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4 National Service Standards 4.1 Pre-Dialysis - Retarding Progression and Reducing the Comorbid Burden in Renal Disease 4.1.1 Causes of End Stage Renal Failure (ESRF) 4.1.2 Retarding Disease Progression 4.1.3 Co-morbidity Burden in ESRF 4.1.4 Overlap with the National Service Framework for Coronary Heart Disease (CHD)63 4.1.5 Interface with Primary Care 4.2 Preparation for Renal Replacement Therapy (RRT) 4.2.1 Early Referral 4.2.2 Selection of Patients 4.2.3 Education, Counselling and Informed Choice of Modality 4.2.4 Exploring Transplant Options 4.2.5 Vascular and Peritoneal Access 4.2.6 Timely Initiation of Dialysis 4.2.7 Anaemia Management in Pre Dialysis Patients 4.3 Vascular and Peritoneal Access 4.3.1 Background 4.3.2 Interfacing Requirements to Available Specialities 4.3.3 Outreach Provision of Expertise 4.3.4 Service Level Agreements (SLA's) 4.3.5 Quality Issues and Audit 4.4 Effective Delivery - Renal Association Standards and Continuous Quality Improvement 4.4.1 Renal Association Standards 4.4.2 Reporting to the UK Renal Registry 4.4.3 Audit - Local and Regional 4.4.4 Peer Review 4.5 Patient/Carer Experience 4.5.1 General Support 4.5.2 Convenience and Comfort of Dialysis Facilities 4.5.3 Admission to Hospital 4.5.4 Access to Medical, Nursing and Paramedical Expertise 4.5.5 Involvement in Local and National Initiatives 4.5.6 Holiday Dialysis 4.6 Conservative Management of ESRF, Palliative Care and Withdrawal from Dialysis 4.6.1 Conservative/Supportive Management of ESRF 4.6.2 Palliative Care 4.6.3 Withdrawal from Dialysis 4.7 Equity of Provision 4.7.1 Recent Expansion of Nephrology and Dialysis Services 4.7.2 Future Configuration of Services 4.7.3 Filling in 'Blank Spots' in Service Provision The Standards described in this section constitute the core objectives of the strategic plan for renal services into the next 5 years, which aims to ensure that patients with ESRF receive the best medical care. Wherever possible, the evidence base for the recommendations is described. Some recommendations reflect the enlightened level of expectation of patients in a modern healthcare system. Other recommendations reflect the developments which will be necessary to reverse the inequities in access to therapy and quality which have long been characteristic of the UK renal service. Success in the delivery of standards set out in this document and in the National Service Frameworks will be judged in each Region by the achievement of performance targets within the new Performance Framework mainly by the attainment of the actual milestones and targets set (ref. 29). This covers: • Health Improvement • Fair Access • Effective delivery of appropriate healthcare • Efficiency • Patient/Carer Experience • Health Outcomes of NHS care The National Service Standards described in this Section reflect these broad categories.  |