2. Renal NSF Update Clinical Directors’ Forum Friday 7 March Governor’s Hall, St Thomas’s, London Dr Donal O’Donoghue National Clinical Director of Kidney Care Working for Better Kidney Care Juliette Kingcombe Renal Policy Team Leader Beverley Matthews West Midlands Renal Network Manager

3. Provision and commissioning of kidney care EOL Care Supportive & palliative care Modified from Levey AS et Al. KI 2005:2089-2100 Public Health Primary Care Specialist Kidney Care

4. Chronic Kidney Disease – QOF Prevalence & Age Specific Prevalence Aged 18+ - 2006/7 – By SHA

5. Chronic Kidney Disease – QOF Prevalence & Age Specific Prevalence Aged 18+ - 2006/7 – By PCT London SHA

6. Chronic Kidney Disease – QOF Prevalence & Age Specific Prevalence Aged 18+ - 2006/7 – By General Practice The 2 London PCTs with the lowest CKD Prevalence Aged 18+ The 2 London PCTs with the highest CKD Prevalence Aged 18+

7. QOF Results as reported QOF Results as a % of people on the CKD Register

9. 2007 HOSTED BODIES REVIEW Establishment of the NHS Improvement Team –Cancer –Cardiac –Stroke Review of National Diabetes Support Team Where does kidney care fit in?

10. National Diabetes & Kidney Support Team Develop a combined central team with a regional interface to support: –successful implementation of the Diabetes and Renal NSFs and other national guidance –the National Clinical Directors for Diabetes and Kidney Care

11. National Diabetes & Kidney Support Team Diabetes CareKidney Care

12. Kidney Care This is an opportunity to support Kidney Care Network development and improvement on behalf of commissioners, providers and users to: –Enable patient and public engagement –Ensure Focused Service Improvement –Facilitate wide clinical involvement –Have oversight of delivery and performance of services and Capacity Planning –Support Needs Assessment

13. West Midlands Renal Network

14. 5.3 million population 7(8) Adult Renal Units 1 Paediatric Renal Unit 2 Transplant Centres 2,000 Heamodialysis Patients 1 SHA 1 Specialised Commissioning Team 5 Local Collaborative Commissioning Boards 17 PCTs West Midlands Renal Network

15. WM Strategic Commissioning Group Primary Care TrustsAcute Trusts WEST MIDLANDS RENAL NETWORK 7 Adult Renal Units  1 Paediatric Renal Unit  1 Specialised Commissioning Team  5 Local Commissioning Boards  Chairs of Local Renal Groups  Chairs of Renal Forums EXECUTIVE TEAM Chair – PCT CE Network Manager Lead Clinician Lead Commissioner Public Health Lead (SCT WM) Coventry & WarwickshireHerefordshire & Worcestershire Shropshire & StaffordshirePan BirminghamBlack Country LOCAL RENAL GROUPS RENAL FORUMS Finance Transplant Patient & Carer Clinical Expert

16. The West Midlands Renal Network: ACCOUNTABILITYWM Strategic Commissioning Group CHAIRPaul Jennings, CEO Walsall tPCT NETWORK MANAGERBev MatthewsFull time CLINICAL LEADSteve Smith2 Session PA17.5 hours SUPPORTIT Manager SpR Public Health, GP Trainees FUNDING£112,000pa17 PCTs

17. The West Midlands Renal Network: Key Achievements: Ability to influence LDP process Strategic Framework for Managing CKD in Primary Care Supportive Care Pathway Standards for Kidney Care  Transplant  Dialysis 5 Year Haemodialysis Capacity Plan PCT Renal Drug Formulary

18. THE CARTER REVIEW: The Carter Review of Specialised Commissioning makes explicit recommendations relating to clinical (network) engagement with Strategic Commissioning Groups (SCGs. 12“Each SCG should have an annual process for debating priorities and explicit mechanisms for eliciting and documenting the views of providers (clinical and managerial), PCT members, practice based commissioning leads, Public and Patient Involvement (PPI) representatives, and commissioning teams…… 19 “SCGs should work closely with their clinical networks so as to ensure that commissioning and investment plans support the delivery of integrated care”, and 20 “SCGs should provide oversight and ensure coordination of clinical network plans, where the service in question has a planning population larger than a single network.”

19. CARTER: Managed Clinical Networks ‘Managed Clinical Networks' are defined as linked groups of health professionals and organisations from primary, secondary and tertiary care, working in a co-ordinated manner, unconstrained by existing professional and Health Board boundaries, to ensure equitable provision of high quality clinically effective services’

20. Kidney Care – Listening Exercise: What do we want? What will it do? Who it’s for? Why will it be better that the current structure?

21. It sets out the national rules for the service over the coming business year It is designed to help the local NHS shape services around the needs of local communities and details the key targets and priorities the NHS needs to focus on to achieve our strategic objectives. What is the Operating Framework

22. AprilJuneFebMayMarchSeptDecAugJulyJanOctNov Central Government Department of Health The NHS Local Government The Budget Pre-Budget Report Focus on Business Planning Publish accounts NHS CE Annual Report Monitor NHS Performance and review strategy Publish Departmental Report Focus on strategy and review CMO Annual Report Focus on performance and development Publish NHS Operating Framework Sign off Local Delivery Plans Publish planning framework Publish DH business plan NHS allocations LA Grant settlement Negotiation of LA priorities & improvement targets Sign off Local Area Agreements Review and agree SHA balanced scorecard

23. How it is structured The 2008-09 Operating Framework sets out: The health and service priorities for the year ahead: freeing up the front line by moving towards local stretch targets, whilst delivering on national priorities. 2008/09 is the start of the next three-year planning round. In this context, the Operating framework sets out the priorities and planning framework for the NHS for the 2008/09 financial year, within the context of the 3 year CSR period 2008/09 – 2010/11; The reform levers and enabling strategies: reform with a purpose – to improve services. The focus will be on developing world class commissioning as the key agent for change on behalf of patients and the public, using the full range of levers and incentives to transform services and improve outcomes; The financial regime: setting out a framework that fully supports reform goals and incentivises transformational improvements in services within available resources. Key to this will be the need to sustain the surpluses the NHS is on track to deliver; The business processes: ensuring a business-like and transparent approach to planning that supports locally led decisions whilst providing accountability. There is a strong emphasis on genuine partnership working at a local level with local government and other partners to ensure that local health and wellbeing needs are better understood and addressed in partnership.

24. What we said about dialysis

25. World Class Commissioning

26. What we are doing in DH Letter to SHAs, SCGs, PCTs asking for plans 6 ‘documents’ received to date Visits to SHAS – profile raising Commitment to revisit NSF modelling E16 share the learning Paper on capacity options

27. Please send us your survey results to mbrenalnsf@dh.gsi.gov.uk (copied to Martin at RA)

28. Thank you for all your contributions to our work at DH – we rely on your expertise (and your time!) Juliette.kingcombe@dh.gsi.gov.uk