Interesting times: Evolution of dialysis in Australia's Northern Territory (1980-2014)

Background: Treatments for kidney disease have been available in Australia for more than 50 years. Despite this, and the Northern Territory (NT) having Australia's highest rates of kidney disease, the range of models of dialysis care in the NT has been limited until quite recently.

Objective: The paper provides a brief history of the development of dialysis services in the NT and examines the contexts in which unique models of dialysis care have emerged. Data reviewed included published and unpublished documents and reports, relevant Departmental and ANZDATA information and interviews with past and present staff.

Discussion: The early development of renal services in the NT was characterised by a desire to limit expenditure, despite repeated disease projections that indicated rapidly escalating demand. An integrated policy response was not forthcoming to address the magnitude, persistence and growth in the burden of kidney disease. Repeated periods of capacity crisis requiring Ministerial intervention have dominated the historical landscape. In the meantime, Aboriginal patients, communities and clinicians have advocated, with some success, for services that are closer to home and more responsive to patients' health, social and cultural needs.

Conclusion: There has been considerable expansion of dialysis services across the NT, with several unique models of dialysis care developing over the last 15 years. While there are now some community-led services, the NT Government continues to provide the bulk of staffed services. It is yet to be seen if the new MBS item for remote dialysis services will be another game-changer.