We welcome the National Kidney Federation’s 2025 manifesto which is closely aligned to NHS England’s existing national priorities to expand home dialysis, reduce inequalities, and improve patient choice.

NHS England is supporting this through renal networks by improving transparency via unit‑level dashboards, standardising pre‑dialysis education so home therapies are routinely offered, embedding home dialysis in local commissioning plans with integrated care boards, and reviewing renal tariffs to better support clinically appropriate home‑based care.

NHS England is currently working to update the Renal Service Specification which aims to support increased home dialysis provision in line with the Renal Services Transformation Programme ambition for at least 20% of patients to be treated at home.

Delivery will be supported through accountability and reporting via renal networks and National Health Service commissioners.

NHS England is taking action through the Renal Services Transformation Programme and renal networks to increase home dialysis uptake by strengthening early patient education and shared decision‑making through standardised pre‑dialysis pathways, supporting multidisciplinary care models, and working with providers on workforce capacity and training. This is complemented by improvements to operational processes, including home assessments and installation pathways, to ensure patients can access home therapies in a timely and consistent way.

Progress is being made towards the ambition through NHS England’s Renal Services Transformation Programme and renal networks, which promote a “home‑first” approach and routine offering of home therapies.

Some regions have improved, with renal networks and regional specialised commissioners using UK Renal Registry data and regional dashboards to benchmark uptake, track progress, and target support in other areas. Increasing home dialysis uptake remains a core national priority.

We recognise the regional variation in home dialysis uptake, as identified through UK Renal Registry data, reflecting differences in workforce, infrastructure, and local practice.

To address this, renal networks are using data dashboards to benchmark variation, supporting some centres to implement improvement plans, standardising pathways such as pre‑dialysis education and home set‑up processes, and sharing best practice from high‑performing “home‑first” models to improve equity of access.

The Department funds research primarily through the National Institute for Health and Care Research (NIHR). The NIHR does not generally allocate funding to specific conditions and funds research through open and fair competition and peer review, to ensure that the highest-quality proposals most likely to deliver real impact for patients are funded, without imposing financial targets or limits. The NIHR continues to encourage and welcome high-quality research proposals across all areas, including kidney disease, so that patients can benefit from advances in prevention, diagnosis and treatment. Further information is available at the following link:

https://www.nihr.ac.uk/get-involved/suggest-a-research-topic‌

The National Health Service website section on medicines is in the process of being transformed. NHS England undertook in-depth research to understand what the user needs are for medicine information on the NHS.UK website and then designed, tested, and iterated a new medicines page format, which is now rolling out across the medicines content, rather than being specific to folic acid.

This new format is shorter and simpler than the legacy medicines topic pages, making them more accessible and easier to maintain, decreasing risk. As NHS England cannot provide definitive advice for all patients in all situations, instead patients are encouraged to read the relevant Patient Information Leaflet and to consult a physician if they have any existing medical condition.

The National Health Service website section on medicines is in the process of being transformed. NHS England undertook in-depth research to understand what the user needs are for medicine information on the NHS.UK website and then designed, tested, and iterated a new medicines page format, which is now rolling out across the medicines content, rather than being specific to folic acid.

This new format is shorter and simpler than the legacy medicines topic pages, making them more accessible and easier to maintain, decreasing risk. As NHS England cannot provide definitive advice for all patients in all situations, instead patients are encouraged to read the relevant Patient Information Leaflet and to consult a physician if they have any existing medical condition.

NHS England recognises that tariff arrangements can influence the delivery of home dialysis.

Subject to resource availability, NHS England aims to review renal replacement therapy tariffs in 2026/27. The review will cover in-centre dialysis, home dialysis, and transplantation, with the aim of ensuring that funding reflects clinical best practice and supports greater uptake of home dialysis where clinically appropriate.

NHS England also plans to calculate future prices using 2023/24 cost and activity data. Prices for 2027/28 will be the first to use post-COVID data, allowing changes in clinical activity and reported costs to be reflected.

The Government recognises the importance of raising awareness about the interconnectedness of conditions such as cardiovascular disease, obesity, and kidney disease amongst healthcare professionals and the public.

To tackle unwarranted variation, support consistent, high-quality care across the cardiovascular disease pathway, and to support the Government’s ambition to reduce premature deaths from heart disease and stroke by 25% within a decade, we will publish a new cardiovascular disease Modern Service Framework (CVD MSF) shortly. In developing the CVD MSF, we are reviewing evidence and engaging stakeholders on a range of pathway areas and risk factors for cardiovascular disease.

The NHS Health Check programme, a core component of England’s cardiovascular disease prevention programme, aims to detect people at risk of heart disease, stroke, type 2 diabetes, and kidney disease in those aged between 40 and 74 years old. The programme plays a key role in raising awareness and assessing the top risk factors associated with these conditions and refers people for further support through behavioural interventions, for example weight management, clinical assessment, and treatment where appropriate.

The NHS Health Check Best Practice Guidance assists healthcare professionals to understand, identify, and manage cardiovascular disease risk factors alongside National Institute for Health and Care Excellence guidelines, and how to communicate meaningful advice to patients following their health check.

The Government recognises the importance of raising awareness about the interconnectedness of conditions such as cardiovascular disease, obesity, and kidney disease amongst healthcare professionals and the public.

