Monday, 23 March 2009

The art of care planning

World Kidney Day 2009 was a fabulous occasion for me – and not because of the reception at the Palace of Westminster, not because my mum was proud to see me interviewed on BBC News, not even because I was able to witness the performance art “demolition dialysis’. They were all fun and seeing the increased public facility of kidney disease is certainly encouraging.

For me the high point of Thursday 12 March 2009 was the launch of the ‘Kidney Care Plans’, NHS Kidney Care’s first major achievement. Lead by clinicians, produced in partnership with the whole kidney community, aligned to the Government commitment that everyone with a long term condition will have the right care plan by 2010 and tailored for local ownership that they are the culmination of a tremendous amount of thought, work and experimentation.

These kidney care plans are not perfect, but they are good and they provide a platform that can be transformational. They are not a check-list. They are based on the real experience and views of patients and clinicians. The questions they contain are prompts for potential discussion points. Advanced kidney disease is not routine – every person’s clinical situation is unique, even people with the same underlying cause of kidney disease will have significant differences in their medical history. In manufacturing variability is a sin. It occurs when process control has failed. It represents poor quality. Quality in healthcare is not so simple – it is both a science and an art. We need vigorous process control in many aspects of kidney care – to eradicate delays, to put safety first and to monitor the level of kidney function – to name a few. Care planning cannot be handled in that way – care planning is all about the individual and individuals are infinitely variable. Care planning is about values it is not about standardisation. It is about building strong relationships between staff and patients. It is about trust. It is about empowering all staff to support the individual with kidney disease to set and achieve their own goal. It is about patient experience. It’s an art rather than a science.

So the care plans are a platform upon which we can address some of the challenges that care planning will hold – such as, getting enough time and space for staff to have the discussions with people who have kidney disease. You can use care planning to improve the understanding that people have of their condition and the limitations it will place upon them. Entering into a shared responsibility with patients and their families will challenge some aspects of our thinking about disease processes and the outcomes that we should be pursuing. Listening is sometimes difficult when talking! The care plans, the scientific platform – the process platform, if you like, are the easy bit, but I think the process of care planning itself is not new, we need to rediscover it and given the values of the people in kidney care, indeed the people in the whole NHS, I think care planning should come naturally. Have a go!!