The NHS Ten-Year Health Plan for England lays out a bold ambition: to shift care closer to home, to improve outcomes for people with long-term conditions and to narrow persistent health inequalities.
One of the clearest opportunities to demonstrate delivery on these goals liesin kidney care. Chronic kidney disease affects more than seven million people in the UK, and numbers are rising fast. It is a key contributor to multi-morbidity, avoidable hospital admissions and workforce absence – yet remains under-recognised in national policy frameworks. There is currently no national strategy, no service specification and no targeted funding model.
As kidney disease progresses, many patients require dialysis to stay alive. For decades, this has mostly meant multiple weekly trips to hospital – despite the existence of safe and
effective home-based options. Internationally, home dialysis is achievable: uptake reaches 35 per cent in New Zealand and over 70 per cent in Hong Kong, while Scandinavian countries have the highest use of home dialysis across Europe.
In England, uptake has stalled at 16 per cent and in some regions is below 10 per cent.Worse still, black patients receive home dialysis 36 per cent less often, and South Asian patients 27 per cent less often, than white patients – highlighting unwarranted inequities in the system
This isn’t just a question of clinical preference. Home dialysis can offermore independence, better outcomes, a reduced carbon footprint and lower system costs over time. It allows peopleto maintain employment, care for family and live more flexibly – aligning directly with the ten-year plan’s emphasis on prevention, productivity and personalisation.
But systemic change doesn’t happen by accident. It requires coordinated action – across commissioners, providers, policymakers and industry. That includes:
- Establishing a National Kidney Modern Service Framework, with delivery requirements across integrated care systems
- Setting a clear target to reach 30 per cent of dialysis patients on home therapies by 2030, and 40 per cent by 2035
- Reforming the funding architecture to support patient choice and whole-pathway value
- Investing in the renal workforce, with training and resource to expand home-dialysis capacity
- And actively measuring and closing equity gaps, using kidney care as a visible test of NHS fairness
This is not a call for new money, but for smarter use of existing resources – and a sharper focus on delivery in an area with proven benefit.
Kidney care may not dominate political or media headlines, but it offers a real-world, near-term opportunity to demonstrate the kind of reform the NHS is seeking – evidence-based, cost aware and designed around people’s lives.
The tools are in place, the benefits are clear and the need is pressing. Making progress here would send a powerful signal: that the ambitions of the ten-year plan are indeed achievable.
UK-RC00-250028
Related
