9 Epsom & St Helier Hospitals

What are your plans for increasing home dialysis?

1. To maintain staff at current levels in HHD team and increase staffing in PD team (funding agreed) audit speed of review of referrals and starting training to ensure we have a rapid process when needed.

2. We are expanding our pre-dialysis advanced kidney care service with more clinics opening up locally and the HHD team will work with these nurses to provide more education around home options.

3. We have also increased consultant provision in the teams that looks after new starter HD patients and will discuss HHD at this point in patients with an acute start onto the dialysis programme.

4. Peer participation in education to help increase confidence of new starters to take up home therapy.

5. Consider a ‘try before you choose’ programme, hands on experience sessions for home therapy options, to support patient confidence in choosing home therapies. For PD we are participating with London Kidney Network (LKN) to improve PD peritonitis rates to reduce patients having to change from PD to in centre HD.

For HHD

1. We have now got shared care targets in our Key Performance Indicators (KPIs) with our private providers in the satellite units but have not been holding them to these, mainly because they have also had staffing issues, we now intend to do this and also ensure that we are holding our own units to similar targets.

2. Our private providers have also agreed that they will provide training for patients to self-needle so that this is part of their training which can be carried out locally. Again, we need to ensure they are supported by our HHD staff to be able to do this and hold them to their agreement to do so.

3. Once we have opened up more dialysis capacity in two units (end of 2022/spring 2023) then we would aim to carry out some HHD training for patients in a Surrey unit.

Do you have any examples of good practice that can be shared?

1. Advanced percutaneous PD catheter insertion programme.

A Patients can have PD catheter within 24 hours if needed.

B Patients with previous abdominal surgery can still have percutaneous PD catheter.

C 3 Fluoroscopy guided PD catheter repositioning for poorly functioning PD catheters.

2. Working collaboratively with wider choice of industry partners to increase availability of training for patient starting PD.

3. We offer both portable and static HHD options, nocturnal HHD and solo HHD. We accept almost all those who wish to dialyse at home apart from those who are very unstable on dialysis, or who have a living kidney transplant planned within 6 months.

4. We already refund electricity and water bills for HHD patients.

5. A very pro-home therapy approach of the unit.