In an ideal world Wanganui locals wanting to receive dialysis in their homes could do so.
However, the reality was more complex than that, Whanganui District Health Board (WDHB) general manager of service and business planning Tracey Schiebli said at the DHB's community and public health disability support and advisory committee meeting on Friday.
"We discussed whether this would work for us and believe we have come to understand the issues," Ms Schiebli said.
A 2010 report had said the WDHB and MidCentral DHB could consider a satellite renal unit in Wanganui, and last year the two DHBs sat down to see how this could work.
Ms Schiebli said the most important step would be to develop a workforce to support a patient at home, but Wanganui was a long way from that.
There was also the balance between access and cost.
MidCentral DHB operations director of hospital services Lyn Horgan said it would be ideal if patients could receive dialysis at home, and that was what the joint DHB Renal Working Group would continue to work towards.
But it was a significant challenge to develop a workforce capable of helping keep patients in their homes, Mrs Horgan said .
Renal patients required specialist care and it took up to five years' experience to understand the types of renal care they might need.
Dialysis was a highly technical area; the nurses needed to know how to troubleshoot, how to be one step ahead and become good assessors of the disease process and what dialysis was doing, Mrs Horgan said.
There were also those who may not want to receive dialysis at home. For some, it was important to be among others.
Committee member Judith MacDonald said renal care required a whole-of-life approach and with an ageing community on dialysis, respite care was not available locally.
Whanau support was required for these people because sometimes they were vulnerable in their own homes, Mrs MacDonald said.
WDHB chair Kate Joblin said she accepted the future direction for renal services for the two DHBs, but did not accept enough was being done to provide for the Whanganui population. She added that this work had been moving at "glacial speed" and wanted it kept on the radar.
The recommendation was to apply a "co-design" approach to future development, working with service users and their families to define local support needs.
A report will come back to committees in three months.