I re-read the NHS Constitution again last week. It seemed an appropriate thing to do, on the day that what has become to known as Francis 2, the second inquiry into the standards of care at the Mid-Staffordshire hospital was published. A couple of things jumped out at me. In particular, the fifth principle “The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population”. This resonated well with me from a kidney care perspective.
Historically, renal services have usually worked seamlessly between dialysis and transplant services, which of course are often in different hospitals. Rather surprisingly the variance in proportion of people transplant listed, delays in listing, live donor and pre-emptive transplant rates, cannot be explained by a lack of focus in non-transplanting units. As a general rule the transplanting units are not necessarily better at timely listing than the non-transplanting dialysis services. As a system, we are now making improvements in the timeliness of transplant listing in both types of units. Once listed nearly all kidney patients receive high quality care across the boundaries of the different NHS hospitals.
Elsewhere in the kidney care pathway things are not so good. Although, unplanned starts on dialysis have fallen, overall 30% in the last 5-6 years they are still double, what they could be in many units. Time for preparation and support in making shared decision about management , treatment and care when end stage renal failure is reached, takes time, skills, commitment and systems that span the virtual, or is it virtually insurmountable, boundary between primary and secondary care. Many of the same skills and systems are essential for good conservative kidney care and to achieve a peaceful and dignified death in renal failure.
The NHS constitution sets the tone and values for the whole NHS including the NHS commissioning board, which will assume operational responsibilities for the NHS from April this year. It enshrines people’s rights and is a ‘must do’ alongside the outcomes framework in the NHS mandate. It ensures a waiting time targets remain in place (they apply to live donor transplantation as well as other planned surgery)– they are in the handbook of the NHS Constitution. Some of the other rights and pledges are less easy to measure, but are no less important. In kidney care, it is the fractures in the system that often carries a risk. The handover from the medical team to the renal team in acute kidney injury, the working relationship between GPs and kidney Consultants, the link between renal community staff and primary care nursing teams, and the commissioning of specialist services (dialysis and transplantation) with the other parts of the pathway.
The Constitution and Francis 2 are as relevant to kidney care, as they are to the rest of the NHS- this relates to treatment and care services. Have you read it? Are you using it to improve patient experience and outcomes?