Transplant First NHS Kidney Care NHS Blood and

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

UK Pre-emptive Kidney Transplantation* Kidney only Tx. (n) Pre-emptive Tx. (%) Adult DDTx 1409 7. 6 Adult LDTx 958 31. 8 Paediatric DDTx 73 19. 5 Paediatric LDTx 69 39. 4 * NHS Blood and Transplant April 2009 -March 2010 Timely Listing West Midlands, July 2015

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, Plymouth Single centre Southmead, Bristol Single centre Imperial, WLRTC Single centre ‘network’, Lister** Manchester Royal Infirmary Salford Royal Nottingham City Derby The Freeman, Newcastle James Cook Queen Elizabeth, Birmingham Shrewsbury, Wolves. , North Staffs. , Heart of England Liverpool for North Wales Aintree Cardiff University Swansea Royal Infirmary, Edinburgh Regional Belfast City Regional Timely Listing West Midlands, July 2015 *(n=11) ** participating referring centres

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* *http: //www. odt. nhs. uk/pdf/Transplant_First_Timely_Listing_for_Kidney_Transplantation_Marc 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 1881 15. 4 Adult LDTx 1050 34. 3 Paediatric DDTx 73 23. 3 Paediatric LDTx 69 39. 1 * 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” http: //odt. nhs. uk/pdf/ldkt_2020_strategy. pdf Timely Listing West Midlands, July 2015

Objectives: LDKT 2020 1. 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 Oversight Group Chair Aisling Courtney NHSBT Lead Lisa Burnapp Commissioning Nesta Hawker Access & Availability Donor Safety Aisling Courtney Vassilios Papalois Timely Listing West Midlands, July 2015 Higher Immune Risk Nizam Mamode

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

Thank you. Timely Listing West Midlands, July 2015