Kidney the Heart of a New CVD Strategy

Living well for longer needs good kidney function. Many will have seen the press coverage of the Lancet article on “UKhealth performance: findings of the global burden of disease study 2010” earlier in the week. It concluded that although life expectancy in the UK has increased by 4.2 years, in the twenty years from 1990-2010 the UK’s position in the league table of other developed countries remains poor and is significantly below the average in Europe, North America and Australia. It calls for an integrated and strategic response to improve public health, prevention, early intervention and treatment.

The same morning the Lancet article appeared, the Secretary of State for health launched a call to action to reduce avoidable premature mortality. Stopping smoking is probably the most important thing a healthcare professional can advise and help with, and certainly outweighs anything else an individual smoker can do for their health. Smoking takes 16 years off life expectancy, causes kidney disease and accelerates the loss of kidney function. Smokers are less likely to be suitable for transplantation.

The call to action illustrates the problem- for instance the all cause mortality for women in England is placed 15th out of 17 European countries. Last year, 37,000 people died of circulatory diseases - that includes kidney disease. Those living in the most deprived areas are more than two times more likely to die prematurely when compared to the least deprived 20% of our nation. Kidney disease has an earlier onset, is more severe and has worse outcomes in deprived populations. What can we do? Answer: Everything we can- more prevention, earlier diagnosis, better treatment, more choice, improved dignity and care. England would have 29,000 fewer deaths per year if it had the same mortality rates as Switzerland.

The “reforms” of the Health and Social Care Act will be in place by 1^st April this year. Not only is that April fools day, it is also Easter Monday. Despite that the  various bits of the health  jigsaw -  in the NHS Commissioning Board, Public Health England, Local Government and the Local NHS need to fit together and unite behind the goal of reducing avoidable premature morbidity and mortality.

Okay, what does that mean? Well, look at the Cardiovascular Disease Outcome Strategy, it has identified 10 actions covering:

• Manage CVD as a single family of diseases
• Improve prevention and risk management
• Improving and enhancing case finding in primary care
• Better identification of very high risk families /  individuals
• Better early management in secondary intervention in the community 
• Improve acute care- this includes avoiding acute kidney injury
• Improve care for patients living with CVD
• Improve end of life care for patients
• Improve intelligence, monitoring and  research and support commissioning

Health care professionals, commissioners, carers and families, patients, health and well-being boards and the public all have a part to play in this strategy that recognises the importance of kidney disease, as both the vascular disease and a vascular risk factor or amplifier.

During the development of the strategy what I regularly heard was:

 “Treat me as a person and not a single condition”

 “Get the various bits of the NHS that look after me to pool their expertise and share information about my care”

“Don’t miss opportunities to improve my treatment and care, because you’re only interested in the heart…diabetes… or the kidney”

“Prevention is definitely better than living with a long-term condition that can’t be cured”

“Look after me safely when I am sick- protect my kidneys”

“We live in the 21^st Century – use information to drive better understanding and improvement”

Jeremy Hunt cannot make these things happen. David Nicholson cannot make these things happen. The kidney community- that is you can play its part to make all these things happen. The only place quality is actually delivered in the NHS is in the interactions between patients and health care staff  face to face, by telephone, by renal patient view  and other means at all of our disposal