SERVICE SPECIFICATION
Common Themes
Table of Contents
Page
1
Populations
2
2
Exclusions
2
3
Support for patients and carers
2
4
Patient and Carer Feedback
3
5
Equity and Consistency
4
6
Outcomes
4
7
Workforce and Clinical Skills
4
8
Pathways
5
9
Primary Care
6
10 National Guidance and Innovations
6
11 Audit & Clinical Governance
6
Appendices
1 Impact Assessment
2 Consultation Record, Document History & Version Control
Rather than repeat elements common to each specification these are placed in
this section. Consequently, each Specification should be read in conjunction with
this document, each one refers to the need to read this one and no specification
is a complete document without this one.
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1
Populations
The services outlined are for patients ordinarily resident in Wales or who are
otherwise the commissioning responsibility of the NHS in Wales (for the
purposes of commissioning health services, this EXCLUDES patients who, whilst
resident in Wales, are registered with a GP Practice in England, but INCLUDES
patients resident in England who are registered with a GP Practice in Wales).
2
Exclusions
Young people under the age of 18 years.
Specialist support will be provided for young adults (age 18-25). This will include
those who are in the process of transferring from paediatrics, those who have
transferred from paediatrics or those who have come straight into adult services at a
young age. Transition will involve a period of joint care from paediatric and adult
services and multi-disciplinary teams (MDTs) should be aware that this group may
have additional developmental needs. Arrangements will vary significantly across
Wales due to variances in the numbers of young patients in each unit and the
variation in where paediatric specialist services are provided.
3
Support for patients and carers
Patient support groups : Patients and carers will be provided with information
about local and national support groups and how to access them, as it is
recognised that these are a vital source of peer support, advice and information
for patients. Signposting information will be displayed within the provider’s
facilities.
Patients and carers will be encouraged to set up local groups which can have
many benefits including peer support and a mechanism through which to
represent patient views at local and national planning and strategy meetings. If
possible, some support in setting up such groups, especially in the early stages,
can be provided by members of the renal multi-disciplinary team.
Supporting Technology: Providers will have an IT system integrated into the
hospital IT system to manage patients with renal disease. This system will be
able to provide information to the UK National Renal Registry, and link with
Renal Patient View (RPV) - a web based system which gives patients direct
access their blood test results and clinic letters. The IT system will provide
information for monitoring the quality of care for commissioners and should be
developed in such a way to facilitate clinical audit beyond simple biochemistry.
All people with ERF or transplants will be offered access to RPV.
Education & Choices: Patients should be supported to make informed choices
regarding treatment options, using shared decision making principles and tools
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and in managing their condition to achieve their goals and the best possible
quality of life.
The provider will offer appropriate information covering advice, treatment and
care to patients, general practitioners and patient groups that is nondiscriminatory and culturally appropriate. This may be printed information,
DVDs or online resource. The information should also be accessible to patients
with additional needs such as physical, sensory or learning disabilities. Providers
should also make patients aware of other sources of information, including
appropriate websites.
The provider will ensure that patients are given as much information about the
range of treatment options available to them as they want, at the appropriate
time, to support their shared decision-making.
The provider will offer all patients, with their families and carers, appropriate
opportunities to learn more about their kidney disease and the treatment
options available to them. More formal education may be offered which might
include members from the multi-professional team who can provide a wider
range of information.
Care Plan and Named Carer: Every patient with end stage renal failure
including those who choose dialysis treatment, maximum conservative
management and those who have been transplanted, will have a named carer or
team, and an individual care plan.
Temporary Dialysis away from base (DAFB): The provider will make
arrangements to facilitate temporary treatment arrangements for dialysis
patients who are travelling (whether for holiday, business or personal reasons)
to the locality of the provider. The provision to accommodate temporary dialysis
away from base shall be according to available capacity, the safety of the
patient, the risk to the base unit and the frequency and financial constraints.
The provider will facilitate arrangements for local patients who wish to, or need
to travel on a temporary basis, to other parts of the UK and those wishing to
travel outside the UK in accordance with national agreements on the
management of dialysis away from base. This will include facilitating delivery of
PD fluids.
4
Patient and Carer Feedback
Patient feedback is vital to assess the quality of care provided as perceived by
patients. There will be regular assessment of this by questionnaire for all endstage renal failure patients.
It should be a matter of demonstrable routine for services to be clearly
responsive to feedback.
