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5 Structures Necessary and Organisation of Services 5.1 Regional Framework 5.2 Partnerships 5.3 Responsibilities of Primary, Secondary and Tertiary Care 5.4 Local Management 5.5 Information Technology and Audit 5.6 Human Resources 5.6.1 NHS Workforce Planning Reforms 5.6.2 Future Staffing Requirements 5.7 Finance 5.8 Organisation of Services 5.8.1 Managed Clinical Networks and Shared Resources 5.8.2 Infrastructure of Renal Centres 5.8.3 The Private Finance Initiative (PFI) and Private Provision of Renal Services 5.8 Organisation of Services 5.8.3 The Private Finance Initiative (PFI) and Private Provision of Renal Services The use of private capital to facilitate the expansion of renal services first took place in Wales in the mid 1980's. At that time the commercial partners were inexperienced in provision of renal services and emphasis was on the acquisition of capital for buildings and machines. It is now ingrained into NHS planning that private capital can be, and is expected to be, sought for new projects which helps overcome the inertia inherent in the NHS where capital is in short supply. Although successive governments have been supportive of the Private Finance Initiative (PFI), privatisation of clinical services rather than buildings and equipment is much more politically contentious. In the last decade, dialysis equipment manufacturers, in response to business opportunities in the USA and new opportunities in Eastern Europe and Asia, have transformed themselves into service providers. Through a series of acquisitions and mergers there are now a small number of large multinational providers of renal services. The largest, Baxter, Fresenius Medical Care and Gambro have been increasingly active in the UK and a significant proportion of dialysis facilities are now owned and managed by these companies (currently 25% of UK satellites are owned by companies). It has become the norm to provide the whole service including the employment and management of nurses, a model much preferred by the commercial providers. The transfer of patient care to the commercial sector is likely to continue due to the influence and competitiveness of the large companies and the continuing difficulties in accessing capital in the NHS. Although it has not yet surfaced as a major issue, there are potential training, R&D and clinical governance implications when the management of a major part of the workload of a renal centre is taken over by a commercial company.  |