August News
Welcome to our August newsletter.
This month we focus on successes and achievements from across London in 2023-24, sharing case studies which featured in our annual report.
Congratulations to everyone who’s been involved in any quality improvement work in the last year, and thank you to everyone who’s been part of the huge amount of work undertaken in the LKN. Here’s to another successful year during 2024-25, improving quality, experience and outcomes for kidney patients across London and beyond.
Quality Improvement in Health Equity at Barts Health
Using the support and expertise of the LKN’s Health Equities Group (HEG), a pilot project launched at Barts Health in 2023. It combined staff training in Making Every Contact Count (MECC) with the introduction of Healthy Living Advisor (HLA) to both record the extent of inequalities and to help mitigate their impact on patients’ health. Funding was sought by the Barts Health Public Health team to enable three renal staff to attend a MECC Train the Trainer programme. In turn these staff were able to train 12 members of the New Starters Dialysis Team at Bart’s Health. Evaluation showed the training increased staff confidence in making brief interventions to support patients to make positive changes in their lifestyle.
Alongside this, a HLA was introduced, funded by Barts Charity, to support staff working with patients in the New Starters Unit. Between September and December 2023 the HLA screened all 131 patients starting dialysis in the unit. 75% of patients lived in the first (25%) or second (50%) most deprived quintiles of deprivation. Of the 131 paitents, 27% reported financial insecurity, 14% reported food insecurity, and 9% reported housing insecurity in the last 2 months.
73% of patients benefited from either simple advice, signposting to relevant services or an onward referral to another service. The most frequently requested area of support related to diet, which was mostly through dietitian referral, but also referrals to food banks (10%). The second most common need was financial. People requited help with applying for benefits and signposting to grants for kidney
patients.
50 patients have been followed up since their intervention with the HLA, 66% of whom were referred or signposted to more than one additional route of support. Of those, 76% reported that they were either contacted by the service or had made direct contact with the signposted service. 90% of those patients reported that the referral and signposting were beneficial.
There was an improvement in mean EQ-5D (a measure of health) score following the intervention; 1.4 before Vs 1.6 after.
The MECC project highlighted the extent of social deprivation for patients newly starting dialysis at Barts Health, with high levels of food, housing and financial insecurity. Further work is ongoing to collect follow-up data for the remaining patients screened. There is also a plan for staff in the Low Clearance team to receive MECC training so that more patients can benefit from this intervention across the Renal
service at Barts Health.
Quality Improvement in Vascular Access at Imperial College Health Care
Using learning from the LKN VA Group, Imperial created a vascular access pathway coordinator role. In the first three months in post, Daniel Magdzinski has dramatically improved patient outcomes and waiting times. In addition, the dialysis access clinic DNA rate has dropped by 12%, from 17% to 5%. He is now training members of the wider renal administrative team across NWL about how to manage dialysis access clinics. This will ensure sustainability of improvements in outcomes, and will upskill and support colleagues across the service. Daniel will then focus on other aspects of the vascular access pathway, such as supporting the Vascular Access MDT.
The collegiate approach Imperial have taken with the London Kidney Network has helped them raise the profile of vascular access internally and facilitated improved collaboration with the clinical team, says Natasha Shenton, Deputy General manager. Nadine MacLean, Kidney and Transplant Business Manager, has been key in service improvement within the ICHT vascular access service. Working closely with the vascular access lead surgeon, Mr Paul Herbert, Head of Specialty for Kidney Surgery, Mr Anand Muthusamy, Vascular Access Clinical Nurse Specialist, Saidat Abbas, and Renal Quality and Information Manager, Darren Duffield, Nadine has made significant improvements with the internal vascular access referral and booking processes. As a direct result, fistula creation waiting time has halved, from 12 to 6 weeks, and there is improved oversight and visibility of vascular access referrals from across NWL.
Mr Paul Herbert
Head of Specialty for Kidney Surgery
“Imperial College NHS Trust cares for a huge cohort of renal patients and the establishment of Daniel’s role and the support of the management team has allowed start to make real progress in this area.”
Natasha Shenton
Deputy General manager
““The Imperial College Healthcare NHS Trust (ICHT) renal vascular access service has hugely benefited from the LKN VA group, and the impact on patient outcomes is tangible. For example, as a result of shared learning and benchmarking discussions with colleagues across the region, we were able to establish a dedicated vascular access pathway coordinator to support the service. This absolutely would not have been possible without the support of the London vascular access and kidney network, as the shared learning and outcomes from other providers supported the case for change, and the increase in administrative establishment within our service.”
