Response to: Draft Renal NSF document: “Designed to Tackle

Response to: Draft Renal NSF document:
“Designed to Tackle Renal Disease in Wales”: A National Service Framework.
Anglesey Local Health Board is pleased to be able to comment on the
above document. The response will be formatted as follows:
1. Do you agree with the standards we have chosen?
The Standards detailed within the five core modules are clear and succinct.
These will ease the process of facilitation and local implementation.
2. Do you think they will effectively tackle renal disease in Wales and
improve the quality of renal care?
These modules in isolation will not improve the quality of renal care. The
challenge that lies ahead is to further integrate care between primary,
secondary and tertiary care utilising other supporting strategies that will drive
forward this agenda. There are clear overlaps between this draft document
and other NSF`s (such as children, diabetes, CHD, Older person`s and long
term conditions) that promote the basic requirement of promoting health and
well-being via education (for the workforce, patient and supporting health and
social care interface).There are clearly defined roles for primary care (that
must be addressed via QOF and formation of renal registers) and voluntary
organisations (in particular –the role of the expert-patient programme).
3. When writing the key interventions which underpin each standard,
every attempt has been made to ensure each one is clear, specific,
and measurable to enable effective audit. Are there any key
interventions which you do not consider meet the above criteria? If
so, how would you suggest a form of wording that would improve the
key action?
These appear to be measurable key indicators that could be audited within
the 10 year development of this NSF (If benchmarked against the Designed
for Life document)
4. Do you consider they could be achieved in your area over time?
Yes, with a clear implementation plan and service re-design via local
planning committees.
5. Do you have any other comments that you would like to make about
this document?
No comments offered for this section.
6. How would you like to see the NSF standards document presented?
e.g. loose leaf binder, one complete publication as a bound book,
split publications e.g. each separate module as a booklet, or adult
and children’s sections
One completed publication as a bound book – as a key reference to the NSF.
7. Which of the key interventions do you think will have the biggest
impact on renal disease and the services to diagnose and treat?
Module 3: The screening, assessment, diagnosis and management of renal
disease (and forming renal registers)will have the biggest impact, especially if
included within QOF 2006/07.Also the clear definition of diagnostic
biochemistry to be used, when and by whom (in particular GFR). This should
be incorporated within an integrated care pathway for Renal disease.
With a population of 67,000 and having the highest prevalence rates for
chronic conditions in Wales, preventative work via primary care and NPHS is
essential. It is estimated that 40% of our population are over 50, with
projected population rates within the next five years suggesting that there will
be a further 40% increase in our elderly population (over 75 years). Tackling
the chronic and long term condition is therefore a priority for health and social
care on the Island.
8. The key interventions are going to be implemented over time. Which
of the key interventions do you think are the most urgent for
implementation? Please give specific reference.
The key priorities should be tackling areas in relation to primary prevention of
renal disease via screening and pharmacological support .
9. What ideas do you have to ensure patients and the Multidisciplinary
Renal Team are involved in influencing implementation, the setting
up of renal networks and the work of the Renal Advisory Group?
We would assume that the most effective method would be to ensure that
there is effective cross-boundary representation from all key stakeholders that
will be able to feed-back information locally to Local Health Boards (including
patients, carers or voluntary organisations).
10. Do you have any ideas about how developments at Welsh Assembly
Government level on renal disease can be communicated to you
more effectively?
Information can be filtered via Renal Networks (to organisational leads) or the
designated website. Information could also be provided electronically via
Welsh Health Circulars.
11. What ideas do you have to ensure patients can be involved to help
organisations to make their service better?
(As per response to question 9.)
12. Can you foresee any barriers to the implementation of these
standards? If so, are there any actions which the Welsh Assembly
Government should take to overcome these barriers?
Rationale provided: In support of the implementation process and programmes of
action being developed, there are a series of groups looking at different aspects:
finance, workforce and information.
It would be useful to have an agreed timetable for reporting
mechanisms for each group looking at the standards included within this NSF.
Are there aspects of implementation you think these groups
should be addressing that these groups are not currently considering?
What programmes of action to support implementation do you think are
The NSF website has recently been reviewed and updated.
1. How useful is the website to you and your organisation?
At the moment, the website works as a directory of members on the different
implementation groups. We would anticipate that this website is frequently
updated in relation to progress made against implementation and
development of planning and commissioning strategies so that as a LHB we
are kept informed of the process.
2. Could it be improved to meet your and your organisations requirements
more effectively?
Yes, through the formation of a link for staff to be notified of updates (similarly
to the Welsh Health Circulars.
What would enable you to share your knowledge and your
examples of best practice with others through the website?
Structured sections ranging from varying models to case management
scenarios by various Health and Social care organisations
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