Thursday, 7 January 2010

New Year resolutions - goals for the year ahead

With the festive period behind us, minds are focussed on the year ahead and what we hope to achieve. The pundits say that “you should have 3 goals or less. Any more and you won’t be able to focus on them”.

Taking that advice I have set 3 goals that I will prioritise over everything else. They are raising the profile of acute kidney injury so that it gets on every healthcare professional’s radar and every healthcare organisation’s agenda; driving the data into knowledge initiatives that will support improved quality and outcomes for people with kidney disease and promoting shared decision making which I believe is at the centre of high quality personalised care planning for long term conditions.

The risk with New Year resolutions is always that we either set our sights too high or that all those urgent things that clutter our days push out the important things we need to do to achieve the goals. The trick is apparently to break the tasks down into bite size chunks that are within reach and to share the goals which provides increased accountability to help achieve your aims.

The challenge of managing acute renal failure, as it was then termed, and the prize of seeing desperately sick people recover was one of the main reasons clinicians of my generation chose kidney medicine as a career. Last year’s NCEPOD report on AKI confirmed what many people thought – services provided for those with AKI are poor. We need to do better. To address the concerns highlighted by the NCEPOD report and to co-ordinate a whole system approach to improving care, I have established an Acute Kidney Injury Delivery Board that will bring together all the necessary expertise to implement the report’s recommendations.

The kidney community led the way in using data to manage both individual patients and the end stage renal failure populations we serve. The Renal Registry has been pivotal in raising the understanding of renal replacement therapy and helping local teams to drive up quality. The NHS collects as much, if not more data, than any other healthcare system but we haven’t yet capitalised on that goldmine. Now that we have the National Renal Dataset that was mandated last May, we have the opportunity to establish data linkages, develop quality metrics and turn that information into knowledge to support improvements and efficiencies in care. That’s what the Kidney Quality Improvement Partnership (KQIP) set up last year and supported by NHS Kidney Care is all about. We will be appointing a clinical lead for that programme later this month.

World Kidney Day 2009 saw the launch date of our Kidney Care Plan. Engaging, educating, empowering and encouraging all people of every shape and size, and every colour and religion, with or at risk of chronic diseases is perhaps the biggest challenge healthcare faces globally. It cuts across all the long term conditions – vascular, obesity, cancer and mental health. It’s also one of the ways to reduce infectious diseases, accidents, trauma and the other causes of premature mortality. We have to move from the sickess/cure paradigm to a health/risk management one which means moving from a “doctor knows best” to team working in partnership with the public and patients. Care planning in short. Coming from a secondary care renal background, one of the areas I am most passionate about is “the year before” as our NSF calls it. Advanced kidney disease before replacement therapy or the decision to opt for conservative care has been made. There is a lot happening in this space – cause for concern registers, increased pre-emptive live donation now increasing across ABO and HLA barriers and encouraging home dialysis therapies to restrict the list to 3.

Setting these 3 priorities - AKI, linking routine data flows to improve quality of care and supporting patients to make the best choices to optimise experience and outcomes for themselves doesn’t mean everything else stops. What it does mean is that working towards these goals will not constantly take a back seat to ordinary work.

I hope that you have had a good break, that the snow hasn’t disrupted your goal setting and that 2010 will be a year for progressing quality of care. Quality if the organising principle of the NHS. As we tackle the issues the financial crisis will raise we need to stay focussed on that central goal.