Clinical innovation


If he transferred to our South Norwood service, he would have had to travel back to hospital three times a week for treatment. This would have been uncomfortable for David, disruptive to his rehabilitation and would have required costly specialist patient transport with both a doctor and nurse accompanying him. Working collaboratively with the hospital


discharge team and commissioners at the ICB, we spent 12 months developing a solution that would enable David to receive dialysis within Fairlie Healthcare. This required detailed planning and close


partnership working to address a wide range of clinical, operational and governance considerations. Key questions needed to be answered by


commissioners, the hospital and us before the move could proceed, including: n Could we safely support David’s highly complex clinical needs outside an acute hospital setting?


n Did the nursing team have the appropriate knowledge, competence and governance arrangements to deliver haemodialysis safely?


n How would the haemodialysis machine be procured, installed, maintained and serviced within an older nursing home building?


n What infrastructure and installation requirements would need to be addressed?


n What standard operating procedures, governance frameworks and clinical oversight would be required?


n How would staff be trained and assessed as competent?


n How could treatment be delivered safely whilst maintaining continuity of care and reducing unnecessary hospital attendance?


These questions were successfully addressed through collaborative planning. Our nursing team received specialist haemodialysis training from the hospital’s renal team, comprehensive governance arrangements were established, and a haemodialysis machine was installed within our service. This enabled David to have his treatment ‘at home’, closely aligning with the ambitions of the NHS 10 Year Plan to deliver more care closer to home wherever possible. The impact for David has been


transformational. He now receives regular physiotherapy which has enabled him to regain control of his hand and write his name. He is able to sit out of bed, participate in a varied programme of activities and enjoy a greatly improved quality of life. Through careful clinical management and a tailored renal diet, the frequency of his dialysis has reduced from three sessions each week to just two. The outcomes for David and the wider


health system have been significant. David has experienced improvements in his mobility and mental wellbeing while remaining clinically stable. Since his admission, he has had no acute hospital admissions related to his ongoing care, demonstrating that complex dialysis and respiratory care can be delivered safely within a specialist nursing-led care environment. The move has also released a long-term


hospital bed, reduced pressure on acute services, eliminated the need for regular specialist patient transport and delivered a more cost-effective model of care. The feedback from commissioners


and the hospital teams involved has been overwhelmingly positive. The combined approach to David’s care has been commended as an example of how partnership working, innovation and


specialist expertise can improve patient outcomes while supporting a more sustainable use of NHS resources.


The impact of political change Prime Minister Andy Burnham has promised action to ‘fix’ adult social care but it’s not yet clear how much a new ‘national care service’ would impact on the specialist care sector whose needs are such that ‘patient’ is how we refer to those we care for rather than ‘residents’. While we wait for further detail to emerge,


there is much that providers can do to build positive relationships with commissioners, demonstrate high quality, value for money care that delivers positive outcomes for those who need specialist support. n


Ben Payne


Ben Payne is director for clinical services at Fairlie Healthcare and a chartered physiotherapist. He began his NHS career supporting patients across acute care, rehabilitation, elite sport and military services. He has held senior leadership roles in independent healthcare, managed therapy services, created new clinical pathways and was hospital director of an internationally recognised rehabilitation hospital.


34 www.thecarehomeenvironment.com November 2026


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