the renal association report from the clinical affairs board 12 th march 2010
TRANSCRIPT
The Renal Association Report from the Clinical Affairs Board12th march 2010
12th March 2010
Clinical Affairs Board
• Created in 2004• Function:
– to contribute to the development of all aspects of local and national policy relevant to clinical practice in nephrology
– integrate and plan the work of the:• The UK Renal Registry• The Clinical Practice Guidelines Committee and• The Clinical Service Committee
– Influences through the RA but has no power
• Meets three times a year
12th March 2010
Current membership of CAB
• Chair and Clinical Vice President – Kevin Harris from September 2007
• Committee Chairs– Registry: Charlie Tomson– Guidelines: Robert MacTier– Clinical Services: Martin Raftery
• 2 elected members of the ExecutivePhil Kalra demitted 2009
Andrew LewingtonLiz Lightstone started 2009
• National Clinical Director (ex officio)
12th March 2010
Guidelines Committee
• RA guidelines– the 28 lead co-authors are on schedule to complete the 14 modules
of the 5th edition in 2010. – Website based– Investigating hard copy publication for 60th Anniversary
• Invited commentaries on the 3 current KDIGO guidelines– hepatitis C, mineral and bone disorders in CKD and medical
management of the renal transplant recipient
– The CAB will also provide a commentary on the soon to be published KDIGO AKI guideline.
12th March 2010
Guidelines Committee
• Links with other guideline development groups– EPS, atypical HUS, oral bowel cleansing agents in renal patients,
JBS 3 cardiovascular disease guideline group.
– Contrast induced AKI guideline planned with the British Interventional Radiology and British Interventional Cardiology Societies.
• Application to NHS Evidence for accreditation of the RA clinical practice guidelines– submitted on the 22nd February
12th March 2010
UK Renal Registry
The Renal AssociationUK Renal Registry
The Twelfth Annual ReportDecember 2009
12th March 2010
UK Renal Registry
• Registry will alert Clinical or Specialty Directors to findings relating to mortality in their centre that might deserve further investigation
• Request evidence that this finding has been discussed with the Clinical Governance lead and Chief Executive of the Trust in which the centre is based.
12th March 2010
• Home therapies working parties
– PD working party – chaired by Edwina Brown
– HHD working party - chaired by Dr Robert MacTier & Dr Mark MacGregor.
CAB workstreams
12th March 2010
• Swine Flu pandemic
Briefing and guidance for adult renal units in the UK during an influenza pandemic
• Pandemic planning• Dosing adjustments for antivirals
CAB workstreams
12th March 2010
CAB workstreams
• Liaison with NICE– Belatacept for the prevention of organ rejection in renal
transplantation
– Intradialytic exercise for the management of renal failure
– Machine perfusion systems and cold static storage of kidneys from deceased donors
– On-line Haemodiafiltration for Established Renal Failure
– Peritoneal dialysis
– Tap water haemodialysis systems for established renal failure
– Everolimus in PKD
12th March 2010
• Payment by Results for RRT
CAB workstreams
2006/07 and 2007/08 LC02A Haemodialysis/Filtration 19 years and over
0
50
100
150
200
250
1 2 11 7 6 14 3
Projec
t Ave
rage 17 8 9 16 13 15 4 12 10
Un
it C
os
t £
2007
2008
£153 £153
Annual Therapy Cost of £23,868
12th March 2010
Payment by Results for RRT
• NON-MANDATORY TARIFF 2010/11– Tariffs are based on a session of haemodialysis and a day of
peritoneal dialysis
– Aim remains to move to a mandatory “best practice” tariff in 2011/12.
– Best practice tariff will encourage specific aspects of good practice
• haemodialysis via a fistula
• providing access to home haemodialysis wherever clinically appropriate
CAB workstreams
12th March 2010
CAB workstreams
Payment by Results for RRT• Will renal units lose out if their funding is based on the non-mandatory tariff for 2010/11?
12th March 2010
CAB workstreams
AKI
Improving the quality of medical and surgical care
News Release11 June 2009National enquiry calls for better recognition of kidney failure in acutely ill hospital patients A national enquiry has uncovered systematic failings in the clinical care of patients suffering from acute kidney injury (AKI). The report identifies:
Doctors failing to carry out basic care plans Doctors unable to recognise acute illness Organisational deficiencies inhibiting investigation and management
12th March 2010
CAB workstreams
AKI
• RA actively participating in:– Definitions for AKI– Coding– Guidelines for prevention – Guidelines for appropriate referral and transfer– Education– Audit
12th March 2010
Turbulent times (Chris Winearls. CD forum 2007)
• Financial imbalance in many Trusts• Changing Health Authority structures• Target culture• Capital drought• Commissioning uncertainty – who and how?• Unnecessary re-engineering • Manpower and Training - MMC• Healthcare associated infections
12th March 2010
Challenging times ahead
0
10
20
30
40
50
60
70
80
90
19
74
-75
19
78
-79
19
82
-83
19
86
-87
19
90
-91
19
94
-95
19
98
-99
20
02
-03
20
06
-07
20
10
-11
% o
f G
DP
Public Sector Net Debt
12th March 2010
• Improve the quality
• There is no more money– Flat cash
• Reduce the size of secondary care– Buildings– Staff
Challenging times ahead
12th March 2010
Lean Nephrology
RA to play a key leadership role – supported by you!
A date for your diary:
17th September 2010
Robens Suite
Guys Hospital
Suggestions to
1. John Scoble. [email protected]
2. Kevin Harris. [email protected]