NORTHERN IRELAND

24 Antrim Renal Unit

What are your plans for increasing home dialysis?

1. Northern Health and Social Care Trust (NHSCT) has a strong history of championing Home Therapies, led by the Home Therapies Nursing Team. I am a passionate advocate of Home Therapies and over the last three years I have tried to help develop the service. Our team visited Prof Edwina Brown in West London in August 2019. In NHSCT I identified that a major barrier to PD was insertion of the catheter – there was no local percutaneous service in Northern Ireland (NI) and frequent difficulty in securing theatre slots for surgical insertions. I therefore spent a number of weeks with Sr Elaine Bowes in Kings College London as well as Dr Mark Denton in Beaumont Hospital, Dublin, learning more about their services and how to insert PD catheters percutaneously. I can now carry out this procedure independently for our NHSCT patients. This service is flexible and responsive to patient needs. We also have an excellent PD catheter insertion service developed by Mr Stephen O’Neill in Belfast City Hospital over the last two years; he carries out insertions under fluoroscopy, laparoscopically and using open surgery. He is supported by his transplant surgical colleagues who insert catheters under open surgery.

2. I have read the presentation by Dr Rosie Donne and I am pleased to say we have a very similar service in NHSCT. The statistics for Home Therapies in Northern Ireland from December 2020 need to be interpreted in context. During 2020, Belfast City Hospital Transplant Unit remained open during the early stages of COVID and carried out many more deceased donor transplants than usual (‘over 100 in 100 days’ quoted in the press). Many more Home Therapy patients than In Centre patients were transplanted due to the nature of these patients. In addition, very few PD catheters were inserted during 2020 as they were deemed ‘non-emergency’ by our local Healthcare Management. Both these factors significantly reduced the numbers of Home Therapy patients at that point in time.

3. Transplants have now returned to their normal level, and we have an excellent PD catheter insertion service. The Home Therapies numbers have increased and should continue to do so over the coming months/years.

4. One development that would really help us increase our Home Therapies numbers in NHSCT would be assisted CAPD (two exchanges per day). We have assisted APD carried out by a private Healthcare Company (who struggle to recruit sufficient staff). They decline to provide assisted CAPD. We have one of the oldest RRT populations in the UK and have a very large catchment area. There is a large retirement population who live nearly one hour from our HD unit. A significant number of very elderly patients (over 80s) would be keen for assisted CAPD (two exchanges per day) but would not accept APD as they live alone, do not want to be attached to a machine overnight, cannot connect/disconnect, are concerned about trip hazard of line, and are daunted at the idea of troubleshooting the machine in the evening and overnight. I have appealed to Belfast City Hospital who manage the private Healthcare Company, the Commissioners and the local Procurement Team but have had no success. This is an ongoing challenge for us. We are now considering employing a Band three or Band four Healthcare worker within our own Trust to help with assisted CAPD.

5. Home HD has declined over the last few years, partly due to excellent Transplant and PD services. The extreme pressures on the In Centre HD staff over the COVID period has meant that the ‘Shared Care’ programme which encourages patients to move from In Centre HD to home HD took a back seat. We are now trying to build this programme again and hope to see a consequent increase in home HD patient numbers.

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

See previous answer.