It is now over 8 years since the national service framework for kidney services was published and we have come along way. Chronic kidney disease is seen as common, harmful and treatable and acute kidney injury is on the map. The times they are, a changing and kidney care is leading the way, from a 20th century cure paradigm many of us were trained and grew up in, to a 21st century chronic disease management model of care. This is a cause for celebration. The shift from exclusively cure to care has expanded our focus from the kidney to the person, carers and family of those with kidney disease. Patients working with the health care team as equal partners, reaching shared decisions and tackling the complexity of kidney disease together as a local care team and national kidney care community.
The change in culture from a traditional medical model to a holistic patient centred approach where every clinical interaction should be measured by “Did it add value for the patient?” is I believe our biggest challenge. However, the Nicholson challenge, to save £20 billion over the next 4 years, the changes to the structures of the NHS arising from the Health and Social Care Bill before parliament and the response to the systemic quality failures that the Mid Staffordshire enquiry has revealed are all affecting how kidney care is delivered, the experience and outcomes our patients receive.
I recently asked an audience “How many of you believe quality is the only organising principle of the NHS?” Not many hands went up. Then I changed it to “Would you like quality to be the organising principle of the NHS?” They all went up. The paradox is that we are the system- the NHS is its people and collectively we are the only ones who can achieve that goal.
Putting quality centre stage is the aim of the National Kidney Care Quality Innovation Productivity and Prevention plan. The plan is an aggregative of the best elements of the Regional and Kidney Care Network plans developed over the last 2 years. It identifies nine key tasks across the patient pathway that will drive improvement in care and provide value for money. Where it is possible, prevention is the best medicine and it is certainly the cheapest! Innovation Health and Wealth, the NHS report for the prime minister highlights home haemodialysis and virtual kidney care clinics. It makes the case for innovation to improve outcomes within our current resource constraints. The kidney care national plan builds on the recommendations in this report and brings together much of the learning about the importance of preparation and choice, personalised dialysis prescriptions, early transplantation and conservative kidney care. It is neither a new set of targets nor a bureaucratic paper exercise. It sets ambitious but achievable goals based on the NICE chronic kidney disease quality standards, which taken together provide a measure of the quality of kidney care.
The plan provides a national template of what we know will improve kidney care. Most units I hope will already be addressing some of these issues. How to achieve the best live donor pre-emptive transplant rate, the best patient satisfaction with the dialysis transport or integration with primary care to prevent progressive kidney disease and reduce ‘Crash Landers’ can only be determined and delivered locally. Your actions in individual patient encounters and as a member of the multi-professional team can make the difference between chaotic care and quality care.