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Either through personal involvement of patients and carers or by taking account
of feedback there should be a clear link between service development and the
patient and carer voice and experience.
5
Equity and Consistency
An aim of Welsh renal services is to provide equity of access to all treatments
and services for all patients in Wales and with equally good clinical outcomes.
As the areas of Wales are geographically and epidemiologically disparate, this
may be achieved in different ways in different parts of the country.
6
Outcomes
The service specifications document, or refer to, standards for quality of care
and outcomes.
Services will be safe, high-quality and evidence based, in line with national
policy and guidance.
They will offer services which provide:
 cost effective clinical interventions in an appropriate care setting
 equity of access, including travel times
 a positive patient experience
 optimal clinical outcomes
 adherence to waiting time targets, and, where not achieved, plans to do
so should be provided.
 agreed care pathways and referral criteria
7
Workforce and Clinical Skills
Patients requiring Renal Services have complex medical, emotional and social
needs. Access to a broad range of professionals is essential. The provider shall
have sufficient clinical and support staff to ensure a multi-disciplinary approach
to provision of services in respect of, and at all times in accordance with, good
clinical practice, good healthcare practice, and in line with relevant Renal
Association and NIHCE guidelines.
Services will only be maintained or improved if clinical staff have appropriate
expertise and function well within their MDTs. A development of the
specification documentation may be made to include a description of some, or
all, services which span more than one specification. Dietetics is an example of
this.
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A related piece of work documents the levels of staff in being and this will be
used to confirm whether the level is appropriate, consistent with a good service,
comparable with other providers or supportive of further investment or any
disinvestment.
Some Service Specifications offer detail e.g. Nursing for Unit and Home
Haemodialysis, but for other specialist staff a more general approach is
required.
For Renal Specialist Dietitians and dietetic assistants the Renal Nutrition Group
has reviewed requirements and provided recommendations for contact time for
new and review patients depending on their modality and inpatient status.
Psychology and counselling input should be provided on a case-by-case basis on
referral from the MDT
Arrangements for specialist Medical and other cover for emergencies should be
a matter of record which can be referred to at any time.
8
Pathways
Providers will work with clinical and commissioning colleagues to provide
integrated services across the patient pathway. Any pathway documents will be
based on national policy and guidelines and best practice. Patient preparation
and choice are fundamental to an effective RRT service.
Clinical management of eligible patients will be in line with the agreed care
pathway and any relevant regulations governing delivery of services.
9
Primary Care
Primary care input in planning and designing services and setting local priorities
is encouraged. Good clinical links between primary and secondary care should
be continuously fostered. GPs and Care Homes will be kept informed of the care
of individual patients.
10
National Guidance and Innovations
New technologies and service innovations should be introduced in a safe,
evidenced based and timely way.
11
Audit & Clinical Governance
Each provider will be expected to have a local Clinical Governance structure for
renal services. As a minimum, this will provide a mechanism for:
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a) reviewing patient safety issues highlighted through the local reporting
system and highlighting any lessons learned at a national level when
required
b) reviewing locals deaths
c) responding to alerts from the Renal Registry or NHSBT
d) Root Cause Analyses (RCA) e.g. for crash landers, or use of necklines
Each service specification has suggested audit criteria which will guide the
national renal audit. All providers are expected to fully participate in the national
audit.
Service specifications should be used routinely in local and national audits and
the results of audits should provide evidence of the extent of adherence to the
specifications. In putting an audit in place reference should be made to the
detail of specifications so that the results can provide this evidence.
If there is any reason arising from audit to challenge the content of a
specification this should be made clear to the Network.
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Appendix 1: Impact Statement
This would be a general statement of possible impact and/or a record of what
the impact on each provider is agreed to be. The value of such a statement in
this appendix will be reviewed during 2016 before a statement is included
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Appendix 2: Consultation Record, Document History & Version Control
Document Author:
Executive Lead:
Approved by:
Issue Date:
Review Date:
Document No:
Insert Role Title
Insert Role Title
Insert Committee
To be obtained from Corporate Services
Manager or Corporate Governance Manager
Document History
Revision History
Version
Revision date
No.
Summary of Changes
Updated to
version no.:
Date of next revision
Consultation
Name
Date of Issue
Version
Number
Approvals
Name
Date of Issue
Version No.
Distribution – this document has been distributed to
Name
By
Date of Issue
Version No.
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