tag:blogger.com,1999:blog-47197591587362199812012-02-02T15:34:35.061ZWorking for Better Kidney CareDr Donal O'Donoghuenoreply@blogger.comBlogger4131100tag:blogger.com,1999:blog-4719759158736219981.post-90909787319375863162012-02-02T15:17:00.001Z2012-02-02T15:34:35.067Z

Reducing unnecessary face to face contacts by using by using what we persist in calling the new technology (I wonder if people will be using the same phrase in 500 years time?)  is one of the opportunities we have in our health system .  We all bank online, text and coordinate our arrangements over the internet .  Most people Skype and many ichat  on a daily basis; and yet hospital appointments

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-25962286314923245732012-01-31T14:31:00.001Z2012-01-31T14:33:41.822Z

"It might well be that the difference people make individually is a mere ripple on the surface of our care system, but each of those ripples added together create a wave, a social movement, and if this makes life better for some - then it has to be worthwhile."Sir Michael Parkinson, Dignity ChampionDignified and humane care is every patient’s right. Without it patients suffer in terms of their

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-12981101100290969082012-01-19T14:37:00.006Z2012-01-19T14:42:33.631Z

One of the pleasures on a cold winter’s night in January is to either scramble around to get the final data and analysis to write an abstract or sit back with a stack of them to mark for one of the forth-coming annual national meetings. It has been my pleasure to do the latter for a number of years, and this year I was invited to mark some of the British Renal Society Service Delivery Quality and

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-68432471978662528602012-01-18T13:03:00.005Z2012-01-18T13:19:13.568Z

The Futures Forum was set up to advice on the development of the health service so that patients will be at the centre of every decision, and quality will be the organising principle for the NHS published its second phase report last week. Steve Field and colleagues are leading the review and have been up and down the country meeting thousands of members of the public, patients and service users,

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-23086304641742740692012-01-04T11:08:00.009Z2012-01-04T15:45:51.472Z

Unbeknownst to me whilst I was extolling the virtues of looking for variation to identify where improvements might be likely to succeed, in another part of the blog-o-sphere Professor Alan Maynard was penning his commentary on the same topic for Health Policy Insight . Tess Harris chair of the PKD sent it through to me – Thanks Tess. Suffice to say that he has a different opinion from me.

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-77241867414879198262012-01-03T12:38:00.005Z2012-01-03T12:51:11.543Z

You would have to be living in deepest outer space not to have noticed that the NHS is changing. Indeed Sir David Nicholson, Chief Executive of the NHS has famously gone on record to say that the changes are so big they can be seen from the surface of Mars! So what will this mean for kidney care and what will it mean for kidney patients and there families?Health care professionals will see the

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-49365479209333462052012-01-03T11:55:00.012Z2012-01-03T12:23:34.824Z

J. Allison Glover, a medical officer in the pre-World War II Department of Health is credited with identifying unwarranted variation by discovering that a child’s chances of undergoing tonsillectomy depending on which school they were attending. Glover examined the effects of overcrowding, poverty, bad housing and climate but concluded that the major source of variation was differences in the

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-63976085187785153362011-12-22T10:43:00.013Z2011-12-22T13:43:04.989Z

Why aren’t people with kidney disease told about their condition? I would have thought it was a basic right but there is a lot of evidence that there is systematic secrecy on the issue of kidney disease across the NHS. Personally, I would be pretty annoyed if I found out I was on a chronic disease register and hadn’t been told. That wouldn’t feel much like a patient-centred service with quality

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-85512802457637575592011-12-15T13:05:00.000Z2011-12-15T12:14:14.827Z

Sir David Nicholson in his foreword to the Operating Framework for the NHS in England 2012-13 draws attention to the need to get the basics right every time. The cause of short-comings in dignity and basic care are complex and deep routed, often as much to do with culture and behaviour as with resourcing and prioritisation.The Operating Framework, work of kidney and other charities, the General

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-24825388238909232382011-12-15T12:07:00.003Z2011-12-15T12:28:44.284Z

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

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-91095340507840619542011-12-13T12:51:00.005Z2011-12-13T13:53:07.459Z

The actions individuals and carers take for themselves, their children, their families and others to stay fit and maintain good physical and mental health: meet social and psychological needs; prevent illness or accidents; care for minor ailments and long-term conditions; and maintain health and well being after an acute illness or discharge from hospital.The above definition is from the

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-81107426810288509122011-12-07T08:53:00.004Z2011-12-07T11:30:33.814Z

“I don’t pretend we have all the answers. But the questions are certainly worth thinking about”Arthur C ClarkeWho asks the questions in the interviews you go to? The doctor, the nurse or the patient? The power of ask 3 questionsWhat are my options?What are the possible benefits and risks?How can we make a decision together that is right for me?was brought home to me recently at a visit to

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-45718394578685644262011-12-06T14:39:00.016Z2011-12-13T13:37:51.845Z

I recall the smiles and merriment around the room when Mr Neil Parrott (Consultant Transplant Surgeon, Central Manchester) was incorrectly down as a representative of the British Transport not Transplant Society at one of our BRS workforce meetings in 2002. Hoots of laughter – but no-one asked the question “well who is representing transport?”. The difficulty of identifying someone to own the

