Wednesday, 11 July 2007

Juggling and the Capacity Gap

In Manchester we have benefitted from the £60M that the DH allocated for expansion between 2001 and 2005. Despite opening new units in Bolton and Wigan, expanding at Manchester Royal Infirmary,in Rochdale and at Hope Hospital, capacity remains a real problem. Everyone in or associated with the renal community is frustrated at the lack of concrete plans for increased capacity beyond 2008. We are not alone. Capacity is a major issue nationally. We have coped by "juggling" - not a word I have seen in the journals or reports to describe the situation. I guess you know what I mean - admitting patients to start dialysis as inpatients, usually using our acute kidney injury capacity, prioritising the next day's dialysis on chemistry and ? clinical grounds rather than scheduling and keeping the patients incarcerated until a vacancy in the main or satellite units becomes available.

The sister of one of our patients so managed came to talk to me about what this bad experience feels like – I found it more than a bit uncomfortable having that particular mirror held up in front of me. The call for her sister to be admitted occurred on a Wednesday lunchtime - “no it can ' t wait, you must take the afternoon off to bring her in before 3.30pm”. Bloods were taken on the Thursday and the first dialysis was on the Saturday. That was in May and last Friday I was asked “when do you think my sister will be discharged?”.

As I prepare my slides for the opening scene setting talk at the All Party Kidney Group and National Kidney Federation Dialysis Summit at the House of Commons this Thursday, that lady and her sister’s story are at the forefront of my mind. Admitting people to start haemodialysis is hardly empowering.

By coincidence, while I was having that discussion, Jackie Buck sent me a copy of her article on “Why do patients known to renal services still undergo urgent dialysis initiation?” that was published on line by NDT on 5 July. If we take Jackie and the Leicester Group’s definition of known acute s – patients known to renal services for greater than 4 months who commence dialysis using a haemodialysis catheter or who require admission to start dialysis, I wonder what percentage of people starting replacement therapy fall into that category? A lot more than start with pre-emptive transplantation no doubt – in the East Midlands Renal Network they found that 44.9% fell into that category. It was a morning of Coincide nces , also at the same time as discussing the experiences of this particular patient, I had an offer from the NHS Heart Improvement Programme for their team to work with the kidney care team in the DH to share experiences and information from their projects that may allow us to develop some tools, support and national guidance on initiating dialysis. This could complement the capacity planning and capacity realisation that we also urgently need.