Timely Listing West Midlands, July 2015 ‘Transplant First’ NHS Kidney Care NHS Blood and Transplant 2011/12 Lisa Burnapp Lead Nurse-Living Donation NHSBT

Timely Listing West Midlands, July 2015 *Renal Registry 2010 Renal Replacement Modality at Day 90*

Timely Listing West Midlands, July 2015 UK Pre-emptive Kidney Transplantation* Kidney only Tx. (n) Pre-emptive Tx. (%) Adult DDTx Adult LDTx Paediatric DDTx Paediatric LDTx * NHS Blood and Transplant April 2009-March 2010

Timely Listing West Midlands, July 2015

The Project 2011/12 “Promote timely listing for transplantation & increase opportunities for pre-emptive transplantation from deceased & living donors” UK-wide initiative –NHS Kidney Care (England) –NHS Blood and Transplant (Wales, Scotland, NI) Bids invited from all referring kidney units & Tx centres ‘In-year’ funding (6 months)

Timely Listing West Midlands, July 2015 Measurable Outcomes Each funded unit would: Provide an action plan to identify barriers to pre- emptive transplantation (Tx) Share learning & best practice UK-wide Establish clinical pathways to support pre-emptive Tx Increase number of patients listed for pre-emptive Tx Develop activity reporting in conjunction with NHSBT

Timely Listing West Midlands, July 2015 Other Deliverables Presentations at relevant meetings –E.g. BRS, BTS, RA, EDTNA, ESOT Sustainability plan Monthly ‘Survey Monkey’ RAG ratings

Timely Listing West Midlands, July 2015 Bids 20 bids from England 5 bids from Devolved administrations Analysis based on –Work plan –Deliverables –Cost effectiveness –Overall feasibility

Timely Listing West Midlands, July 2015 Referring Kidney Units* Aintree (Liverpool)Shrewsbury & Telford (B’Ham.) Bradford (Leeds)Wolverhampton (B’Ham.) Salford Royal (Manchester)North Staffordshire (B’Ham) Lister (WLRTC, RFH, Addenbrookes) Heart of England (B’Ham., Coventry) Colchester (Addenbrookes)Royal Berkshire (Oxford) James Cook (Newcastle)Brighton & Sussex (St. Georges) Derby (Nottingham)Morriston, Swansea (Cardiff) *(n=14)

Timely Listing West Midlands, July 2015 Transplant Centres* Derriford, PlymouthSingle centre Southmead, BristolSingle centre Imperial, WLRTCSingle centre ‘network’, Lister** Manchester Royal InfirmarySalford Royal Nottingham CityDerby The Freeman, NewcastleJames Cook Queen Elizabeth, BirminghamShrewsbury, Wolves., North Staffs.,Heart of England Liverpool for North WalesAintree Cardiff UniversitySwansea Royal Infirmary, EdinburghRegional Belfast CityRegional *(n=11) ** participating referring centres

Timely Listing West Midlands, July 2015 Similarities Overall aims & objectives Nursing support/MDT approach Finance (pro-rata) Sustainability Recruitment challenges

Timely Listing West Midlands, July 2015 Variables Distribution of bids Starting points in individual units/centres Strength: level of detail & content Local v regional remit Understanding of quality improvement strategies Engagement between ‘hubs & spokes’ Measurable/deliverable outcomes

Timely Listing West Midlands, July 2015 General Points Short timeframe –Some over-optimism –Balance of planning v action in project plans Areas for development –E.g. Quality improvement methodology –Sharing expertise Engagement is key –Across regional networks –Across all projects to share best practice

Timely Listing West Midlands, July 2015 Challenges Technology –Optimising networking & development opportunities Collaboration –Across regional networks –UK-wide Timeframes –Achieving outcomes –Utilising resources & development opportunities

Timely Listing West Midlands, July 2015 Resources Reference group –Chas Newstead (Chair) –Lisa Burnapp, NHS Blood and Transplant –Bev Matthews, NHS Kidney Care –Helen Hoyland, NHS Kidney Care –Research fellow, NHS Kidney Care Literature review E-Seminars Web-based networking forum Training e.g. process improvement methodology

Timely Listing West Midlands, July 2015 Findings* * h_2013.pdf

Timely Listing West Midlands, July 2015 Barriers to Timely Listing 1.Lack of standardised referral system or pathway 2.Inadequate patient and professional education and engagement 3.Delays due to ineffective use of technology and administrative support 12 Recommendations

Timely Listing West Midlands, July 2015 How are we doing?

Timely Listing West Midlands, July 2015 UK Pre-emptive Kidney Transplantation* Kidney only Tx. (n) Pre-emptive Tx. (%) Adult DDTx Adult LDTx Paediatric DDTx Paediatric LDTx * NHS Blood and Transplant April 2013-March 2014

Timely Listing West Midlands, July 2015 Adult Pre-Emptive LDKT

Timely Listing West Midlands, July 2015 Pre-emptive LDKT by Centre RFH

Timely Listing West Midlands, July 2015 What are we doing now?

Timely Listing West Midlands, July 2015 LDKT 2020 “To match world class performance in living donor kidney transplantation”

Timely Listing West Midlands, July 2015 Objectives: LDKT Increase LDKT activity; state of the art donor care 2.Embed principle of ‘transplant first’ and improve equity of access to LDKT 3.Ensure the National Living Donor Kidney Sharing Schemes (NLDKSS) are clinically and cost effective

Timely Listing West Midlands, July 2015 Delivering LDKT 2020 Chair Aisling Courtney Commissioning Nesta Hawker Access & Availability Aisling Courtney Donor Safety Vassilios Papalois Higher Immune Risk Nizam Mamode NHSBT Lead Lisa Burnapp 2020 Oversight Group

Timely Listing West Midlands, July 2015 Acknowledgements NHS Kidney Care NHSBT Transplant and referring centres LDKT 2020 Strategy Implementation Group

Timely Listing West Midlands, July 2015 Thank you.