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-80808534565510532922011-12-01T09:47:00.006Z2011-12-01T15:22:19.213Z

There are lots of documents out this week including the Department of Health’s Operating Framework for 2012-13, the interim report of the Futures Forum and the first publication of the NHS Commissioning Board – the Commissioning Operating Framework – engagement document.They are all key bits of the jig-saw and if you have a look through them you will start to get a clearer idea of where our

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-49512213579742985732011-11-30T14:47:00.002Z2011-11-30T14:53:20.694Z

Planning for end of life care patient decision aid, developed by Isabel Hospice and the Addenbrookes Hospital kidney care team has been launched by NHS Direct.The English is very clear; it covers care planning, building on “my kidney care plan”, produced by NHS Kidney Care, benefits of talking and starting advanced care planning to help individuals achieve most in their remaining life and to plan

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-6802749147824499042011-11-30T14:04:00.002Z2011-11-30T14:08:09.409Z

The demands of treatment, metabolic consequences of kidney disease and psychosocial impact of major organ failure present a range of obstacles and often immediate problems or even crises that can make focussing on the long term goals of kidney care difficult for healthcare professionals, patients and carers. Yet the goal of care must always be to achieve the best possible state of physical,

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-3615253414650848422011-11-24T10:57:00.003Z2011-11-24T11:02:37.699Z

… it’s getting better all the time (the Beatles 1967). The lyric popped into my head reading the most recent Commonwealth Fund report – the 2011 International Health Policy Survey of Sicker Adults in Eleven Countries. Although Paul McCartney wrote this song walking his dog and watching the sunrise, I think I may have had the lyric in my mind because I recently watched Martin Scorsese’s biopic “

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-70788460207945598282011-11-15T11:15:00.008Z2011-11-16T16:10:32.149Z

Donate Kidneys for Life Receive is the strap line for World Kidney Day 2012 and campaign material for 8 March 2012 is now available. There’s lots to choose from including fact sheets, web banners, stories and t-shirts.March may seem a long time off but if you are going to get a screensaver on your hospital or company’s system for the day, or better still the week, or if you want to plan a local

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-43955917183685300522011-11-03T13:10:00.004Z2011-11-22T11:16:47.591Z

The World Heath Organisation cites the leading cause of global mortality as high blood pressure (13% of total deaths), tobacco use (9%), high blood glucose (6%), physical inactivity (6%) and obesity (5%). Physically inactivity is 4th on the list but it influences most of the other causes. The importance of physical activity in preventing and treating many diseases and conditions is indisputable,

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-49154701052689777792011-11-02T17:02:00.007Z2011-11-03T09:30:14.330Z

Health Secretary Andrew Lansley announced last week that chronic kidney disease (CKD) in primary care would be one of the new 11 topics for national clinical audit as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The CKD audit proposal was led by Hugh Gallagher, Consultant kidney doctor at St Helier hospital on behalf of NHS Kidney Care and the professional

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-75471611606952899652011-11-02T15:44:00.001Z2011-11-02T15:46:11.041Z

If you are thinking of donating a kidney there’s a great new charity and website just launched to support altruistic kidney donation. The history, rationale, risks, statistics and reports are all available but most powerful are the stories: “pity I can’t do it again”; “my heart told me to do it”; “the risks are less than those of mountaineering or micro-light flying”.

Dr Donal O'Donoghuenoreply@blogger.com2tag:blogger.com,1999:blog-4719759158736219981.post-70429967299567860792011-11-01T08:35:00.021Z2011-11-01T13:44:21.460Z

Patient empowerment can be thought of as patients being an active and self determining part of their healthcare, rather than passive recipients of services. The key question is: how to health systems efficiently embed this much admired concept into real everyday practice?A new report from the George Institute for Global Health “Realising the potential of patient empowerment for tackling chronic

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-78570972980112767352011-10-28T11:57:00.002+01:002011-10-28T12:02:54.929+01:00

Congratulations to the Centre for Sustainable Healthcare (CHS) who secured funding at the recent Pitch Pledge Party Event for the promotion of retrofitting heat exchangers to kidney dialysis machines throughout the UK.Pitch Pledge Party is a new initiative by 10:10, The Funding Network and The Guardian to match carbon cutting projects with funders. CSH's project was one of three to secure

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-53317188931629978202011-10-24T16:10:00.002+01:002011-10-24T16:16:07.448+01:00

The census date for the Dialysis Capacity Survey is fast approaching. The survey now, in it's 3rd year, will be conducted on the 31st of October 2011.Nationally we seem to be moving from the inexorable year on year l growth phase towards steady state. For the past 4 years, the acceptance rate onto our renal replacement therapy programmes has been stable at 109 per million of the population. No

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-76288138856276829622011-10-20T16:00:00.013+01:002011-10-20T16:34:09.502+01:00

The autumn issue of the PKD Newsletter leads with results of a survey asking people specifically about the information they are given when they are diagnosed with PKD and what information they would have liked to receive.Below is a summary of the key findings:366 surveys were completed315 by people with PKD51 by carers / relatives66% of respondents were femalenearly 70% were either given ‘no

