Specifically the plan states that "the renal service is working towards increasing the proportion of patients on home-based dialysis. Older patients, however, are sometimes reluctant to, or not capable of managing dialysis at home, and some have no carer to assist.

As well, there are costs involved for the patient on home dialysis and each treatment, on average, requires 270 litres of water.

The renal service plans to introduce an outpatients clinic for home dialysis patients with a nurse practitioner providing support and medical review, to help prevent adverse events and reduce unnecessary hospital admissions.

A recent review of Manning Hospital renal services raised several issues, including the need to accommodate all renal inpatients at Manning Hospital and enhanced allied health support, such as occupational therapy and dietetic outreach clinics.

Demand for patient transport also remains an issue, especially with increasing numbers of older patients requiring dialysis, who may be too unwell to drive.

Taree practitioner, Dr David Keegan says home-based dialysis "is quite a different situation to something like diabetes". He speaks from the experience of a doctor who supported the Nita Reed Community Dialysis Centre in Taree before it was handed over to Hunter New England Health, and as an individual who had an uncle who required renal dialysis.

"It's not like giving yourself insulin when it is just a little jab in the stomach," he explained.

"You have to have a good understanding of pressures and fluid shifts and all sorts of things. You have to be able to cannulate yourself or have someone cannulate you.

"Now the problem is that a lot of the older people are very frail, or they may not have the ability intellectually or physically to dialyse themselves."