Tuesday, 2 March 2010

The Venice of the North

Monday 1 March was a beautiful day in Yorkshire. I am not always a fan of the early morning trans-pennine express but the views en route to Hull were magnificent. One of the privileges of my post is getting out and about to chat to patients and NHS staff and earlier this week I was at the Yorkshire & Humber Network at the invitation of Rebecca Campbell (Network Manager) and their Renal Strategy Group.

I was hoping to get to see around the new 40 station state of the art unit at Hull Royal Infirmary but it was a hive of activity and I certainly didn’t want to be responsible for slowing things down by interrupting the workmen for a sneak preview. It will be open in a few months and hopefully I will get to visit again soon. Helen Collinson (Clinical Director of Kidney Services at Hull) and Elaine Harrison (Renal Nurse at Hull & East Yorkshire Hospital & Nurse Lead Network) did show me round the current “unit” – having to manage 3 physically separate outpatient dialysis areas must be a logistic nightmare! Despite that the staff and patients were really quite cheerful. To have outgrown not 1 but 2 dialysis units while waiting for a new facility is something of an achievement! The buildings themselves had seen better days but I was struck at how much effort is going into keeping the patient environment the best it can be until the move. However, I don’t think anyone will miss the old place when the transfer does occur.

The buildings may have seen better days but the staff were definitely in good form and indeed shape. A team from Hull are doing the coast to coast walk for Kidney Research UK. If you want to sponsor them go to http://www.kidneyresearchukevents.org/coasttocoasters. There was a big emphasis on supporting patients and their families, providing local clinics, linking with primary care, not only for early kidney disease but also for the delivery of conservative and end of life kidney care, and a thriving pre-emptive live donor transplant service linked to Leeds. The multiprofessional philosophy and “can do” mentality will stand the team and their patients in good stead to tackle the quality and productivity challenge facing the whole NHS. Part of that philosophy is understanding that we don’t have all the answers. That’s evident in the Hull clinical team’s approach to quality improvement for the service but also in the way they ask research questions and contribute to our evidence base. Sunil Bhandari (Honorary Senior Lecturer in Renal Medicine) leads an active research group conducting a range of clinical and basic science projects. Time did permit for Sunil to give me a short tutorial on erythropoetic stimulating agents and cardiac modelling, the subject of a recent successful PhD.

Hull seems pretty representative of the whole network with lots of energy, innovative approaches and a real desire to make significant improvements in patients’ experience and outcomes. I was pleased to learn that the Yorkshire & Humber renal strategy has been approved. It’s based on realistic planning assumptions and sets ambitious targets covering the whole pathway. There was a healthy discussion about providing support to home haemodialysis as part of the network rather than each unit trying to do what could be better done as a group. There is already a track record of working together with the northern part of the patch recently investing in a single IT system across the 4 provider Trusts; the vital pulse system will also link directly into primary care and should facilitate the award-winning “virtual nephrologist services” that John Stoves (Consultant Renal Physician) and John Connolly (GP) in Bradford have been leading on. Five CQUINS have also been approved and cover setting thrice weekly haemodialysis as the acceptable minimum, haemodialysis starting as an outpatient, early transplant listing and peritoneal dialysis. Michael Gordon (GP in Sheffield and lead GP for the network) with Greg Fell (Public Health lead) have also produced some neat graphs and statistics to compare individual GP practices’ management of chronic kidney disease with adjacent practices. Capital for refurbishment is an issue in West and North Yorkshire and I think this will be a challenge nationally in the lean years to come. Will McKane (Consultant Renal Physician in Sheffield) also expressed concerns that the move to Payment by Results for chronic dialysis may undermine the provision of an acute kidney injury dialysis service. I always seem to come away with more questions that I need to do homework on when I meet with Will.

PS Les Sellers (Consultant Renal Physician at Hull) told me Hull was the Venice of the North but I was also told that when I was a Senior Registrar in Edinburgh (or perhaps that was "Athens") and have heard the same comment about Aberdeen; according to Wikipedia “the term Venice of the North refers to various cities in northern Europe that contain canals, comparing them to Venice, Italy which is renowned for its canals”, strangely none of the places mentioned above are included!