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-61724462194808277072011-10-18T16:21:00.001+01:002011-10-18T16:28:13.188+01:00

Kidney care clinical networks emerged around the turn of the century to facilitate integrated care across the kidney patient pathway, spanning the range of different healthcare sectors. The presence of networks in the NHS, indeed in renal medicine and in particular transplantation, was not new as healthcare professionals have always worked together; but in the managed clinical networks that

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-32449279146210311932011-10-13T16:06:00.002+01:002011-10-14T15:35:24.480+01:00

How do we integrate care between the... ologies, between primary and secondary care, between expert patients and healthcare practitioners and between health and social care is the big question of our times. Lots of big brains are working on it and not a week passes without a report or commission providing principles and recommendations. Examples directly relevant to UK practice have been thinner

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-8707877871974962092011-10-11T13:45:00.003+01:002011-10-11T13:59:27.237+01:00

The important role of exercise in the health and wellbeing of people with long-term conditions is often overlooked or relegated to a few encouraging nonspecific remarks at the end of a consultation. The publication of two systematic reviews and meta analyses of exercise training provides a useful prompt and reminder to both clinicians and patients about the value of exercise as part of patient

Dr Donal O'Donoghuenoreply@blogger.com2tag:blogger.com,1999:blog-4719759158736219981.post-14278891026443108822011-10-06T13:22:00.002+01:002011-10-06T13:54:33.914+01:00

“No decision about me without me” has put the patient firmly the centre of the many hundreds of millions of individual clinical encounters in the NHS each year and patient experience is now one of the 5 domains of the Outcomes Framework. Up there with amenable mortality, long-term conditions, rehabilitation/recovery and safety; patient experience is set to become a cornerstone of quality of care.

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-11834475120513088062011-10-06T09:29:00.003+01:002011-10-06T09:47:46.595+01:00

The Green Nephrology project to retro-fit heat exchanges to kidney dialysis machines is one of 3 projects shortlisted for the final of the Pitch Pledge Party. The Centre for Sustainable Healthcare will be presenting the project at the event taking place at The Guardian Newspaper offices in London next Monday (10 October) and needs your support – go to the website to check out the three finalists

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-91266352828182519582011-08-04T10:30:00.003+01:002011-08-04T10:40:09.015+01:00

Many people in the kidney community were disappointed when the NICE Chronic Kidney Disease Quality Standards were published and the standard on conservative kidney care that had been trialled was nowhere to be found. Some of us even had to change our slides!Well, as the Old Testament parable goes, there is nothing better than finding something that has previously been lost. The NICE Quality

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-51097667666620327692011-08-03T16:16:00.004+01:002011-08-22T10:20:08.897+01:00

….. modifiable factor that can improve experience and outcomes. The National Kidney Care Audit Vascular Access Report 2011 was published today. This vascular access audit has not been easy to conduct. We had policy drivers and widely endorsed clinical audit measures developed by the Renal Association and Vascular Society of Great Britain and Ireland but, the way local systems are configured, how

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-30075109138158639002011-08-03T16:07:00.001+01:002011-08-03T16:09:28.284+01:00

“Sometimes there will be choices to make about your healthcare. If you are asked to make a choice, make sure you get the answers to these 3 questions:What are my options?What are the benefits and possible risks?How likely are these risks and benefits?”These are the 3 questions that the MAGIC projects are promoting. MAGIC stands for “making good decisions in collaboration” and is a Health

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-33117957599433675222011-07-28T11:23:00.000+01:002011-08-01T11:26:10.645+01:00

I have previously recounted the analogy Guy Hill once used to compare the stress and strains of transport to and from dialysis, 6 journeys a week(!), with the anxiety many of us feel on the way to the airport for holiday when we are rushed or late! For hospital or satellite based haemodialysis patients the arrangements and quality of transport are part of the experience of care; in many instances

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-31621206109329744162011-07-26T07:43:00.000+01:002011-07-26T07:44:32.391+01:00

Increasing value for money in healthcare by improving quality, particularly the quality of patient outcomes, while reducing costs is a challenge facing health systems across the globe. The NHS has the “Nicholson challenge” said to be visible from space - to save £20 billion over the next 4 years at a time when demand on services continues to increase at around 7% per year. Shortly after the scale

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-87450873325038062822011-07-20T11:36:00.010+01:002011-07-25T13:10:04.154+01:00

Q: Dear Donal, I thoroughly enjoyed reading your article "Paying for value, not volume" in the recent BJRM but I'd be grateful for clarification on what constitutes a multi-professional clinic. I suspect after reading your article that we have similar views on what a multi-professional clinic should be: it would included seeing the renal physician, dietician, access nurse, transplant coordinator,

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-19585179462376844592011-07-07T15:20:00.004+01:002011-07-07T16:13:28.603+01:00

The interim report on the evaluation of the web and telephone delivered patient decision support interventions introduced over the last year makes some interesting reading. Glynn Elwyn, a leading expert on shared decision making and colleagues from Cardiff looked at the uptake and initial responses to patient decision aids in 3 areas: osteoarthritis of the knee, localised prostate cancer and

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-17124930693007667342011-07-07T09:52:00.002+01:002011-07-07T10:07:56.090+01:00

