The government’s ten-year Health Plan¹ promises a shift from hospital to community, from analogue to digital and from sickness to prevention. Kidney care, including how and where services are planned, funded and delivered, is where that ambition is tested.
A central part of that shift is moving care into patients’ homes. Yet in kidney care, home-based treatment remains underused and is going backwards nationally.²
Few areas of the NHS cut across so many priorities at once. Kidney disease sits at the intersection of prevention, long-term conditions, digital monitoring, community care and specialised care. It should be an exemplar of reform. Instead, it risks falling short.
The scale alone demands attention. Around 7.2 million people in the UK are living with chronic kidney disease, and more than 72,000 are already on dialysis or living with a transplant.³ ⁴
Early diagnosis is rightly becoming a greater policy priority. But policymakers should be clear-eyed: identifying more patients earlier is essential, yet on its own it will not reduce the number of people progressing to kidney failure or needing dialysis or transplantation. This makes the case for a different model of care not just desirable but necessary.
Unless earlier diagnosis is matched by reform in how kidney services are planned, funded and delivered, it will simply expose greater unmet need in a system already under strain.
We are already seeing the consequences. The transplant waiting list is at a record high, with over 8,000 people waiting.⁵ In-centre dialysis continues to expand. Yet the very model of care the NHS says it wants – treatment at home, closer to patients’ lives – is going backwards. Home dialysis accounts for just 16 per cent of patients⁶, with wide variation between centres.⁷ ⁸ This is not a failure of clinical ambition. The policy direction is clear. But intent alone is not enough. Without the right incentives, accountability and delivery support, change will not happen at scale.
Kidney care still lacks the strategic focus given to other major long- term conditions, and risks being diluted within broader cardio-metabolic policy. That would be a mistake. Kidney disease is not a subcategory – it is a system pressure point.
What is needed is a dedicated Modern Service Framework for Kidney Disease, backed by a home-first model of care with clear national ambitions for home dialysis – 30 per cent by 2030 and 40 per cent by 2035.
Delivering this shift will require genuine partnership across the system, with patient organisations, clinicians, and industry working alongside the NHS to support pathway redesign, digital adoption and service transformation. Home-based care should become the default where clinically appropriate.
Kidney care can become one of the clearest examples of NHS reform working in practice – or it can continue to fall short. Realising that ambition means kidney care is no longer an afterthought. It is the test the NHS cannot afford to fail.
UK-RC00-260007
1. UK Government. Fit for the future: 10 Year Health Plan for England. GOV.UK; 2025. Available at: https://www.gov.uk/government/publications/10-year-health-plan-for-england-fit-for-the-future (published 3 July 2025).
2. Home Dialysis Campaign Manifesto: Increasing Home Dialysis in England for the Benefit of Patients and the NHS Available at: https://www.kidney.org.uk/home-dialysis-campaign-manifesto
3. Kidney Research UK. Kidney disease is a public health emergency that threatens to overwhelm the NHS. 2023. Available at: https://www.kidneyresearchuk.org/2023/06/05/kidney-disease-is-a-public-health-emergency-that-threatens-to-overwhelm-the-nhs-major-new-report-reveals/ (published 5 June 2023).
4. UK Kidney Association. UK Renal Registry 27th Annual Report: Adult patient summary. 2023. Available at: https://www.ukkidney.org/sites/default/files/documents/Adult%20Data.pdf (published July 2025).
5. NHS Blood and Transplant. Organ transplant waiting list hits record high as donor and transplant numbers fall. 2025. Available at: https://www.organdonation.nhs.uk/news/organ-transplant-waiting-list-hits-record-high-as-donor-and-transplant-numbers-fall/ (published 9 July 2025).
6. UK Kidney Association. UK Renal Registry 27th Annual Report. 2023. Available at: https://www.ukkidney.org/sites/default/files/documents/27th%20Annual%20Report_2025.pdf (published July 2025).
7. National Institute for Health and Care Excellence (NICE). Renal replacement therapy and conservative management (NG107). London: NICE; 2018 (updated guidance). Available at: https://www.nice.org.uk/guidance/ng107
8. National Institute for Health and Care Excellence (NICE). Renal replacement therapy services for adults (QS72). London: NICE; 2014. Available at: https://www.nice.org.uk/guidance/qs72
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