Friday, 27 July 2007

Renal NSF Update July 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.

The Renal Policy team, Heart and Stroke team and Diabetes team now form the vascular branch at the Department of Health to facilitate joined up policy and implementation across the broad vascular access agenda. The Children's Transplant and End of Life Teams work in adjacent areas.

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 will be conducting 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 this project was completed in July 2006. The required notice to Official Journal of the European Communities (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
These action learning sets commenced in August 2006 and are nearing completion. They comprise:

  • 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)

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.

  • Quality Management and Analysis System (QMAS) data for 2006/07 shows an SHA level reported prevalence 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.
  • 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.

Health Survey England

  • 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

  • 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 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).
  • Diagnostic technology appraisal - proteinuria - scoping document requested.

Knowledge management

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

  • The Donor Task Force is due to report in June 2007 and 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

  • 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

  • E16 scheme contracts awarded - Cheshire/Mersey and Yorkshire.
  • E16 scheme – commercial close on 20 June 2007. FBC approve for stage commenced.
  • Tranche 4 National Renal Scheme - procurement of area specific HD services in progress.

End of life care strategy
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.
  • The National Liverpool Care Pathway for the dying patient renal project will be producing guidelines for LCP drug prescribing in advanced chronic kidney disease in the near future.