Bedtime reading: Tackling health inequalities: 10 years on

This is a lengthy report but one that is filled with lots of information about indicators and trends relevant to the social determinance of health. Between 1995-1997 and 2005-2007 average life expectancy for all groups in England has increased significantly - for males by an extra 3.1 years and for females by an extra 2.1 years. The report highlights some developments that have worked well but also the challenges that need to be addressed to get further improvements in the health of disadvantages groups and areas, and a long term narrowing of the gap. This will be particularly important in the wake of the more difficult economic conditions, especially through its impact on unemployment, together with environmental challenges like climate change.

Acute Kidney Injury, hyperkalaemia and the safe use of insulin

Acute Kidney Injury (AKI) is gaining visibility. The move to a standard definition and staging system based on the rise in serum creatinine will, I hope, have the same demystifying effect that introducing systematic eGFR reporting has had for chronic kidney disease. One of the complications of AKI is hyperkalaemia or an increase in the serum potassium and my colleague Dr Rowan Hillson (NCD for Diabetes) drew my attention this week to the work of Professor David Cousins from the National Patient Safety Agency work has done on risks to patient safety from insulin therapy. Between 2003 and 2009 a total of 13,180 incidents were reported from the NHS in England and Wales. These included 9 deaths, 863 cases of severe or moderate harm and a number of these cases included the use of insulin in the treatment of hyperkalaemia. In one such case a letter from the prescribing doctor read out in Court said that he believed “one unit of insulin was equivalent to one millilitre”. “I have not received any previous instruction in handling of insulin”. In the National Patient Safety Agency report 3,417 cases involved giving the wrong dose, strength or frequency of insulin.

In Northern Ireland the Clinical Resource Efficiency Support Team (CREST), have produced an excellent guideline for the treatment of hyperkalaemia in adults. One of the clinical pearls in that document was “always consult with a senior doctor responsible for the patient with hyperkalaemia”. Damian Fogarty (Consultant Renal Physician, Belfast) tells me that the Northern Ireland team went further and produced a hyperkalaemia kit that is now present in every adult ward.

We are all awaiting the national confidential enquiry into Patient Outcome and Death report “Adding Insult to Injury” on Acute Kidney Injury; I don’t know what it will say about hyperkalaemia and its treatment but it has looked at the following areas:

· Diagnosis and recognition of AKI
· Recognition of risk factors associated with AKI
· Prevention of AKI
· Assessment of patients recognised as being in AKI
· Management of established AKI
· Recognition and management of complications of AKI
· Organisational factors for the management of AKI patients

The report is to be launched at at the Royal Society of medicine on Thursday 11 June and a place at the event can be booked here

Vascular & kidney disease briefing pack: get your slides here

The vascular branch of the Department of Health includes cardiac, stroke, diabetes and kidney policy teams and also covers the NHS Health Checks Programme that from 1 April this year, is offering a vascular risk assessment for all adults in England aged 40-74.

A briefing pack with over 90 slides for each SHA has been prepared and is now available.

Feel free to download and use the information and slides in local network, primary care trust and commissioning discussions and to develop your own presentations.

Q & A: Haemodialysis nurses and work permits

Q: Dear Donal, a limit to opening HD capacity is getting trained HD nurses. They are a scarce and valuable resource. I gather that the Home Office will not grant them work permits to work as HD nurses even though they are already here working in other roles. This restriction does not apply to theatre nurses. Can you use your influence to get this ruling modified? Dr Chris Winearls, Oxford Kidney Unit

A: Dear Chris, although renal nurses have been taken off the occupation shortage list the NHS employers do provide some further guidance


“Removal of a particular occupation from the list does not mean that a tier 2 application will not be granted for any vacancy that exists. Providing the employer can demonstrate that the post has been advertised and there were no suitable applicants from the resident labour market, an individual from overseas may be selected and appointed providing they meet all the eligibility criteria for tier 2.
The job vacancy must have been advertised to settled workers. If the salary for the job is £40,000 or under, you must advertise it for a minimum of two weeks. If the vacancy is over £40,000, you must advertise it for a minimum of one week”. Donal