Sustainable Health and Green Care Donal ODonoghue National

Sustainable Health and Green Care Donal O’Donoghue National Clinical Director for Kidney Care Working for Better Kidney Care Green Nephrology Summit London th Wednesday 26 September 2012

“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

“Quality is the only organising principle of the NHS” Timely Safe Equitable Efficient Effective Patient Centred Sustainable

Vascular Disease – One Event Leads to Another (REACH Registry) Original Event = Stroke MI Risk • 2 -3 x greater risk Stroke Risk • 9 x greater risk 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 CKD MI Risk • 2 x greater risk Stroke risk • Up 50% 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

Disuse-Disability Spiral Painter (1996)

10% of our wealth is spent on health

Value Waste

Value in Health Care (Porter M: NEJM 363: 2477, 2010, Lee: NEJM: 363: 2481, 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. ”

Value in Health Care (Porter M: NEJM 363: 2477, 2010, Lee: NEJM: 363: 2481, 2010) “Measurement of value is challenging…the critical first step is measurement. Provider organisations need to capture data on outcomes that matter to patients and carers. ”

Results of Public Opinion Survey: Source: Ipsos MORI

Trends in Late Referral by Year 40 35 Late Referral (%) 30 25 20 15 Late referral defined as ≤ 3 months before RRT start 10 5 0 2005 Canada 2006 UK Australia 2007 NZ 2008 2009 Data from Canadian, UK and ANZDATA Renal Registries

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

The mean e. GFR at initiation of RRT is rising The mean e. GFR at initiation of RRT in 2009 in the UK was 8. 6 The mean e. GFR at initiation of RRT in 2008 in the US was 11. 1 Percent distribution at initiation by e. GFR

http: //sdm. rightcare. nhs. uk/

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/

Patient Decision Aids http: //sdm. rightcare. nhs. uk/

http: //sdm. rightcare. nhs. uk/

Aerobic Exercise Training: Haemodialysis bed cycle ergometer training

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

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, 000 km Environmentally sustainable health and social care: scoping review – Naylor and Appleby, March 2012

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

“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