Ofwat

Telephone and video appointments are still common post-pandemic, with an estimated 25%-50% of kidney appointments in the United Kingdom still conducted remotely. This is important as remote consultations may exacerbate pre-existing inequalities in those from underserved groups. Those from underserved groups are often not represented in health research and include those with learning disability, mental health needs, hearing/sight problems, young/older people, those from ethnic minority groups. The aim was to develop a Toolkit to improve the quality of remote kidney care appointments for people from different underserved groups. A parallel mixed methods approach with semistructured interviews/focus groups and survey. We also conducted workshops to develop and validate the Toolkit. Seventy-five renal staff members completed the survey and 21patients participated in the interviews and focus groups. Patients (n = 11) and staff (n = 10) took part in the Toolkit development workshop, and patients (n = 13) took part in the Toolkit validation workshop. Four themes from interviews/focus groups suggested areas in which remote appointments could be improved. Themes were quality of appointment, patient empowerment, patient-practitioner relationship and unique needs for underserved groups. Staff reported difficulty building rapport, confidentiality issues, confidence about diagnosis/advice given, technical difficulties and shared decision making. This study is the first to explore experiences of remote appointments among both staff and those from underserved groups living with kidney disease in the United Kingdom. Whileremote appointments can be beneficial, our findings indicate that remote consultations need optimisation to meet the needs of patients. The project findings informed the development of a Toolkit which will be widely promoted and accessible in the United Kingdom during 2024.

Regulation by output (albeit with an associated investment level assumption related to a price-cap) rather than input is one of the ways in which the Water Services Regulation Authority (Ofwat), the economic regulator of the water industry in England and Wales, incentivises companies to deliver effective asset management. The paper discusses how such arms-length regulation operates, and sets down output indicators for such a regime. The paper draws on experience of some fifteen years of operation and annual monitoring of trends in serviceability indicators, which are the foundation upon which the regulator judges the appropriate financing for capital maintenance at periodic reviews. It describes the UK water industry’s risk based approach to the capital maintenance planning common framework (CMPCF) jointly developed by companies and regulators in 2002, and Ofwat’s approach to its assessment of company business plans submitted for periodic reviews of prices in 2004 (PR04) and 2009 (PR09). The paper highlights issues arising from PR04, development of its asset management assessment (AMA), and setting formal numeric serviceability outputs at PR09. Together, the reviews in PR04 and PR09 allowed overall increases in capital maintenance expenditure of nearly 50 %. Ofwat recognises the need for such expenditure increases to maintain the flow of services to customers and to consolidate the benefits from previous improvement programmes. However, it is questionable whether we are now approaching a sustainable level of capital maintenance for the future.