Renal Health care is increasingly being moved from hospital to community and also from public to private provision. In 2007 the W.A. health department was the first world-wide to corporatise all training and management of all PD and HHD patients. Whilst care outcomes are always of primary importance financial considerations also influenced this project. As the burden of disease grows improved care for less dollars is the trend for health care world-wide. For W.A. Increasing numbers on home therapies from 20%-30% of W.A. renal patients in 7 years is a target. The transition to this new home dialysis programme was change process on a mega-scale. It incorporated creating and changing of locations, conversion all 200 PD patients to new products for dialysis, developing new nursing care teams, and standardising care and protocols previously provided by 3 tertiary hospitals and 17 nephrologists. Reaction to this change from health care professionals and patients varied providing many valuable insights. The changeover process highlighted the need for broad consultation, clear visions and the ability to be tolerant whilst constantly problem solving. New ideas were tried and tested, modified, and tried and tested again. It is impossible to define objectively whether on balance the home dialysis programme has benefited overall from this change but it has certainly increased the level of discussion in W.A. re models of care. This must be positive in the long-term.