Wednesday, 20 January 2010

Getting the finance director to look at the quality report first

…. because then she will know that the clinical service is sustainable and in good shape. That’s the name of the game and has been for some time. Mike Richards the Cancer Tsar, now Sir Michael, said that to me when I was considering taking on the role of National Clinical Director for Kidney Care in 2006. It’s even more true today but we now have a whole new vocabulary for quality – quality accounts, quality indicators, CQUINs, the National Quality Board, quality standards, to name a few.

In kidney services we are also fortunate to be ahead of the curve in having a mandated national renal dataset which we can use to help measure the quality of the services we provide. The move towards Payment by Results for dialysis is another piece of the jigsaw and yesterday “Kidney dialysis – developing costs to deliver an equitable and high quality service” was published on the DH website although many people will have received a copy last year. I am a little perplexed as to why it took so long to get on the DH site! It did however remind me to mention the road testing of the 2010/11 tariffs is drawing to a close. If you wish to comment you have until Friday 22 January. The proposed price for a haemodialysis session is £144, more detail and the relevant "small print" of the non mandatory tariff from April 2010 can be seen here.

You can read the full guidance note at pages 77-79 of Payment by Results Draft Guidance for 2010-11.

Many renal unit directors, Trust finance leads and commissioners are reviewing local arrangements. From what I have heard these are leading to mature discussions focussing on clinical quality and putting plans in place to be able to count and contract for haemodialysis on a sessional basis. Working out how to financially manage the transition from the historic system, one could say byzantine, to a mandated PbR system, hopefully with a best practice tariff for dialysis, from 2011 is a key quality and productivity challenge for the kidney community.