There is a growing consensus based on a substantial evidence base that the more involved people are in their own health and own care can profoundly affect how people view themselves and their outcomes. Patients need more than just information, they also need support to become more informed decision makers and managers of their own health.Activation refers to peoples’ ability and willingness to

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-43693415585205960382011-07-05T14:53:00.002+01:002011-07-05T15:51:31.247+01:00

“We should be celebrating the fact that we are living longer and that young people with disabilities are leading more independent lives than ever before” said Andrew Dilnot launching the report Fairer Care Funding yesterday. On the eve of the 63rd anniversary of the creation of the NHS, Dilnot went on to point out that the issue of funding for adult social care had been ignored for too long by

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-81481634992616756142011-06-28T10:48:00.000+01:002011-06-28T10:49:52.413+01:00

Annual surveys of the public’s attitudes to mental illness in England have been running for nearly 20 years and the most recent report makes interesting reading. Compared to 1994 the number of people agreeing that “mental illness is an illness like any other” has increased from 71% to 77%. The percentage saying they would be comfortable talking to a friend or family member about their mental

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-84528867422994484292011-06-08T08:30:00.010+01:002011-07-05T08:21:10.922+01:00

Travel - with its inherent uncertainties and seemingly inevitable delays – can be frustrating, tiring and unsettling for anyone, however healthy they may be. One need only look at the expressions and body language in a queue for a bus, train or plane to know that. A bad journey can have a big impact on the experience of the event for which the transport was needed. In contrast, when travel is

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-8508956686518617922011-06-07T14:10:00.003+01:002011-06-07T14:17:11.428+01:00

The Department of Health has announced the first 3 recipients of its Innovation Challenge Prize which recognises ideas developed by frontline staff to deliver solutions to the problems facing their patients. Among the 3 is Manchester Royal Infirmary, awarded the maximum prize of £100,000 after developing an innovative approach to redesigning existing dialysis provisions in hospital. The money

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-85952834309203657352011-06-07T12:08:00.001+01:002011-06-09T12:16:56.673+01:00

Modern healthcare is complex. Kidney care is no different . The field is huge, multi-faceted, and the already immense body of clinical and policy literature grows at a frightening rate. There is evidence that better treatment of common comorbid conditions improve health outcomes such as decreasing cardiovascular events and mortality in patients with chronic kidney disease and in end stage renal

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-6125622048811121142011-06-06T12:03:00.001+01:002011-06-09T12:18:22.598+01:00

Yes, but what we mean by care and how we deliver that care is set to change. We, the kidney community have the knowledge and ability to ensure those changes will improve the experience and outcomes for people with kidney disease. But we also have the responsibility to use that knowledge, evidence and know how to drive quality improvement across the whole pathway of care, across our training,

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-28252637296721653512011-05-31T16:24:00.010+01:002011-08-01T16:16:35.119+01:00

Q: Dear Donal, for some time there has been difficulty with funding of Dialysis Away From Base (DAFB) for patients from renal units within the NE, to the point where a certain degree of rationing of funding for DAFB takes place. With the constraints faced by renal units throughout the country due to the current financial climate, and with the imminent arrival of payment by results (PbR) for

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-91847580715432551372011-05-17T13:52:00.001+01:002011-05-18T14:55:00.720+01:00

Dr Sandip Mitra and the team at Manchester Royal Infirmary scooped this year’s NICE shared learning award for their work in transforming home haemodialysis services in Manchester. Many of you reading this blog will know that the Manchester home haemodialysis team have developed an innovative approach to engaging with people who have chronic kidney disease and have a novel approach to dialysis

Dr Donal O'Donoghuenoreply@blogger.com1tag:blogger.com,1999:blog-4719759158736219981.post-31866573399718581342011-05-16T15:38:00.001+01:002011-05-19T15:12:57.839+01:00

The knowledge that clinical systems can cause harm is not new, but the size of this problem has not previously been established systematically. This Health Foundation report therefore provides groundbreaking evidence of the extent to which important clinical systems and processes fail and the potential these failings have to harm patients. “Rather than being the instigators of an accident,

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-90693206963721256092011-05-11T11:16:00.001+01:002011-05-11T11:33:04.184+01:00

To support the implementation of the NICE Quality Standards for chronic kidney disease a “nice” pathway approach to the implementation guidance and quality standards has been produced.It is just a simple way to access the standards and the key recommendations of NICE Clinical Guideline 73 on chronic kidney disease as well as providing links for patients and the public to information about CKD,

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-26538868703758156692011-04-21T07:51:00.000+01:002011-04-21T07:52:58.568+01:00

Nearly 2 in 3 kidney patients commence haemodialysis using a venous catheter, failing to meet Renal Association and Vascular Society guidelines.The second National Vascular Access Report was published on 30 March 2011. We have been awaiting the results for some time but there certainly shouldn’t be any complacency about the findings! It makes uneasy reading.Quality means different things to

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-11656457407738295492011-04-20T07:51:00.000+01:002011-04-20T07:53:38.836+01:00

Like many in the kidney community, and indeed the other clinical communities that have developed managed clinical networks over the last decade or so, I was pleased to read Sir David Nicholson’s, Chief Executive of the NHS and Chief Executive designate of the NHS Commissioning Board, latest letter on managing the transition in which he endorses the role of clinical networks in driving up quality

