1. The Renal Association Report from the Clinical Affairs Board 12 th march 2010

2. 12th March 2010 Clinical Affairs Board Created in 2004 Function: –to contribute to the development of all aspects of local and national policy relevant to clinical practice in nephrology –integrate and plan the work of the: The UK Renal Registry The Clinical Practice Guidelines Committee and The Clinical Service Committee –Influences through the RA but has no power Meets three times a year

3. 12th March 2010 Current membership of CAB Chair and Clinical Vice President –Kevin Harris from September 2007 Committee Chairs –Registry:Charlie Tomson –Guidelines:Robert MacTier –Clinical Services:Martin Raftery 2 elected members of the Executive Phil Kalra demitted 2009 Andrew Lewington Liz Lightstone started 2009 National Clinical Director (ex officio)

4. 12th March 2010 Guidelines Committee RA guidelines –the 28 lead co-authors are on schedule to complete the 14 modules of the 5th edition in 2010. –Website based –Investigating hard copy publication for 60 th Anniversary Invited commentaries on the 3 current KDIGO guidelines –hepatitis C, mineral and bone disorders in CKD and medical management of the renal transplant recipient –The CAB will also provide a commentary on the soon to be published KDIGO AKI guideline.

5. 12th March 2010 Guidelines Committee Links with other guideline development groups –EPS, atypical HUS, oral bowel cleansing agents in renal patients, JBS 3 cardiovascular disease guideline group. –Contrast induced AKI guideline planned with the British Interventional Radiology and British Interventional Cardiology Societies. Application to NHS Evidence for accreditation of the RA clinical practice guidelines –submitted on the 22nd February

6. 12th March 2010 UK Renal Registry The Renal Association UK Renal Registry The Twelfth Annual Report December 2009

7. 12th March 2010 UK Renal Registry Registry will alert Clinical or Specialty Directors to findings relating to mortality in their centre that might deserve further investigation Request evidence that this finding has been discussed with the Clinical Governance lead and Chief Executive of the Trust in which the centre is based.

8. 12th March 2010 Home therapies working parties –PD working party – chaired by Edwina Brown –HHD working party - chaired by Dr Robert MacTier & Dr Mark MacGregor. CAB workstreams

9. 12th March 2010 Swine Flu pandemic Briefing and guidance for adult renal units in the UK during an influenza pandemic Pandemic planning Dosing adjustments for antivirals CAB workstreams

10. 12th March 2010 CAB workstreams Liaison with NICE –Belatacept for the prevention of organ rejection in renal transplantation –Intradialytic exercise for the management of renal failure –Machine perfusion systems and cold static storage of kidneys from deceased donors –On-line Haemodiafiltration for Established Renal Failure –Peritoneal dialysis –Tap water haemodialysis systems for established renal failure –Everolimus in PKD

11. 12th March 2010 Payment by Results for RRT CAB workstreams

12. 12th March 2010 Payment by Results for RRT NON-MANDATORY TARIFF 2010/11 –Tariffs are based on a session of haemodialysis and a day of peritoneal dialysis –Aim remains to move to a mandatory “best practice” tariff in 2011/12. –Best practice tariff will encourage specific aspects of good practice haemodialysis via a fistula providing access to home haemodialysis wherever clinically appropriate CAB workstreams

13. 12th March 2010 CAB workstreams Payment by Results for RRT Will renal units lose out if their funding is based on the non-mandatory tariff for 2010/11?

14. 12th March 2010 CAB workstreams AKI Improving the quality of medical and surgical care News Release 11 June 2009 National enquiry calls for better recognition of kidney failure in acutely ill hospital patients A national enquiry has uncovered systematic failings in the clinical care of patients suffering from acute kidney injury (AKI). The report identifies:  Doctors failing to carry out basic care plans  Doctors unable to recognise acute illness  Organisational deficiencies inhibiting investigation and management

15. 12th March 2010 CAB workstreams AKI RA actively participating in: –Definitions for AKI –Coding –Guidelines for prevention –Guidelines for appropriate referral and transfer –Education –Audit

16. 12th March 2010 Turbulent times (Chris Winearls. CD forum 2007) Financial imbalance in many Trusts Changing Health Authority structures Target culture Capital drought Commissioning uncertainty – who and how? Unnecessary re-engineering Manpower and Training - MMC Healthcare associated infections

17. 12th March 2010 Challenging times ahead Public Sector Net Debt

18. 12th March 2010 Improve the quality There is no more money –Flat cash Reduce the size of secondary care –Buildings –Staff Challenging times ahead

19. 12th March 2010 Lean Nephrology RA to play a key leadership role – supported by you! A date for your diary: 17 th September 2010 Robens Suite Guys Hospital Suggestions to 1.John Scoble. John.Scoble@gstt.nhs.ukJohn.Scoble@gstt.nhs.uk 2.Kevin Harris. Kevin.harris@uhl-tr.nhs.uk