Seasons greetings. It’s been a busy year for kidney care again. Many people have been working hard and progress has been made on many fronts, some of which I have recorded here in my blog. National and international news has been dominated by the global financial crisis and we are all aware of the impending crunch on public service spending from 2011. The focus remains on quality but the challenge is to provide quality with productivity.
Achieving excellence in kidney care: delivering the National Service Framework for Renal Services positions kidney care in the new environment laid out in NHS 2010-2015 from good to great. Preventative, people centred, productive. It cites examples of innovative ideas and excellent practice in various places across the country in most aspects of kidney care. It also highlights the variation in practice that identifies crucially important elements of care where local service improvements can drive better quality and experience for our patients. Change happens locally. Fundamental service improvements are led by local teams working in an empowering environment. They need to be given the responsibility to achieve, permission to take risks, as part of a learning organisation. National policies and guidelines set the framework, but it is through the grass roots understanding of quality and productivity that development of innovative approaches, which lead to lasting improvements, happen. At the centre of this are patients and the high quality relationships built between them and empathetic motivated and skilled practitioners.
We need to accelerate implementation of what we know works such as earlier and better blood pressure control, implementation of the NICE Guidance on chronic kidney disease and anaemia management, and timely preparation for replacement therapy or conservative care. We need to be bold, to innovate and challenge the norm so that we can achieve improvements. This requires co-ordination, partnership and leadership by commissioners and providers, and by clinical, social care professionals and managers in and between primary and specialist care.
We know there is still considerable variation in access to care, there are missed opportunities for prevention, unnecessary delays in treatment and often a failure to provide the conditions for shared decision making. The National Kidney Care Audit on patient transport for haemodialysis, the National Confidential Enquiry into Patient Outcome and Death report on Acute Kidney Injury and the difficulties people on haemodialysis experience in dialysing away from their base unit are 3 areas where we must make real improvement at scale and pace.
The National Renal Dataset is a big step in the right direction and the development of quality metrics will enable best practice to be incentivsed. Improved coding, measurement, analysis and reporting of patient experiences, clinical effectiveness, costs, safety and outcomes are also necessary to achieve the prize - moving our services from being good in parts to being great everywhere. This will not be easy. Enjoy the break over the festive season. I would like to thank the kidney community for their enthusiasm, passion and dedication to improving care across the entire kidney care pathway. I look forward to working with you in 2010 which is shaping up to be a key year for kidney care.