Renal Advisory Group
Thursday 21st September 2006, 10am
City Hall, Cardiff
Present
Ms Betty Bennion
Mr Peter Carr
Dr Kieron Donovan
Dr Peter Drew
Dr Rick Greville
Mr David Heyburn
Dr Arun Midha
Dr Richard Moore
Dr Ash Paul
Mr John Reever
Mr Malcolm Thomas
Dr Jane Wilkinson
Prof John Williams
Role
BB
PC
KD
PD
RG
RH
AM
RM
AP
JR
MT
JW
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In Attendance
Ms Denise Richards
Dr David Salter
Ms Cathy White
Role
DR
DS
CW
Apologies
Mrs Val Doyle
Mr Richard Evans
Mr Mike Fealey
Dr Gruf Jones
Welsh Therapies Advisory Committee
Renal NSF Programme Coordinator
Chair of the Renal NSF Information Sub-group
Chair of the Renal NSF Planning Sub-group
Assoc. of British Pharmaceutical Industries
Specialised Commissioner, HCW
Renal Advisory Group Chair
Welsh Association of Renal Physicians
Deputy Medical Director, HCW
Patient Representative
Trusts Chief Executive Representative
National Public Health Service
Lead Renal Clinician
Nursing Officer, WAG
Deputy Chief Medical Officer, WAG
Policy Lead, WAG
Role
VD
RE
MF
GJ
Welsh Nursing & Midwifery Committee
Assoc. of British Pharmaceutical Industries
National Leadership & Innovation Agency
GP Forum
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Agenda Item
1.
Action
Welcome and Introductions
The Chair welcomed everybody to the first meeting of the Renal
Advisory Group. The Chair emphasised that the group would ensure
multi-disciplinary membership and include meaningful patient
representation.
2.
Role of the Group, Method of Working and Membership
It was noted that the group had been established as an advisory body
to the Assembly Government and also to support development and
implementation of the National Service Framework.
The Group received a paper setting out the proposed membership.
Following discussion it was AGREED that:
i) When the two Renal Networks are established each would provide
a representative and these would be at the LHB Chief Executive level.
In the interim, the co-ordinator would work with the Welsh NHS
Confederation to identify potential LHB Chief Executive
representation.
ii) Additional nursing representation needed to be identified. The coordinator would work with the Nursing Officer from WAG to secure
this.
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iii) that the Chairs of the Renal Information and Renal Planning subgroups should be invited to be full members of the group.
3.
Patient Involvement
The Group received a paper concerning Patient involvement.
Following discussion it was AGREED that:
i) Two patient focus groups to cover North and South Wales would be
established.
ii) The focus groups will be structured in such a way to ensure
representation from all parts of the patient pathway.
4.
Final Draft Policy Statement & NSF Standards for Renal Services
The Group considered the final draft policy statement and NSF for
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Renal services. It was noted that the consultation on the NSF
document ended in June 2006. It was AGREED that:
i) Replies to the responses and the related modifications to the
document would be circulated to modules Chairs and the Renal
Advisory Group members for comments back by 23rd October
ii) A final version of the NSF document should be submitted to the
Welsh Assembly Government management board for approval by
December with a view to formal publication of the NSF by
March 2007.
5.
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Renal Advisory Group Business Objectives 2006/07
The Group Considered the RAG Business Objectives for 2006/07 and
the progress in implementation.
Following discussion, it was AGREED that:
i) The Workforce Planning group to be given the task of taking forward
the development of competency frameworks for the multidisciplinary
renal teams with reference to existing frameworks.
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ii) Serum Creatinine measurements will be standardised to the ID-MS
technique, eGFR will be calculated by 4 part MDRD; this will be
adopted across Wales as the common measurement of renal
impairment and will be included in the NSF document.
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iii) A task & finish group will be established to take forward the
development of care pathways linked to the work already being
undertaken by the Welsh Assembly Government in terms of
integrated care pathways and Map of Medicine.
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iv). Prevalence as opposed to incidence will be used as the
measurement/estimation of numbers of patients requiring Renal
Replacement Therapy (RRT). The NSF document will be altered to
reflect this.
v) The policy objective on increasing the number of registered organ
donors to be altered to emphasise the requirement for more available
organs in addition to increasing numbers of registered donors.
6.
Setting up Networks
The group received a proposal recommending the establishment of
renal networks.
The group discussed the establishment of two Renal Networks (North
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and South) as opposed to three reflecting the regions.
The
differences that exist between Cardiff and Swansea were noted but
the group agreed that there was also significant value in joining the
whole of South Wales together with an opportunity for creating a more
seamless service.
The Group noted that patient flows in East Powys are currently to
England and agreed that this area of the service would need to be
aligned to the English Networks.
