The health secretary has come under fire from charities and MPs for agreeing to transfer the responsibility for renal dialysis commissioning from NHS England to clinical commissioning groups

Jeremy Hunt approved the transfer last week on the recommendation of NHS England’s Prescribed Services Advisory Committee.

However, the move has been met with opposition from patients’ charities and a petition calling for renal dialysis to remain a specialised service which collected more than 15,000 signatures in less than a week.

Last week MP Madeleine Moon told the House of Commons that kidney charities had been “stunned” by the move, describing the decision to bring in the change by next April as “dangerous”.

Mr Hunt was expected to face questions from MPs in the Commons this morning over concerns the move is being rushed and could lead to fragmentation of services.

Fiona Loud, policy director at the British Kidney Patients Association, told HSJ there was concern about the impact on patients of splitting the commissioning of dialysis and transplantation services.

“This is a really sensitive issue with a vulnerable population, no explanation for devolving directly to CCGs, and with an externally dictated deadline,” she said.

“We do not believe that this is in any way an appropriate approach to change, and [it] leaves wide open the possibility of all kinds of risks to quality of kidney care and the kidney patients we support.”

NHS England spends almost £700m on renal dialysis annually to treat around 23,000 patients.

Last week NHS England’s clinical director of specialised services James Palmer revealed it was one of the six specialised services that between them accounted for 50 per cent of growth in the budget.

The £14bn specialised commissioning budget was overspent by nearly £400m in 2013-14 and is forecast to end the year in the red.

Mr Hunt also approved the transfer of the commissioning of surgery for morbid obesity to CCGs last week. The transfer of wheelchair services and GP adult neuroscience and neurology referrals was approved earlier this year.

NHS England reviewed all of the services currently prescribed as specialised earlier this year after incoming chief executive Simon Stevens said he thought they had been “overdefined”.  

HSJ understands renal dialysis and morbid obesity were selected for transfer to CCGs because they commission other significant parts of these patient pathway and preventative services.

Handing CCGs responsibility for the more expensive part of the service is expected to incentivise investment in preventative services.

Subject to a six week consultation, the government will bring forward a bill in February to legislate for the change in responsibility from April 2015.

Steve Kell, co-chair of NHS Clinical Commissioners, said there was a “whole range of factors” that needed to be considered before commissioning responsibility for any specialist service can be moved to CCGs, including the “financial implications, timescales and patient pathways”.

He said it was “equally important” that “staff with the right knowledge and expertise are transferred alongside the necessary resources”.

A spokesperson for NHS England said: “After assessing renal dialysis against criteria that determine whether a service is commissioned by the NHS nationally, clinical experts have recommended renal dialysis services should be commissioned by the NHS locally from April next year 

“There are opportunities to improve services by strengthening links with other aspects of a patient’s care.”

The Department of Health declined to comment.

 

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