LKN Data in Action:
Creating a Kidney Dialysis Occupancy Measure
LKN modelling of demand and capacity of In Centre Haemodialysis (ICH), showed demand growth of around 3% per year, with local variation across the seven renal units in 48 locations in London.
Despite best efforts to mitigate this growth – including early identification and prevention, higher rates of transplantation, and expanding home therapies – demand growth will continue. Working with units, we found that use of ICHD estate capacity was at 88.3% (range 73.5 % – 105.4%) and available staffed capacity at 97.9% (range 88.0 % – 103.9%) across the whole of London by mid 2023-24. A problem statement was agreed with Renal Clinical Directors
“Currently, kidney units, London ICBs and NHSE do not have a systematic and unified way of ensuring clear visibility of the capacity pressure or the risks associated with running ICHD services so close to operational safe capacity.”
With clinical consensus and agreement from the London renal unit Clinical Directors and Clinical Leads, the LKN developed a standard and consistent measure of ICHD capacity- the Kidney DOM. It is intended to be simple to use, easy to measure, and easy to report proxy indicators of clinical safety, patient experience and service resilience.
It was trialled and refined between December and February, and is now being reported on a monthly basis, showing reliable, accurate and up-to-date information about dialysis occupancy. The DOM has been included in the NHS London Specialised Commissioning Intergrated Performance Report and Kidney Networks across England are planning to start using it during 2024-25.
Mark Kowalczuk
General Manager for Renal Services, Barts Health NHS Trust
“The Kidney DOM has been essential in standardising the way in which we review and analyse capacity across different sites and networks across the LKN. One of the key challenges within dialysis is the amount of data available and the number of different ways that you can assess demand and capacity. Some services review demand and capacity in terms of number of patients, others look at number of slots, some look at sessions provided others use SLAM/commissioning activity data. You can look at physical capacity and you can look at staffed capacity. There are added complications when patients go on holiday or are admitted into hospital such that they are not using their chronic dialysis slots, equally some patients dialyse twice per week as opposed to three times. These are small nuances but can have significant impact when looking at large patient cohorts which are being measured via different metrics. When lobbying for additional investment in dialysis capacity there is an obvious need to demonstrate that you are effectively and efficiently using your current capacity and the Kidney DOM has provided a standardized and regulated means to demonstrate this and has been a great help in securing additional investment in dialysis across North East London.”
Are you leading improvement work?
If you are leading improvment work in your unit, and you’d like to share it, we’d love to include it in our monthly newsletters. Email us on [email protected] to find out more.
LKN Annual report:
You can find the full LKN Annual Report on our website, here https://londonkidneynetwork.nhs.uk/annual-report-2023-24/
We’ve made the report interactive with lots of links to completed work, such as education modules, toolkits, reports, and guidance documents. We hope you’ll find something relevant and interesting to you.
Leadership Fora
The eagle eyed among you will have spotted that the Leadership Fora has taken a summer break in July and August! The next forum is scheduled for Thursday 26 September at 1200-1300 and will focus on the Mutual Aid programme for Transplant- how it started, how it works, and what it’s impact has been. We hope to see you there. Teams invites will be going live soon, so keep an eye on your inboxes, and email us on [email protected] if you have any questions.
Other news and opportunities from across London
Dr Adrian Brown is an NIHR Advanced Fellow and Senior Specialist Dietitian at University College London . He is exploring the management of people living with obesity and kidney failure on haemodialysis in the UK and the challenges in helping people to lose weight.
Adrian is looking for all members of the MDT to help by completing a survey. He says
“There are no right or wrong answers, all responses will remain anonymous, and the study will take approximately 15-20 minutes to complete. At the end of the study, you will be offered to join a prize draw to win a gift voucher worth either 1 x £100, 2 x £50 and 4 x £25.”
If you are interested, you can find the study and further information about it here https://redcap.idhs.ucl.ac.uk/surveys/?s=8839DRLATETYE843
This project has been approved by the UCL Research Ethics committee (REC registration number 16191/009).
Opportunities to share
If you have news and opportunities you’d like to share with colleagues across London, please get in touch and we’ll do our best to share if we can.