Monday, 23 November 2009

Establishing new kidney units

The model of renal care in England is really quite unusual with only 52 kidney centres for a population of 50 million. International health comparisons are always interesting but you don’t need to go as far as the USA or indeed Italy or Germany with its 1200 units. Those are very different systems. Looking closer to home, Scotland, Wales and Northern Ireland have between them 26 kidney centres; half the number of England for a combined population a fifth of the size!

As the demand for kidney services grows one of the questions to be asked is should kidney units just get bigger or would there be advantages in establishing new units? The reasons for the English model can be debated but NHS Kidney Care have done better than that and have produced a 7-step tool kit for achieving autonomy for kidney services. The service configuration in England has evolved from a traditional hub and satellite approach to a formal network of kidney care where partnerships and synergies are developing. In the future we must deliver more services locally. In some, but not all instances, this care will be delivered to a higher quality and offer better value for money from a new kidney service that is fully integrated into the local health economy.

We have the trainees to create new units. The NCEPOD report on acute kidney injury highlights the uneven spread of kidney services and recommends development of on site renal services, we need to work closely with primary care in the management of early kidney disease and to deliver better quality conservative kidney care close to peoples’ homes. So it’s not just dialysis growth driving this evolution.

A fully stand-alone kidney unit might need 4-6 consultants depending on whether they are full time or part time and also the extent of the kidney team’s involvement in acute medicine, research and training. That would be difficult if all those set up costs were needed from day one. They are not. New centres can be established incrementally. Separation from the parent unit indicates that autonomy has been achieved but that’s not the first step nor is it the driver for new units. The driver must be better quality of care for people with acute kidney injury and chronic kidney disease.