Monday, 21 May 2007

Renal NSF Update May 2007

The second Renal Services National Service Framework (NSF) progress report was launched on 18 May by Rosie Winterton, Minister of State, at the newly opened Department of Renal Medicine at Doncaster Royal Infirmary. Copies of the report are available at the Department of Health (DH) website.

NSF workshops
The renal policy team has held workshops on:

  • Transport
  • Haemodialysis capacity
  • Quality and patient experience
  • Home dialysis therapies.

Healthcare commission national renal audit
The Healthcare Commission is commissioning national renal audits on the quality of:

  • Management of early kidney disease
  • Timely creation of vascular access for haemodialysis
  • Transport arrangements for haemodialysis

The scope for renal audits was completed in July 2006. The required notice to OJEC was entered in August 2006 for interested parties to express an interest (EOIs) in undertaking the national audit project. EOIs were received in August 2006. Funds are available from 2007/08 and the interested potential suppliers have been sent the tender specification to respond by July 2007.

Action learning sets 2006/07
The DH has funded several Action Learning Sets reporting the experience of groups in selected areas who have been tasked with ‘sharing learning’ on specific problems. The following learning sets commenced in August 2006 are nearing completion (a summary of progress can be downloaded here):

  • Transitional care for young adults with kidney disease (Great Ormond Street and Birmingham Children’s Hospital/University Hospital, Birmingham)
  • Acute Kidney Injury (West London Renal Centre, Preston Royal Hospital and Lancashire Hospitals)
  • The year before RRT (Addenbrookes Hospital Cambridge, York District General Hospital)

Previous ALSs were:

  • CKD
  • Palliative and supportive care
  • Transport for dialysis (Cheshire & Merseyside)

Early kidney disease
The consequences of eGFR reporting and the inclusion of CKD points in the Quality Outcomes Framework of the GP contract are of great interest.

  • QMAS data for 2006/07 shows a prevalence of CKD stages 3-5 of 1.6-2.8%.
    Clinical Directors have been advised to work with their PCTs to improve detection, early management and referral.
  • eGFR reporting has been reviewed by the Pathology team; greater than 90% of UK NEQAS labs are now reporting eGFR.
  • Discussions have been hosted between the BNF, RA and JSC/UK CKD Guidelines Group on GFR reporting and medicines management. This is a complex area as guidance in datasheets is almost all based on creatinine clearance without normalization for body size, so eGFR (which is normalized for an average body size) cannot simply be substituted.
    The Pathology group has been asked to advise on proteinuria/albuminuria currencies, costs and practicalities.
  • Submissions have been made by the Vascular Branch to the 2008/09 QOF revision. These are not yet public, but the JSC submission will be available from the JSC page.

Health Survey England
Each year the Health Survey for England focuses on a different demographic group and looks at such health indicators as cardio-vascular disease, physical activity, eating habits, oral health, accidents, and asthma.

  • Proposal to assay historic blood samples submitted.
  • Proposal for urine ACR and PCR evaluation in future surveys submitted.

Payment by Results (PBR) and programme budgeting
PbR means reimbursement of a standard amount for treatments according to a centrally determined tariff. Development of these tariffs has been problematic. PBR for renal services is now expected to commence in April 2009.

  • Renal expenditure to be separately itemised in programme budgeting from 2008.
  • Renal advisory group established to provide comment and advice on PBR calculations and implementation.

NICE guidelines and topics
NICE issues recommendations and guidance on treatments for use in the NHS, based on evidence of effectiveness and cost-effectiveness.

  • NICE CKD guidelines – expected Q2 2008.
  • NICE – DH vascular branch co-ordinating work on cardiovascular risk assessment.
  • NICE topic selection board for cardiovascular topics (CHD and stroke, CKD and DM).

Knowledge management

  • The Renal National Electronic Library for Health was launched on World Kidney Day.
  • NHS Institute for Innovation and Improvement collaborative website pilot in progress.
  • Map of Medicine. Renal elements not in place. Plans/progress awaited.

Renal dataset
Support for collection of items in the national renal dataset will be obligatory for Local Service Providers, which will facilitate information exchange and comparison.

  • Draft approved at Information Standards Board April 2007.
  • Pilots in 5 of 9 volunteer units imminent.
  • Expected to be mandated for collection from April 2010.

Donor task force
This is a UK Blood and Transplant Agency project to examine how to expand the donor pool.

  • The Task Force report due in June 2007 represents a real opportunity to make a substantial difference to donor rates nationally.
  • The focus will be that organ donation is an issue for the whole NHS and indeed wider community not just the transplanting centres.
  • Comparative data will be used to leverage improvements – possibly linked to national audits.
  • Detailed recommendations about governance arrangements for a national transplant donor network are expected.
  • The importance of increasing donation rates in the black and ethnic minority communities is expected to be emphasised.

HCAI/MRSA renal project
Health care associated infection is a major concern and it is appreciated that renal patients are particularly affected by staphylococcal and other infections.

  • High impact intervention – renal dialysis catheter care, published.
  • Renal toolkit to assist implementation of saving lives published.
  • Conference on HCAI/MRSA on World Kidney Day.
  • Renal surveillance pilots of extended national mandatory enhanced surveillance system (MESS) reported successfully and renal pages in the MESS are now live.
  • Targeted support to specific renal units – ongoing.

Independent Treatment Sector Centres
The DH has established contracts with independent service providers in each health region with the aim of raising the proportion of private provision across all sectors to an average of at least 15%. Renal projects are developing in several regions.

  • Tranche 3 E16 scheme contracts awarded - Cheshire/Mersey and Yorkshire.
  • Tranche 4 National Renal Scheme – procurement of area specific HD services in progress.

End of life care strategy
The Cancer Tsar is leading the development of this strategy on end of life care for non-cancer patients. Link to EOL pathway information on DH website. It is intended to publish and End of Life Care Strategy by December 2007.

Working groups on the following have been established:

  • Care Pathways and Service Models.
  • Commissioning, levers for change.
  • Analysis and modelling.
  • Care homes.
  • Measurement of quality and outcomes.
  • Workforce development.

Reports from each work stream are in preparation with a view to the EOLCS drafting in September/October 2007.