renal staff. They do magnificent work; they are saving lives and they are keeping people alive. It is wonderful, and we thank them for it. The support available should also include a consistent approach to utility bill contributions from the NHS, in order to ensure equality for every renal dialysis patient across this great United Kingdom of Great Britain and Northern Ireland. The Government must ensure that educational resources are also provided to local authorities and trusts, enabling them to respond appropriately to the needs of people in their area who want to choose home therapies.

Thank you very much, Sir George, for the chance to raise the issue of dialysis treatment and bring it to Westminster Hall in a way that, I hope, both raises awareness and lets people out there on dialysis treatment know that we in this House care for them—I believe we do—and that we are seeking change. I look forward very much to other contributions in the Chamber today, but I look forward particularly to the response from the Minister.