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Sustainable Health and Green Care

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

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Sustainable Health and Green Care

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

  2. “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

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

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

  5. Disuse-Disability Spiral Painter (1996)

  6. 10% of our wealth is spent on health

  7. Value Waste Value Waste

  8. 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.”

  9. 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.”

  10. Results of Public Opinion Survey: Source: Ipsos MORI

  11. Trends in Late Referral by Year Late referral defined as ≤3 months before RRT start Data from Canadian, UK and ANZDATA Renal Registries

  12. 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

  13. The mean eGFR at initiation of RRT is rising The mean eGFR at initiation of RRT in 2009 in the UK was 8.6 The mean eGFR at initiation of RRT in 2008 in the US was 11.1 Percent distribution at initiation by eGFR

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

  15. Shared Decision Making: The care team communicates to the patient personalised information about the options, outcomes, probabilities and scientific uncertainties of the various treatments. “is a fundamental part of care planning and promotes the best choice in what otherwise can be a complex and overwhelming situation.” 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/

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

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

  18. Aerobic Exercise Training: Haemodialysis bed cycle ergometer training

  19. 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

  20. 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 31,000km Environmentally sustainable health and social care: scoping review – Naylor and Appleby, March 2012

  21. 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

  22. “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

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