Facts and Figures

If you haven't yet arranged for screensavers to celebrate Transplant Week which is from Monday 9th July 2012 - Sunday 15th July 2012, look no further - NHS Blood and Transplant have made some great graphics.

New kidney transplant targets announced

Tony Ward - Transplant recipient, mountaineer, husband, father and great advocate for kidney care carrying the Olympic torch

The UK lags behind many countries in Europe and North America in rates of kidney transplantation despite strong public support, a series of initiatives over the years and an undisputed economic case. The Organ Donation Task Force report published in 2008 set a goal increasing organ donation by 50% by 2013. Importantly, under Chris Rudge’s leadership, it implemented the infrastructure needed to move organ donation from a somewhat haphazard variably event to be regarded as a usual occurrence in hospital as part of a planned and resourced system of care. Much of that work is now complete and the recent .focus has been on driving processes to increase the level of organ donation to reach or exceed the 50% increase target set nearly 5 years ago. Progress has been slower than anyone in the kidney community would have liked, but the foundations are now solid and I was pleased to see more ambitious organ donation figures in the new NHS Blood and Transplant strategic plan 2012-17.

Predicting the future is always difficult! I recall a comment from a good friend some 15 years ago, when the Greater Manchester Renal Project Group estimated future demand and came up with a figure of 978 patients requiring dialysis some 5 years into the future. Not 960, not 980, not nearly a thousand but 978! Colin Short, recently retired consultant renal physician at Manchester Renal Infirmary, said, “You're wrong- I am just not sure by how much!” Colin was of course correct. Ranges are better than precise targets. Even though some will regard a 60% increase in deceased organ donation by 2017 as modest, no one is saying lets get to 4480 transplants and stop!! Let us aim to break the 5000 barrier sooner rather than later.

The NHS Blood and Transplant plan has some detailed objectives to build on the infrastructure now in place. This needs to link with the black and minority ethnic (BME) manifesto to improve organ donation and transplant rates in these communities. The manifesto was launched on March 7th, World Kidney Day, in the House of Commons by the all-party kidney group and consists of 4 strategic challenges and 12 specific action points to help raise awareness, encourage greater donation rates and optimise access to transplantation among BME communities. It is excellent that Kirit Modi the Vice Chairman of the National Kidney Federation is now co-chairing the implementation of this initiative.

Finally (for now), and last but not least, it was great to see Chris Rudge – former Chief Executive of UK Transplant and National Clinical Director for Transplantation, along with Jonathan Hope- previous chair of the Guy’s, St. Thomas and King’s College Hospital, kidney care modernisation initiative recognised in the Queen’s special birthday honours this year.

Variation - the good, the bad and the downright ugly

The NHS Atlas of variation and the interactive online maps demonstrate the postcode lottery of kidney care provided across the country. Some of this will represent strong local ownership and integration of care. The population of Bradford and East Kent are very different – they are highly unlikely to want precisely the same pattern of care. They are both fortunate to have local kidney care teams using IT to integrate and improve services.

Variation based on the needs and priorities of the local people is to be applauded. Unwarranted variation – due to resource constraints, clinical bias in primary and secondary care or failure to integrate service provision across the whole pathway of health and health care - is ‘the bad’. That said the fact other teams can do so much better at timely referral to kidney services, early transplantation and supporting home dialysis options should become the focus for local quality improvement – variation shows what can be achieved! The ‘downright ugly’ is the poor quality coding that makes a mess of the data captured – coding needs to be seen as an integral part of clinical care. We can only improve when we can define and measure what we do in both the individual case and the community we are part of .

Exploring the questions that the Kidney Care Atlas raises should prompt improvements in the local organisation of care delivery. Building on the best examples that currently exist. Promote a shift to establishing shared decision-making systems between patients and healthcare professionals as the norm for preference-sensitive care such as choice of modality of renal replacement therapy or whether to opt for conservative care. In addition, strengthen the science of healthcare delivery to foster innovation and put effective care delivery on a solid scientific foundation.

The Kidney Care Atlas is a landmark in the study of variation in kidney care in England. Data from the UKRR and QOF, as well as other datasets, have been used to illustrate how aspects of healthcare specific to kidney disease vary. The maps highlight only 18 of potentially numerous indicators relating to kidney care. They represent a sample of the variation in value and quality in renal services across England.  Identifying, mapping and attempting to address unwarranted variation should not be regarded as independent pursuits, but instead be perceived as intertwined with the quality improvement agenda for renal services. Have a look, share it, ask questions about your place on the map, discuss the issues with patients and set some local goals.