1. Sheffield Teaching Hospitals NHS Foundation Trust Home HD Set-Up Costs Will McKane Martin Wilkie

2. Sheffield Teaching Hospitals NHS Foundation Trust Context HHD growth promotion by DH Spectrum of maturity of HHD programmes Transition to PbR for HD –“We intend to collect and refine cost data on home haemodialysis with a view to incorporating it into the mandatory scope of PbR in the future.” Perception that capital for HHD is difficult

3. Sheffield Teaching Hospitals NHS Foundation Trust

4. Sheffield Teaching Hospitals NHS Foundation Trust Capital Costs Estimate Components of capital Amortization period Total cost ( £ k)Annual cost ( £ k) Dialysis machine7 years10-151.4- 2.1 RO7 years 4 – 8 0.6-1.1 Home conversionTechnique period ie 18 months 2 – 10 1.3-6.6 Total16-33 3.3 – 9.8

5. Sheffield Teaching Hospitals NHS Foundation Trust How to approach capital? Build it into the HHD tariff Capital Fund for HHD –How, who….? Leasing from any willing provider –Tender as for satellite HD New technologies –Marketed on a cost per treatment

6. Sheffield Teaching Hospitals NHS Foundation Trust New technologies cost per treatment “ The benefits to your trust are there would be no need for any capital funding to be found, the trust would save on the cost of conversion of the patients home and also decommissioning of the patients home should the patient come of home dialysis.” Absence of capital may force new HHD programmes to take this approach Pressure from patients… More expensive in long run? Proven advantages?

7. Sheffield Teaching Hospitals NHS Foundation Trust Revenue Costs STH current funding for HHD –£19k per annum –All in cost (includes ESA, drugs, nursing etc) –Mostly 4 x week –Increasing funding to hospital 3 x hospital HD tariff (£25k) as an incentive will be sufficient to meet capital but renal unit may not “see” this money New technology provider 1 –£26k per annum –Just an HD cost New technology provider 2 –£25k per annum –Just an HD cost

8. Sheffield Teaching Hospitals NHS Foundation Trust How to take this forward? Is this a national or just a Y and H problem? Would CDs support a national survey? A national approach may improve negotiating power with commercial providers –Aligned to an HHD tariff that recognises the capital burden