Monday, 6 April 2009

Centre not satellite for Tunbridge Wells

The Oxford English dictionary dates the origin of the term satellite from the mid-16th Century – in the sense “follower, obsequious underling” derived from the French and, in turn, Latin. Despite the fog in Manchester this morning, a bit like a film set depicting the middle-ages, I got to Tunbridge Wells Kidney Treatment Centre on St John’s Road, a busy High Street at the heart of Tunbridge Wells, in a shorter time then I would have got from Tunbridge Wells to the dialysis unit at Guys & St Thomas’s Hospital. A surprising feat given the distances, but distance doesn’t always equate to travel times. The soon to be published transport for haemodialysis audit will draw attention to that fact.

Debra Mundle (Satellite Unit Matron), and Nick Gadd (Deputy Divisional Director for Managed Networks) met me and, with Simon Steddon (Clinical Director for Kidney & Urology Services), showed me the main dialysis area where I was able to chat with a number of patients. They mentioned that it was quieter, less “clinical” and easier to get to and park. Alan Williams (Charge Nurse), showed me the patient resource room and David Gandy (Chief Renal Technician), tried to explain the intricacies of the water treatment plant to me. I didn’t like to admit that physics had never been one of my very strong points so I was starting from a low base but left considerably more knowledgeable about water quality. There is no waiting room as people don’t wait for dialysis now! Now that’s clearly a good thing. A couple of patients did mention the risk of a loss of camaraderie amongst the patients now they are in better facilities and don’t have to wait as a group. That’s a tricky one. Sense of community is very important for many people with advanced kidney disease. Some units do have formal service user groups and I know of several kidney teams that have regular social events such as an annual dialysis dinner, summer Balls and Christmas parties.

Locally dialysis units do of course reduce travel times, improve patient experience and in addition reduce the carbon footprint associated with dialysis services. But I was not going to the Tunbridge Wells Satellite Dialysis Unit. The not so old Pembury Hospital Satellite Dialysis Unit, a portacabin style structure that was opened in 1966 and had been in the grounds of a local hospital was closed earlier this year; and yes, Tunbridge Wells kidney treatment centre does contain a “satellite dialysis unit” – bigger, better, brighter and quieter than the old unit. John Scoble (Consultant Kidney Doctor), did look a few years younger and the machines in the new centre are slicker than those in the photograph that was on show of the opening of Pembury, but the big change that struck me was the move from delivering satellite dialysis at a distance to providing a locally responsive service. The kidney centre also contains a training area for home dialysis and a self care section on the first floor quite separate from the main dialysis unit on the ground floor and clinic rooms for consultation with nursing, medical and surgical staff.

Cormac Breen (Consultant Kidney Doctor) showed me the Guys renal IT system working fast and comprehensively and that enables patients across the whole kidney care pathway to be safely, effectively and efficiently managed in the High Street in Tunbridge Wells as well at Guys tower at London Bridge. Soon venous imaging and Doppler studies will be available on site – so decisions about vascular access can be made locally. The centre offers a range of services including dialysis, transplant follow-up, chronic kidney disease assessment, conservative kidney care management and dietetics.

It was therefore a great pleasure to open the centre with Mike Rusbridge (Mayor of Tunbridge Wells). The team have made a film of building the new centre, leaving the old unit and the scramble that was opening day. It’s fun, it would make you smile and I think it embarrassed Debra but what it shows is a multi-disciplinary team working together across the boundaries that can sometimes slow us down or stop us, it shows a commitment to high quality care and a clinical vision based on the needs of local people with kidney disease. The centre is building relationships with local GPs and community services. Also, as a result of the medical presence on site in the High Street most days, the link with Kent & Sussex Hospital for education, acute kidney injury management, access to local services and joint management when inter-current illnesses develop in people with chronic kidney disease is actually stronger, more responsive and more personalised to the individuals’ needs than when a nephrologist visits the hospital for their weekly clinic.