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-16683287701681270102011-04-07T10:09:00.005+01:002011-04-07T10:32:42.445+01:00

Well that might be an aspiration – to get so good at early identification and management of kidney disease that people didn’t need dialysis any more. We are a long way off that but if we do achieve the goals of the organ donor task force and the current levelling off in the number of new patients requiring dialysis, seen over the last few years continues, we might not need to keep expanding the

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-40187079373174269152011-04-05T14:57:00.007+01:002011-06-30T11:08:37.226+01:00

Q: I am worried about the possible closure of selected UK transplant centres so that we have only a limited number of specialised centres, and the impact this will have on travelling times for living donors and all recipients. Do you think that this may end up having a negative effect on transplantation in general? My Transplant centre is Newcastle, which covers an area from the west coast of

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-76825571917558676262011-03-17T08:32:00.001Z2011-03-17T08:52:45.564Z

Demand for renal replacement therapy represents a significant healthcare burden consuming between 1.5-2% of the National Health Service budget in England. Programme budgeting data available from the Department of Health continues to show large year-on-year increases in spending on kidney disease (category 17b). Our strategies to address the growing number of people with chronic kidney disease

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-18253341905900646022011-03-16T08:24:00.001Z2011-03-16T08:26:01.834Z

Q: Dear Donal, we, along with all other Trusts, have been trying to make sense and work out the implications of the new Operating Framework. With regard to the matter of penalties for 30 day re-admissions I am told that patients on regular outpatient haemodialysis, who are admitted 3x per week for their routine treatment, will NOT be excluded from this measure … meaning that, as I understand it,

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-24531299479474748962011-03-10T14:49:00.007Z2011-03-14T09:20:02.358Z

To mark World Kidney Day the National Institute for Health and Clinical Excellence (NICE) have published the chronic kidney disease (CKD) standards to which the NHS will be held to account. The Information Centre has also uploaded the results showing how different services are performing against the indicators of quality improvement. The quality standards cover the whole of the CKD pathway from

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-82744525632695764052011-03-08T08:09:00.002Z2011-03-08T08:13:47.592Z

.... in 7 hours. A long time to print a picture of a kidney but what Anthony Atala is describing on TED is "printing" a solid 3 dimensional kidney made up of human cells!It's a fascinating concept and a fitting presentation for World Kidney Day.

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-19806514774153642762011-03-01T15:13:00.004Z2011-03-07T19:33:44.617Z

Q: Dear Donal, connecting for health are telling our coders that the term CKD is not acceptable. To quote:“I am afraid we have a problem with our Local Policy with you and your team around the stages of CKD, when it is stated on the discharge summary/case notes CKD 1 – 5.Connecting for Health have informed us that we are unable to assign Chronic Kidney Failure codes to this abbreviation as it is

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-27541737333517994162011-02-28T15:04:00.004Z2011-03-07T19:35:19.248Z

Barnsley renal unit have been running a Personal Health Budget (PHB) pilot for renal patient transport over the past year. The Barnsley team encountered quite a few barriers to establishing this pilot including having to separate out the financial element of the renal transport contract from the block contract which NHS Barnsley holds with the Yorkshire Ambulance Service.The following typical day

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-78261746614724158682011-02-17T09:50:00.001Z2011-03-07T19:35:41.450Z

NHS Evidence have rated the move to giving intravenous iron in patients’ homes and community hospitals to be highly effective and efficient at improving quality for patients and savings for the NHS.The Royal Cornwall team led by Rob Parry and colleagues have provided the case study that demonstrates the potential for cost savings of approximately £14.5M across the NHS in England.

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-37695649521427070912011-02-10T14:12:00.002Z2011-03-07T19:36:01.301Z

Outcomes for people with advanced chronic kidney disease are dependent on meaningful engagement with patients, carers and families and high quality preparation for the chosen modality of renal replacement therapy or conservative kidney care. That needs a committed, skilled and adequately resourced multi-professional team working with “activated” patients.To support kidney care multi-professional

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-72923675490436510312011-02-08T16:24:00.008Z2011-03-07T19:36:32.125Z

The Health Service Journal has picked up on the large increase in kidney care spending identified in the recently published programme budgeting:“Latest figures revealing the spiralling cost of treating kidney disease highlight trusts’ failure to tackle the growing problem of acute kidney injury, HSJ has been told.Data published by the Department of Health this month shows the NHS spent £1.64bn

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-55015559863096300372011-02-03T15:31:00.005Z2011-03-07T19:37:02.591Z

Q: How can we get Individual Care Plans to become universally applied to all chronically ill patients as is laid out in Lord Darzi's report? I ask the question because of concern that the individual care plans developed for renal patients seem to be the only ones produced to date. The consequence is that ICPs may be confined to renal patient care.While I am a renal patient I do have other health

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-43046864620757237432011-02-02T08:37:00.004Z2011-03-07T19:40:13.181Z

60 out of a possible 63 kidney units have returned data to the vascular access audit. Over half had 100% data completeness and overall data completeness was 97.5%.This represents data on 2,353 incident dialysis patients and is a fantastic achievement. It underlines the importance the kidney community places on clinical audit and the central role vascular access has in improving the experience of

