Tuesday, 22 June 2010

Operating framework – signals for kidney disease?

The Operating Framework sets out the agenda for the NHS and is published in the Autumn to signal the priorities for the next financial year. It is unusual for it to be revised mid-year but these are unusual times. The financial challenges remain but the political landscape has changed. Quality continues to be the watchword with patients at the heart of decision making and a new focus on outcomes. The revised Operating Framework published on 21 June 2010 sets out some important immediate changes and heralds the direction of travel for 2011/12.

Is it just change of rhetoric or a real change in priorities? Is it a response to financial pressures or something more profound? What does this mean for people with kidney disease?

The rhetoric is strong – “reward excellent performance and be tough on poor quality”; the cuts in management costs are substantial - £500M this year and next and £850M by 2013/14 and changes of both clinical emphasis and how the NHS does business are significant. Few specific disease areas are mentioned but all will be affected. Dementia is singled out as a key priority and elsewhere in the revised document the requirement to integrate social and healthcare is emphasised. Many people with advanced kidney disease could benefit if we can achieve closer and better working of our NHS and Local Authority services. The payment system will also change – it is seen as essential to supporting quality and efficiency. Payment for performance must be structured around outcomes, be capable of aggregation along patient pathways, extend across service sectors, be benchmarked for quality and costs; and incentivised for quality. To achieve this we will see the development of tariff pathways. This could drive better pre-dialysis care. Getting things right in the year before renal replacement therapy, sometimes called the golden year, is the key to better experience and improved outcomes in transplantation, dialysis and conservative kidney care.

Making hospitals responsible for a patient’s ongoing care after discharge aims to create joined up working between hospitals and community services and maybe supported by the developments in re-ablement and post discharge support. The goal is to improve quality and performance and shift focus to the outcome for the patient. How do we measure outcomes? Well here, renal services are ahead of the game with our regular clinical audit supported by the Renal Registry but the quality and completeness of our data falls short of what our patients and commissioners need to be confident about the quality of services and what clinicians need to drive further quality improvements. The NHS is not short on data, turning that into transparent information for patients, clinicians and managers is going to get more important. It is the way to understand kidney services and can provide the knowledge needed to secure better health and care for people with kidney disease.