The Chair asked the group to agree the outline proposal for the
establishment of the Renal Networks, the following principles were
AGREED:
i) That two Renal Networks should be established in Wales (North
and South) ensuring that local issues and differences are
acknowledged in their work programme.
ii) The basic structure required for each Network was agreed:
 Full time Network Manager
 2 sessions of clinical input (nursing and/or medical)
 part time administrative support
iii) Chief Executives of Local Health Board and Health Commission
Wales within each region, to nominate one of themselves as Chair of
the Network.
iv) The Chief Executives from the Local Health Boards, Health
Commission Wales and Trusts from within each Network to agree the
make up of the network core team and their own individual
contributions to the costs of staffing and accommodating the core
team.
v) The employing organisation for the Network Chair to agree to act
as host for the Network and to lead the recruitment of the Network
core team.
In reference to the above principles, the following action was
AGREED:
i) The RAG Chair to write to the Chief Executives of all LHBs, HCW
and Trusts and copy this letter to the Regional Directors, setting out
the key requirements of the Networks and asking them to facilitate the
process of establishing the Networks.
7.
Data Set for Clinical Audit
The group received a presentation from the Chair of Renal
Information Sub-group.
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It was noted that currently across Wales; renal units submit data to
the UK Renal Registries and participate in audits implemented by the
Welsh Association of Renal Physicians.
It was noted that there has been a validation exercise conducted of
the current data submitted also a baseline assessment of the current
IT infrastructure used in the collection of renal data. A demographic
analysis / planning tool has also been developed.
It was AGREED that:
8.
i) The Information Sub-group should align its programme of work to
the Corporate Health Information Project (CHIP) and to Informing
Health Care (IHC).
Info
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ii) That the Map of Medicine tool should be used to assist this
programme of work.
Info
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iii) The Information Sub-group was to develop a basic renal data set.
It would take into account the developments in England, and if
appropriate adopt the same structure for the data set.
Info
Sub-gp
iv) The Information Sub-group identify a variety of audit tools that
could measure compliance of the NSF quality standards, in particular
to identify service outliers.
Info
Sub-gp
Haemodialysis Planning
The group received a presentation from Dr Donovan on the work
undertaken to identify the range of issues associated with current
Haemodialysis provision across Wales. A planning document to
accompany the presentation was circulated.
The key issue raised in the paper were the difference between the
capacity for providing accessible haemodialysis and the current and
growing demand:
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Current shortfall of 30 stations across Wales
3 main regions with population >60 minutes drive from a unit
3 counties with significantly low HD prevalence
Lack of an all-Wales plan and common pathway.
The key strategic considerations identified were:
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Current and future capacity gaps may require additional capital
infrastructure and commissioning of expanded dialysis
services.
Identification of the most appropriate locations of any
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expanded capacity that appropriately meets the needs of the
population, recognising dynamic influences.
It was noted that the planning document is intended to inform Health
Commission Wales (HCW) in developing an all-Wales planning
strategy.
It was AGREED that:
9.
i) Similar planning work to be included to cover Powys.
Planning
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ii) Opportunities associated with home dialysis would need to be
presented in this planning document.
Planning
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iii) The plans to provide prioritisation and demonstrate appropriate
authorised sign off.
Planning
sub-gp
iv) The group to provide comment in response to the presentation and
the planning document to Peter Carr by 6th October 2006 in advance
of being submitted to HCW
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Vascular Access Audit
The group discussed the provision of vascular access to
haemodialysis patients, specifically the use of native arterio-venous
fistulas.
It was noted that current native arterio-venous fistula provision to
haemodialysis patients across Wales is variable and that an all-Wales
audit is required to identify the levels of vascular access. The NSF
states that 80% of prevalent haemodialysis patients are to receive
dialysis using a native arterio-venous fistula by March 2008.
It was AGREED that:
i) The planning sub-group to be tasked with the development of an
audit tool and a costed implementation plan.
ii) The Deputy Chief Medical Officer recommend the inclusion of
vascular access as a day case basket procedure to be monitored
under the day surgery programme.
10. Any Other Business
Erythropoietin (EPO) anaemia treatment
The current understanding is that the EPO prescribing costs are
borne by the relevant Local Health Boards participating in a shared
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care prescribing arrangement. Recently in Gwent, the Local Medical
Committee has indicated that they no longer wish to prescribe EPO
meaning patients in Gwent may not be able to receive the required
anaemia treatment.
The Specialised Commissioner for HCW recognised the issue, noting
that the combined commissioning arrangements in Gwent require
specific attention.
It was AGREED that:
i) The Renal Advisory Group writes to the Local Health Boards in
Gwent seeking confirmation that they will continue to support the
anaemia service in its current form.
11. Date and time of the next meeting
The next meeting will be held in January 2007, date and time to be
confirmed. Alternative arrangements for different venues around
Wales and video conferencing would be considered within practical
limits.
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