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-35660544873830921782011-02-01T17:33:00.003Z2011-03-07T19:40:46.287Z

My good friend Harry Caton chairs the NIGB – oh what’s the NIGB? The NIBG is the National Information Governance Board for Health and Social Care – oh very clear! Well, it’s the body that ensures information about you and I, that is patients, is handled appropriately. It’s recently set out a Care Record Guarantee that aims to support the highest quality of healthcare. We also need information and

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-63304779229659471152011-02-01T14:01:00.007Z2011-03-07T19:41:25.427Z

“The triangle of care: service user, professional and carer” was recently published and provides a guide to best practice in acute mental healthcare. 1.5 million people care for someone with a mental illness in the UK; that’s one in every 40 people or one in 4 of the UK’s 6 million carers.Alan Worthington, one of the authors and a carer with a long experience of engaging with acute services on

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-51313528694424590792011-01-26T15:00:00.002Z2011-03-07T19:37:39.036Z

This short clinical guideline is now out for consultation until 18 February. It makes interesting reading and there are some key recommendations including:The offer to patients, and their families and carers, should include oral and written information about conservative care, pre-emptive transplantation and dialysisThe importance of ensuring patients have been informed and understand that

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-42275155125393730952011-01-19T10:42:00.002Z2011-03-07T19:38:09.328Z

The Department of Health has recently issued further guidance on mixed sex accommodation. National Health Services organisations are expected to eliminate mixed sex accommodation, except when it is in the overall best interests of the patients or reflects their personal choice. The Operating Framework for the NHS 2011-12 confirms requirements for reporting and sanctioning breaches of national

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-23779411134488961302011-01-18T17:57:00.002Z2011-03-07T19:39:00.888Z

Quality accounts were introduced into the NHS by the Health Act 2009. They are a new form of annual report to the public about the quality of services. They were introduced with the dual aim of increasing NHS accountability about the quality of services offered and to encourage Boards and senior managers to focus on quality improvement and state where they intended to make improvements. They

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-65072574681494173862011-01-18T16:13:00.004Z2011-03-07T19:39:33.995Z

Q: Dear Donal, I speak as someone who would welcome a financial "grenade" to try to prove to our local surgeons and management that dialysis access is worth investing in. Nevertheless even as grenades go I feel that what is proposed and the way it is to be implemented will lead to serious unintended consequences.In a unit such as ours where approximately 40 % of patients are on peritoneal

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-53837592396750858522011-01-06T16:35:00.004Z2011-03-07T19:38:32.294Z

Once I got over the fact that the snow had returned, my drive to the hospital on the first day back proved quite interesting and somewhat amusing. Like others, I guess, I was thinking about not only the day and week ahead but also what 2011 will bring.The radio told me not to look directly at the sun! I was driving into Manchester (and it was a pretty grey day on 4 January) rather than home from

Dr Donal O'Donoghuenoreply@blogger.com0tag:blogger.com,1999:blog-4719759158736219981.post-48201263407877023412010-12-23T08:46:00.002Z2010-12-23T08:58:06.944Z

This is a complex work in progress with different parts of the health and social care system moving at different rates. Shadow arrangements are being put in place in anticipation of Parliamentary approval of the Health and Social Care Bill that will be introduced next session. Pathfinders have been announced, consortia are forming, clustering arrangements are emerging and commissioning support

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-58475465136893933352010-12-20T17:41:00.005Z2010-12-21T07:59:08.068Z

The NHS Outcomes Framework was published today (20 December 2010) and follows the format consulted on in July. Its aims are:To provide a national level overview of how well the NHS is performing wherever possible in an international context; To provide an accountability mechanism between the Secretary of State for Health and the NHS Commissioning Board; To act as a catalyst for driving quality

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-1656518059836335062010-12-20T10:51:00.004Z2010-12-20T10:59:22.736Z

As 2010 draws to a close it is time to reflect on the last year, to say some thank-yous and to begin to set our priorities for 2011.Before doing that it is worth remembering that our National Service Framework is approaching the 10th anniversary of its announcement in February 2001 by Alan Milburn, then Secretary of State for Health. The groundwork had been laid by the kidney community over the

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-91378661554369338182010-12-20T10:50:00.005Z2010-12-20T12:19:45.273Z

Health Survey England, commissioned by NHS Kidney Care, included kidney disease as a special topic for the first time this year. It recognises CKD as a global health problem and the link with stroke and heart attack. On the face of it, the headline figure of 5% of men and 7% of women having stage 3-5 chronic kidney disease (Fig 3C) might not seem that interesting. These levels are what we might

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-70601086368678425072010-12-16T14:18:00.000Z2010-12-16T14:19:01.857Z

The English health reforms present a range of challenges. Currently there is much more focus on improving quality while budgets are reducing and both Primary Care Trusts and Strategic Health Authorities are in transition to general practice lead commissioning. One of the other central planks of the coalition government’s proposals is to extend choice and competition and to reduce reliance on

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-63186391014822827942010-12-01T16:17:00.002Z2010-12-07T10:15:12.556Z

