Wednesday, 22 October 2008

Build it and they will come

Kevin Costner’s cult film was invoked by Kim Cox (Specialised Services Commissioning Lead, Yorkshire & Humber) to describe the consequences of building a new dialysis unit. The teams responsible for developing and providing the new autonomous kidney care services at Doncaster and Northampton and the group working on the Worcester service had come together to share experience and to identify the challenges, work around S and solutions to achieving new local services.

Each of the units are at different stages of development and have different histories. David Throstle (recent Clinical Director, Sheffield Kidney Institute) and Ian Stott (Consultant Nephrologist, Doncaster) told the South Yorkshire story of a commissioner led 10 year investment plan, 2 Foundation Trusts with different business models – neither wrong, just different approaches, and how the whole kidney care community made the Doncaster service a local and Sheffield win-win, but mainly a win for people with kidney disease from Doncaster. The service now includes a 24-7 acute kidney injury (AKI) capability, all modalities of renal replacement therapy (RRT) except the acute phase of transplantation and home haemodialysis support, a full multi-professional kidney care team, a 24 bedded inpatient unit plus the dialysis unit.

Warren Pickering (Consultant Nephrologist, Northampton) gave a graphic account of historic land grabs, the reality of practicing and receiving care at the interface between different units or networks and the organic growth of the Northampton service as part of the East Midlands Renal Network supported by the Leicester mother unit.

The growth of the RRT population was a major driver for the creation of both these units. Modelling had shown that critical mass would soon be reached and central expansion or local provision were the only options. Because we don’t have good information on transport costs or carbon footprint data the savings, and there must be savings, in these areas haven’t been quantified. It was clear from talking to Ian and Warren that their input into AKI in their hospitals and ICUs was quicker, more responsive and mainly consultant delivered in comparison to many regional acute services where transfer with all its attendant delays takes a disproportionate amount of time and effort.

Paul Bates (CEO, Worcestershire PCT) is no strange to kidney care having sat on the National Service Framework External Reference Group for 3 years. Paul is steering the development of the services for Worcestershire and Herefordshire with the local teams, the University Hospital Birmingham physicians and commissioners. Paul emphasised the importance of tripartite dialogue between the specialists, the provider organisation and the commissioners so that both the business and clinical risks can be managed. I learned a lot about Local Authority Health Overview and Scrutiny Committees – these HOSC groups will have an increasing say in how local services are developed and delivered.

A debate about the pattern of service in England is beginning – we have 52 main renal units, the other 3 home countries with only 20% of the English population have 26 main units! The geography and demography are different but the stories from Doncaster, Northampton and Worcester describe some of the benefits of providing comprehensive kidney care close to peoples’ homes. The learning from these projects will help others considering similar schemes and will be made available via NHS Kidney Care ( soon.