Sustainable Health and Green Care

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Sustainable Health and Green Care

• Donal ODonoghue
• National Clinical Director for Kidney Care

Working for Better Kidney Care
Green Nephrology Summit London Wednesday 26th
September 2012
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Some service areas are already leading the way.
For example, Green Nephrology includes a network
which brings together clinicians, patients, renal
technicians and industry partners.

• Environmentally sustainable health and social
  care scoping review Naylor and Appleby, March
  2012

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Quality is the only organising principle of the
NHS
Timely
Efficient
Safe
Effective
Patient Centred
Sustainable
Equitable
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Vascular Disease One Event Leads to Another
(REACH Registry)

• CKD
• MI Risk
• 2 x greater risk
• Stroke risk
• Up 50

• Original Event Stroke
• MI Risk
• 2-3 x greater risk
• Stroke Risk
• 9 x greater risk

Diabetes (type 2) Because of the increased risk
associated with diabetes, it should be considered
a cardiovascular risk equivalent to a
non-diabetic patient with previous MI

• Original Event MI
• MI Risk
• 5-7 x greater risk
• Stroke Risk
• 3-4 x greater risk

• Original Condition PAD
• MI Risk
• 4 x greater risk
• Stroke Risk
• 2-3 x greater risk

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Disuse-Disability Spiral
Painter (1996)
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10 of our wealth is spent on health
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Value
Waste
Value
Waste
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Value in Health Care(Porter M NEJM 3632477,
2010, Lee NEJM3632481, 2010)

• Value should always be defined around the
  consumer and the creation of the value for
  patients should determine the rewards for all
  other actors in the system.

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Value in Health Care(Porter M NEJM 3632477,
2010, Lee NEJM3632481, 2010)

• Measurement of value is challengingthe
  critical first step is measurement. Provider
  organisations need to capture data on outcomes
  that matter to patients and carers.

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Results of Public Opinion Survey
Source Ipsos MORI
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Trends in Late Referral by Year
Late referral defined as 3 months before RRT
start
Data from Canadian, UK and ANZDATA Renal
Registries
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Demand for renal replacement therapy continues
to increase
but incident rates appear to be reaching a
plateau or falling
Prevalent patients by treatment
RRT incident rates
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The mean eGFR at initiation of RRT is rising
The mean eGFR at initiation of RRT in 2009 in
the UK was 8.6 The mean eGFR at initiation of
RRT in 2008 in the US was 11.1
Percent distribution at initiation by eGFR
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http//sdm.rightcare.nhs.uk/
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Shared Decision Making
is a fundamental part of care planning and
promotes the best choice in what otherwise can be
a complex and overwhelming situation.

• The care team communicates to the patient
  personalised information about the options,
  outcomes, probabilities and scientific
  uncertainties of the various treatments.

The patient communicates his or her values and
relative importance he or she places on the
potential benefits and harms.
http//sdm.rightcare.nhs.uk/
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Patient Decision Aids
http//sdm.rightcare.nhs.uk/
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http//sdm.rightcare.nhs.uk/
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Aerobic Exercise Training Haemodialysis bed
cycle ergometer training
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5 of transport emissions in the UK are estimated
to be accounted for by healthcare facilities
Environmentally sustainable health and social
care scoping review Naylor and Appleby, March
2012
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5 of transport emissions in the UK are estimated
to be accounted for by healthcare
facilities Ingredients in a steak and kidney pie
served in one hospital had travelled a total of
31,000km
Environmentally sustainable health and social
care scoping review Naylor and Appleby, March
2012
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Motivate and inspire

• Influence key levers and mechanisms to support
  uptake
• Legislation, Inspection, Incentives
• Performance management of new Commissioning
  Consortia through the Outcomes Framework
• National clinical audit
• Education/ accreditation/ CPD e.g. via Royal
  Colleges and professional bodies
• Workforce development
• Promoting evidence into practice guidelines
• Developing the evidence base
• Patient stories

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• Often change need not be cajoled or coerced.
  Instead it can be unleashed.

Kelman, S. (2005) Unleashing Change. A study of
organizational renewal in government, Brookings
Institution Press Washington, D.C
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