Consultant nephrologist at the Heart of England NHS Foundation Trust. From 2000 to 2009 he was Medical Director (Medicine). From 2009 to 2012 he was a Clinical Director in Birmingham East and North Primary Care Trust. He is currently Clinical Lead for the Renal Expert Advisory Group in the West Midlands Strategic Clinical Network and Senate.
prevention is better than cure
Hospital has become the default healthcare destination due to inadequate services and support in the community. Patients in hospital are subjected to expensive and inappropriate investigations and treatments. This sucks resources out of the community, so perpetuating the problem.
Reversing this tide takes time and effort but can be done. I will describe how it has been achieved for people with kidney disease. Although the details will differ in other diseases, the principles apply to all long-term conditions.
Kidney failure usually develops over many years, so there is plenty of time to treat it. The decline in kidney function can be slowed by controlling blood pressure, a diet rich in fruit and vegetables and sometimes by taking sodium bicarbonate tablets, as well as by treatment for specific diseases.
People do not feel ill until they are near to needing dialysis or a transplant. Unless the healthcare system actively seeks out and supports people early, they can miss the chance of avoiding kidney failure. But finding more patients to treat is given a low priority when the system is already overwhelmed.
Such a system has been operating for over ten years in the Heartlands kidney unit, which serves East and North Birmingham and Solihull. During this time the number of people starting long-term treatment for kidney failure each year has declined.
Those patients who do start treatment are more likely to be well known to the kidney unit.
Starting dialysis shortly after being seen at the kidney unit is associated with a worse experience and higher risk of dying.
The treatment is more likely to be delivered in a way that avoids complications.
This leads to a higher survival rate on the treatment.
The number of people having treatment for kidney failure at the Heartlands unit is falling, saving the NHS millions of pounds.
So here are my suggested actions:
1. Create medical leadership roles that have responsibility for improving the care of populations of people with long-term conditions. With responsibility must come authority to challenge the vested interests of different parts of the system.
2. Strengthen links between hospitals and GPs by assigning areas around each hospital to individual consultants. Make this link role part of the consultant’s job plan and give them training in how to do it.
3. Invest in joined up clinical IT systems so that information can be shared by the whole team: in health and social care; in the community and in the hospital; and by the patient.
4. Make data publicly available on the performance over time of the local healthcare system in a way that is relevant and meaningful to people with a long term condition. The charts in this blog are examples of the kinds of data that could be published.
5. Resist every move towards fragmentation and division in the NHS.