The year began with a solar eclipse - partial in fact, obscuring the upper three-quarters of the sun leaving a "smiley face” which I thought at the time might be a good omen. Perhaps it was a celestial smile at the turmoil and changes we would see from the Arab Spring to the Euro crisis and things closer to home? Well, we got over the introduction of tariff, lots of hospitals are now using e-alert systems to identify early acute kidney injury and steady progress has been made with Cause for Concern registers; and the world didn’t finish!
The dialysis and then transplant paradigm is also shifting. We have seen an increase in live donor transplants again this year and increasing these are performed pre-emptively. I think every unit has now moved over to a laparoscopic keyhole approach for the donor. As a system, we are beginning to think transplantation first whenever possible. Some units are now at 60% of their live donor transplants occurring pre-emptively and the NHS Kidney Care timely listing project will, I am sure, drive further quality improvement, reduced delays in transplant work-up and result in many more people not having to have the intrusion and risk of dialysis for they get their "gift of life”.
Live donor transplant before the need for dialysis also saves money and, given efficiency is one of the 7 dimensions of quality we shouldn’t shy away from cash-saving where it improves experience of care and outcomes for patients. The Kidney Care Quality Innovation, Productivity and Prevention initiative or QIPP initiative consulted on and developed through the Autumn sets out the goals that if /WHEN achieved will improve quality for patients and provide value for money for taxpayers: home therapies, including transplantation when they are the patient’s preferred modality; integrated and co-ordinated care with primary care colleagues using IT and virtual clinics to manage the local population providing individualised care planning and involving patients in care through renal patient view, in shared decision making for conservative care as well as home therapies – indeed in all care decisions and in service planning such as transport for haemodialysis..
Despite the uncertainty of 2011, the changing NHS structures and the global upheaval, a lot of certainties remain – kidney disease is here to stay, healthcare professionals together with the patients and carers can improve the outlook for people with kidney disease and lots of research questions remain to be answered.
Enjoy the holiday season. Spare a thought for the generous families who have donated this year and for the carers who give unstintingly (and unpaid) and start the New Year with ambition, passion and compassion. Let’s come out fighting for all our NHS in 2012.