End stage renal failure (ESRF) arises from a variety of renal disorders and is fatal if untreated. Dialysis or transplantation reduce the toxic metabolic burden which results when the kidneys fail and preserve life. Transplantation in addition restores other functions of the kidney, including Erythropoietin and Vitamin D production. The quality of that preserved life varies according to the efficiency of the treatment and the co-morbidity of the patient. Studies confirm that the quality of life experienced by the patient is often acceptable despite objective evidence of residual disability.
In the UK between 1993 and 1998 the number of patients with ESRF receiving treatment rose from a prevalence of 396 to 539 per million population (PMP). The incident rate of new patients rose from 67 to 92 pmp. It has proved possible to treat patients who, through age or co-morbidity, have disabilities which would previously have been judged to make the management of their renal disease too intrusive.
This is a success story. However, it is clear from the data in Wales and Scotland and from valid international comparison that, in both quantity and quality, the service provided for the management of renal disease in England still lags behind to an unacceptable degree. The government has laid down criteria by which health services will be judged. These include:
|Effective delivery of appropriate healthcare|
|Health outcomes of NHS care|
We welcome this framework and present details of our own assessment of the current provision of renal services in relation to it. Our analysis reveals that much of the infrastructure which has been developed to treat ESRF in the UK generally, is sound. However, the analysis also shows that too few patients are receiving treatment, that some of this treatment is inadequate when judged by objective criteria and expert opinion and that there are glaring inequalities in access to services and in the quality of the service across the country.
We have developed a vision of ‘Equity and Excellence’ in Renal Services which we hope will commend itself to government and its agencies as a goal to work towards if we are to offer a compassionate, yet evidence based service to these patients, who without treatment are mortally ill. We call for timely action to improve equity and quality in renal services which are currently under threat from a negative spiral of rising need, limited access and falling quality.