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?