To tackle unwarranted variation, support consistent, high-quality care across the cardiovascular disease pathway, and to support the Government’s ambition to reduce premature deaths from heart disease and stroke by 25% within a decade, we will publish a new cardiovascular disease Modern Service Framework (CVD MSF) shortly. In developing the CVD MSF, we are reviewing evidence and engaging stakeholders on a range of pathway areas and risk factors for cardiovascular disease.

The NHS Health Check programme, a core component of England’s cardiovascular disease prevention programme, aims to detect people at risk of heart disease, stroke, type 2 diabetes, and kidney disease in those aged between 40 and 74 years old. The programme plays a key role in raising awareness and assessing the top risk factors associated with these conditions and refers people for further support through behavioural interventions, for example weight management, clinical assessment, and treatment where appropriate.

The NHS Health Check Best Practice Guidance assists healthcare professionals to understand, identify, and manage cardiovascular disease risk factors alongside National Institute for Health and Care Excellence guidelines, and how to communicate meaningful advice to patients following their health check.

The NHS Health Check aims to detect those at risk of chronic kidney disease (CKD) by testing for key risk factors such as high blood pressure. The programme does not undertake the tests required to diagnose CKD. As a result, data on the number of individuals who are subsequently tested for CKD is not currently collected.

However, general practitioners (GPs) assess the results of an individual’s NHS Health Check and then undertake further clinical investigation, such as urine albumin to creatinine ratio tests for CKD, if required.

Information regarding CKD treatment pathways is collected via a national auditing tool of GP records called ‘CVDPREVENT’. Department officials are carefully considering opportunities to enhance data monitoring for the NHS Health Check as part of the National Audit Office recommendation.

Alongside this, we plan to publish the Cardiovascular Disease Modern Service Framework shortly. During the framework’s development, Department officials are considering opportunities for earlier detection, diagnosis, and management of cardiovascular, kidney, and metabolic risk factors strongly associated with cardiovascular disease.

The NHS Health Check aims to detect those at risk of chronic kidney disease (CKD) by testing for key risk factors such as high blood pressure. The programme does not undertake the tests required to diagnose CKD. As a result, data on the number of individuals who are subsequently tested for CKD is not currently collected.

However, general practitioners (GPs) assess the results of an individual’s NHS Health Check and then undertake further clinical investigation, such as urine albumin to creatinine ratio tests for CKD, if required.

Information regarding CKD treatment pathways is collected via a national auditing tool of GP records called ‘CVDPREVENT’. Department officials are carefully considering opportunities to enhance data monitoring for the NHS Health Check as part of the National Audit Office recommendation.

Alongside this, we plan to publish the Cardiovascular Disease Modern Service Framework shortly. During the framework’s development, Department officials are considering opportunities for earlier detection, diagnosis, and management of cardiovascular, kidney, and metabolic risk factors strongly associated with cardiovascular disease.

The information on folic acid was shortened and simplified as part of the process of redesigning medicines information on the NHS website. The NHS website sets out that before taking folic acid, patients, which includes those with stents or receiving kidney dialysis, should tell their doctor if they have any medical conditions. It also advises patients to check the information provided in the leaflet that comes with their medicine or contact a health professional to ensure that the medicine is suitable for them.

Chronic kidney disease (CKD) and cardiovascular disease (CVD) are closely linked, with shared risk factors, as well as being risk factors for each other. As set out in the 10-Year Health Plan, we will publish a new cardiovascular disease Modern Service Framework (MSF). As part of its development, officials are also considering opportunities for prevention and earlier diagnosis of CKD and are engaging widely to identify the best evidenced interventions.

The Government will consider long-term conditions for future waves of MSFs. The criteria for determining other conditions for future MSFs, including kidney disease, will be based on where there is potential for rapid and significant improvements in quality of care and productivity. After the initial wave of MSFs is complete, the National Quality Board will determine the conditions to prioritise for new MSFs as part of its work programme.

NHS England is delivering a comprehensive programme to improve the diagnosis, treatment, and outcomes of people with kidney disease. Eight commissioned regional renal clinical networks are implementing the renal service transformation toolkit in collaboration with providers, with a clear focus on improving early diagnosis, slowing disease progression, and reducing the number of patients reaching advanced stages of kidney disease. This work is supported nationally by the Renal Clinical Reference Group.

The latest UK Renal Registry report in 2025 shows that the uptake of home dialysis has increased, with continued progress in expanding home therapies, which account for around 15–20% of dialysis patients. A copy of the report is attached.

NHS England, renal networks, providers and patient organisations are working together to continue to increase access to home-based therapies.

The specification is being worked on by NHS England in line with its national service specification methods process. Stakeholder testing was recently undertaken. The timing of full publication has yet to be decided upon as the feedback from stakeholders is being considered, alongside any changes required. NHS England will set out the expected date of publication as soon as this is available.

NHS England is increasing access to home-based therapies through the Renal Services Transformation Toolkit (2023), which aims for at least 20% of patients to be treated at home. The specification will support the 20% ambition.

The Government will consider long-term conditions for future waves of modern service frameworks (MSFs). The criteria for determining other conditions for future MSFs will be based on where there is potential for rapid and significant improvements in the quality of care and productivity. After the initial wave of MSFs is complete, the National Quality Board will determine the conditions to prioritise for any new MSFs as part of its work programme.

The specification is being worked on by NHS England in line with their national service specification methods process, which is available at the following link:

https://www.england.nhs.uk/publication/methods-national-service-specifications/

Stakeholder testing was recently undertaken. The timing of full publication has yet to be decided upon as the feedback from stakeholders is being considered, alongside any changes required. NHS England will set out the expected date of publication as soon as this is available.