NKF chief executive Tim Statham outlined the main worries that the NKF has about the prospective NSF for renal care to an audience of renal health professionals at a conference organised by the Harrogate Management Centre.
He put forward a list of pertinent queries about the delayed NSF:
As well as posing these difficult questions, which received no answer at the conference, Mr Statham outlined the main functions of the NKF and its role in persuading the Government to commission a renal NSF by helping to launch A Framework for Planning and Service Delivery.
The keynote address at the conference was given by Professor Robert Wilkinson, consultant nephrologist at Newcastle Hospitals Trust and co-chair of the External Reference Group for the renal NSF.
He outlined the problems which the renal NSF would he hoped help to solve – a shortage of dialysis facilities and staff leading to no choice for patients and a shortage of organs for transplant. He described the modular approach for the NSF – dialysis, transplantation, primary care, prevention and acute real failure and end of life care.
He forecast a multi-skilled renal workforce, leading to more patient –orientated education and choice, clinics and dialysis closer to home, long term care plans, easier patient access to multidisciplinary teams, better access to surgical and radiological services, more transplants, better prevention and fewer complications of ESRF.
The patient will notice more choice in clinic visits, mode of dialysis, place and time of dialysis and transport. There will also be a better quality of treatment and environment and renal failure will be prevented or postponed.
The Government viewpoint was given by Dr Peter Doyle, senior medical officer renal and transplant policy team at the Department of Health. He listed the developments initiated by the DoH, including the NSF, and discussed the multi-disciplinary challenges facing renal care. He listed the many professionals involved in renal care – nephrologists, immunologists, surgeons, radiologists, nurses, renal technicians, dieticians, pharmacists, occupational therapists, social workers, counsellors and psychologists - and said they wanted more staff, more equipment, better facilities, better control, and more “toys”.
The impact on patients he described as having a “sword of Damocles” hanging over them as any small symptom or event may spell complication or even life-threatening disaster. All the critical decisions – what type of dialysis, whether to list for transplant – are all judgements based only partly on the results of judgements only partly on the results of tests but also on the patient’s symptoms and circumstances.
The future lies with a patient-centred, responsive and flexible service, which delivers the services patients need at a time they need it. Patients can be encouraged to be expert patients through the Expert Patient Programme.
The Modernisation Agency had told them to “think outside the box” by developing a multi-skilled workforce, with the key driver the NSF itself. The means of implementing the NSF may not be identical to some previous NSFs as they have to be consistent with recent NHS reforms, but there will be mechanisms.
Dr Doyle mentioned the Long-term Conditions Care Group Workforce team, a renal NSF information strategy, NICE, NHS Estates, UK Renal Registry, UK Transplant, CHAI and CPPIH.
“If we can achieve this change, then we will also achieve the central aim of the NSF, which is to drive up both the quantity and quality of renal care,” said Dr Doyle.
Commissioning renal care was the subject of a talk by Dr Jean Peters, senior lecturer in public health at Sheffield University, and Dr John Bradley, director of renal medicine at Addenbrooke’s Hospital, Cambridge. They described the new system of commissioning by Primary Care Trusts, with three- year contracts for specialised services. An expanding service faces constraints that vary between regions and limit the ability to deliver improvement without further investment. Asked about how the new system could be monitored, they thought that the new body CHAI which monitors the health service would be effective.
Medical director of UK Transplant Chris Rudge gave an upbeat assessment of the position of renal transplants since UK Transplant took over. The good news is that results are improving, organ donation is improving and immunosuppression is improving. The bad news is that the waiting list is increasing and there is not equality of access to transplantation.
The challenge is to make transplantation available to more patients, more effectively and more equitably in properly staffed transplant units.
Prof Terry Feest, chair of the Renal Registry, Southmead Hospital, Bristol, described the work of the Renal Registry in monitoring the quality of care in UK renal units. The main difficulties are to act on the information to bring about change and the need to identify areas of possible improvements.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
Page created: 7 October 2003
Last updated: 21 April 2008
This website is intended for UK residents only.
If you have any comments about this site, please EMAIL the webmaster