The Commissioning of Quality and Innovation (CQUIN) payment framework established after the “Next Stage Review” conducted by Lord DArzi is supported by the coalition government indeed the current Secretary of State has gone so far as to state that “quality is the only organising principle of the NHS”. CQUINs are one way to achieve that goal. A range of CQUIN exemplar goals that broadly align

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-33803993823050515252010-11-29T14:29:00.013Z2010-12-07T10:04:29.684Z

The NHS Atlas of Variation in healthcare was published last Thursday to co-incide with the NHS Medical Directors’ Conference. It contains a series of maps of variation of activity, expenditure, quality, outcome, value and equity to stimulate the NHS to tackle the causes and drivers of that variation.“If all variation were bad, solutions would be easy. The difficulty is in reducing the bad

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-87844820151397312222010-11-17T09:09:00.013Z2010-11-18T09:33:46.519Z

A requirement to quantify proteinuria preferably by a urine albumin creatinine ratio was added to the Chronic Kidney Disease domain of the QoF in April 2009. The first year results are just out and they show that 78% of those on primary care CKD registers have had proteinuria recorded in the last year.This is a remarkable achievement – well done primary care. Given the importance of proteinuria

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-61898700468895793522010-11-16T17:14:00.012Z2010-11-18T10:20:51.452Z

Baxter Health have made available a simple model designed for providers and commissioners to work out the cost implications of changing dialysis mix. The capacity planning tool is available by download for both Blackberry and iPhone.Change in demand for renal replacement therapy is an input so it should work well with national modelling tools which don’t currently model costs at the same level of

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-65525505524492802942010-11-16T15:26:00.001Z2011-05-03T13:20:44.703+01:00

Good kidney care has always been based on teamwork. The complexity of renal failure, the wide range of treatment options – from an ABO incompatible live donor transplant or daily dialysis to conservative care requires detailed knowledge, precision and technical skills. The impact on physiology, diet, psychological wellbeing and social functioning brings added dimensions to kidney care. Achieving

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-30869183592326065932010-11-11T08:49:00.002Z2010-11-11T09:16:14.321Z

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report on “Elective & Emergency Surgery in the Elderly: An Age Old Problem (2010)” was published this morning and widely reported in the media.It asks the question “how good is care in the elderly who undergo surgery?”; only a third of the over 80s receive good care!!Frailty, poor nutrition and memory impairment are

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-58042186995529257382010-11-02T17:24:00.000Z2010-11-04T09:59:23.258Z

Q: Our son is a 30 year living and working away from home. He had a diseased kidney removed 20 years ago. At that time we were told that his remaining kidney was fine and that it was working at 75% capacity.He recently dropped a bombshell on us by telling us that this kidney was now functioning at only 28% and that he has been suffering with recurring bouts of gout in his big toes for which his

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-3086424013165042312010-11-01T17:33:00.000Z2010-11-04T09:58:45.299Z

Q: I am a fifty year old man of Indian origin and have been on dialysis at the local hospital for 5 years. I am doing well but would like to have more control over my lifestyle. I am on the transplant list. My close family members have offered their kidney to me but none has been suitable because of health reasons related to the potential donors. I have been told that my chances of getting a

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-5164040717563415812010-11-01T17:26:00.001Z2010-12-20T11:50:13.724Z

The new health information strategy was published for comment on 18 October. “An Information Revolution” is a grand title but it’s not rocket science below the lid (the word “cloud” doesn’t appear at all). If we did do all the things in the strategy, and most are simple and really do-able, it would provide the basis for revolutionising care and bringing health systems into the 21st century.There

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-73702654870392804452010-10-27T13:47:00.013+01:002010-10-27T16:22:18.960+01:00

The rate of increase in recorded prevalence of Chronic Kidney Disease (CKD) has fallen below 10 percent in the UK for the first time since the introduction of CKD registers across primary care as part of the Quality and Outcomes Framework, the pay for performance scheme for General Practice, in 2006.Figures released from the Information Centre last week showed that 1,817,871 in England, that’s

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-75440124458978007722010-10-26T17:27:00.007+01:002010-11-04T09:56:36.277Z

Q: As the number of dialysis patients increases year on year with some patients now dialysing for many years, what plans are afoot to tackle the resulting complications both physical and mental.A: Thank you for raising the issue of the health and mental wellbeing of people on dialysis. You are quite right about the numbers of people on dialysis continuing to rise year on year. Most people on

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-85281051049152086832010-10-26T17:19:00.005+01:002010-10-27T10:57:23.507+01:00

Q: Whilst many patients at my unit would not want to Dialyze at home, there are many who would like the freedom that this could give them. Is there any chance of persuading Nephrologists, and those who hold the purse strings to give us this choice ?'A: Thank you for the question. Self Care dialysis offers many advantages for both patients and carers whether that is at home or in hospital. In my

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-22791546290684307342010-10-21T13:35:00.000+01:002010-10-21T13:37:06.125+01:00

Two publications caught my eye this weekend; Keith Richard’s autobiography of The Rolling Stones and “Real Time Patient Feedback” best practice guide from the Practice Management Network. From the serialisation in The Times, the former sounds like a fascinating glimpse into the inner dynamics of one of the most successful rock and roll bands ever, no doubt it will lead to new management books on

