Regional differences in the provision of adult renal dialysis services in the UK
From the 1University of Sheffield, Sheffield, 2The National Kidney Research Fund, 3Renal Unit, Hope Hospital, Salford, 4Richard Bright Renal Unit, Southmead Hospital, Bristol, 5Department of Renal Medicine, Guys Hospital, London, 6North Sheffield Primary Care Trust, Sheffield, and 7Department of Renal Medicine, Addenbrooke's Hospital, Cambridge
Received 9 July 2004 and in revised form 12 November 2004
Background: Provision of renal dialysis varies between UK regions.
Aim: To analyse these differences in provision and investigate their causes.
Design: Questionnaire-based survey.
Methods: A questionnaire was posted to all renal provider units and renal commissioning groups in the UK. Questions covered issues such as dialysis modalities and patient choice. Data were collected by telephone interview (or post in some cases) and analysed using SPSS.
Results: All renal provider units in the UK responded. A full range of modalities was provided by the majority of units. Clear variations in the level and quality of dialysis provision were seen between the UK regions. These included variation in choice of dialysis modality, provision of high-cost drugs, vascular access waiting times, number of support staff and availability of spare dialysis slots.
Discussion: The considerable variation between UK regions in the provision of adult renal dialysis services cannot be entirely explained by age or ethnic variation, and is in part due to limited bed space, dialysis machines and support staff, as well as changes in commissioning arrangements. To meet the requirements of the renal national service framework in most regions, changes to policy and funding will be required, such that the relatively new commissioning groups implement more appropriate funding structures in closer dialogue with their provider units.
Address correspondence to Dr L. Blank, Section of Public Health, ScHARR, Regent Court, 30 Regent Street, Sheffield, S1 4DA. e-mail: l.blank{at}sheffield.ac.uk
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