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-8832679280062111662010-10-21T11:06:00.001+01:002010-10-25T08:55:19.389+01:00

The Manchester Conference on Home Dialysis goes from strength to strength. The social movement that began at this meeting three years ago is now in full flow. In 2008 there was a feeling that home dialysis’ time had come, last year individuals and teams came to learn how to set up programmes and a show of hands last week revealed what progress has been achieved. Going from none on home

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-33769809453068120682010-10-13T11:00:00.003+01:002010-10-14T07:43:01.921+01:00

60 mils/min/1.73m2Maximum estimated Glomerular filtration rate that is associated with all cause and cardiovascular mortality in the general population The Week in NumbersBritish Medical Journal, 9 October 2010The accompanying lead editorial by Vlado Perkovic and Alan Cass at the George Institute for Global Health starts with the statement – “prevention of stroke, through the identification and

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-86076115883043509802010-10-06T10:21:00.000+01:002010-10-06T10:22:27.024+01:00

There’s not long to go before the second Patient Transport survey takes place in all renal units on 13 and 14 October. All haemodialysis patients will be given a survey to complete when they attend their unit for dialysis on those days. It will ask about their recent experience of travelling to and from dialysis. There are also surveys for every renal unit manager and renal transport

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-32627323860317734632010-10-05T16:35:00.002+01:002010-10-05T16:39:51.903+01:00

The National Institute for Health and Clinical Excellence (NICE) have issued a draft Quality Standard for Chronic Kidney Disease covering the whole CKD care pathway and supported by 14 quality statements. The statements range from early detection of those at risk, specialist assessment, planning for dialysis and transplantation to experience of care including transport for those receiving

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-69094743229999881482010-10-05T12:31:00.002+01:002010-10-05T12:50:12.698+01:00

How can the latter stages of patients’ hospital stay function more effectively to improve patient experience within the ward, encourage confidence on discharge and improve long term outcomes? The Outcomes Framework, the need to improve efficiency – length of stay is a major cost driver, and the move to make hospitals responsible for patients for 31 days after discharge by not paying for

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-70240061749700038612010-09-28T14:05:00.003+01:002010-09-30T07:48:50.181+01:00

The NHS Kidney Care home dialysis roadshows came to an end yesterday in London. They have been great fun – every network and area now seems energised. At each event the patient stories were the most compelling reason to look at how we offer choice and consider how we might extend home therapies to all those who want it and are suitable. Paul Connelly who spoke at the London workshop bemoaned the

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-32504993135691362342010-09-28T09:15:00.006+01:002010-09-28T16:36:08.598+01:00

The National Kidney Care Audit of patient transport for haemodialysis will be collecting data again on 13-14 October 2010. The audit comprises a patient and an organisational survey and is based on the National Service Framework Part 1 that states:“adequate transport is so important to people on haemodialysis that it plays a vital role in the formation of patient views and attitudes towards

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-10558775914154056232010-09-16T12:32:00.001+01:002010-09-16T12:34:06.093+01:00

On my first day as a consultant I was called to the antenatal clinic. Pregnancy in young women with kidney disease wasn’t particularly well covered in training back then and I gained most of my understanding of the issues by experience and asking those who knew more. A nineteenth century approach, so I have been pleased to see greater emphasis on this in training and the growing literature which

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-21107248495321843612010-09-16T12:22:00.001+01:002010-09-16T12:31:11.905+01:00

Identifying savings is the order of the day and it seems to be acquiring its own jargon. I was informed the other day that we need to dis-intermediate. I thought to myself “how do we get traction for dis-intermediation across the architecture of the new provider landscape?”.The first step was to establish a more granular comprehension of the complex closed managed adaptive system that is our

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-22939908348379548132010-09-08T08:24:00.003+01:002010-09-08T08:34:45.960+01:00

Shared decision making is moving centre stage. A Google search a few weeks ago brought up 9,800,000 results and it figures prominently in “Liberating the NHS”, the Con-Lib White Paper on health. During the last few decades decisions about health have been shifting from a paternalistic “doctor knows best” approach to an autonomy based model where the service user or “customer” knows best. The move

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-87053155430327910032010-09-06T17:31:00.003+01:002010-09-06T17:39:43.471+01:00

Unless you have been holidaying on Mars for the past 2 months, you will be aware that Andrew Lansley, the Secretary of State for Health set out his plans for reforming the NHS in the White Paper “Equity and Excellence: liberating the NHS” in the early weeks of July. The White Paper is supported by a series of consultation documents which are now underway.It is clear that the quality and

Dr Donal O'Donoghuenoreply@blogger.comtag:blogger.com,1999:blog-4719759158736219981.post-65994260943455594252010-08-18T16:54:00.024+01:002010-08-19T08:36:58.618+01:00

Art can be a very personal thing. I myself like alsorts of different styles of painting , sculpture and performance art but particularly if there’s some fun involved – be that Holbein’s “The Ambassadors” which can be seen at the National Gallery in London – one could spend a lifetime working out what all the symbols mean – or Kristof’s wrapping of the Reichstag in a large white blanket! So my

Dr Donal O'Donoghuenoreply@blogger.com