Joe Wildy of CSL Vifor outlines the importance of delivering integrated renal services through adopting whole person care for people living with CKD in England, looking at the opportunity that delegated commissioning of specialised services provides in achieving this.
This article has been developed and funded by CSL Vifor.
Chronic kidney disease presents an ongoing challenge to public health, impacting the lives of patients across the country. It affects 7.2 million people in the UK and costs the NHS £6.4bn annually. CKD is a long-term condition that can lead to a gradual loss of kidney function.[1]
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Through harnessing opportunities to embrace integrated care, the NHS can look to turn the tide on the impact of CKD on patients.
In the current model of CKD management, certain groups, such as those from ethnic minorities or socially deprived communities, are likely to have a different experience of the CKD care pathway than others.[2] This disparity within CKD patients’ experience of the health system may have a role in deepening health inequalities in wider society.
Looking to understand these challenges, CSL Vifor recently conducted a national call for evidence with patient groups, clinicians, and policymakers to assess the state of renal services and understand solutions to improving CKD patient care.
Responses highlighted that healthcare inequalities are present across the whole CKD pathway, from risk factor management to end-stage care, and that perceptions of healthcare inequalities in CKD are widening in comparison to previous years.[3]
Responders highlighted a lack of integration between services as one of the key challenges,[3] suggesting that CKD is often treated in isolation from other comorbidities (cardiovascular disease, diabetes, hypertension), which are all associated with CKD.[4]
As the UK population ages, more people are living with multiple conditions, requiring an integrated approach to service delivery.[5] Without this, we risk seeing poorer health outcomes for people most likely to live with multiple long-term conditions: those from minority ethnic and poorer socioeconomic backgrounds.[5]
There have been positive developments from NHS England that illustrate they understand the challenges arising from these demographic changes. Specifically, the focus on integration as a central tenet of its overarching strategies, demonstrated most recently by integrating specialised services within integrated care systems, is welcome.
Delegation of specialised renal services to ICSs represents an opportunity to bring commissioning for the entire CKD pathway together, combatting the existing fragmented approach to CKD care.[6] End-to-end local commissioning can allow integrated care boards to take control of the CKD treatment journey and tailor decisions to their communities, reducing disparities and focusing on individual care.[6]
At CSL Vifor, we have been working to support NHS cardio and renal teams to develop expanded intravenous iron treatment services to jointly manage cardio-renal patients diagnosed with iron deficiency anaemia. Initiatives like this could mitigate delays in access to essential care without impacting wider capacity, remedying the lack of resource that can often prevent successful integration within the NHS.
NHSE has already taken welcome steps to try and improve how people with CKD are managed, through the Renal Service Transformation Programme and creation of a national clinical director for renal medicine. The delegation of specialised commissioning is another initiative that has the potential to transform the delivery of renal services. ICBs can harness this to implement renal services in a way that reduces disparities rather than widening them.
About CSL Vifor
CSL Vifor is a global partner of choice for pharmaceuticals and innovative, leading therapies in iron deficiency and nephrology. We specialise in strategic global partnering, in-licensing and developing, manufacturing and marketing pharmaceutical products for precision healthcare, aiming to help patients around the world lead better, healthier lives.
Job number: UK-NA-2400021
Preparation date: April 2024
References
[1] Kidney Research UK (2023). Kidney disease: A UK public health emergency. Available at: https://www.kidneyresearchuk.org/2023/06/05/kidney-disease-is-a-public-health-emergency-that-threatens-to-overwhelm-the-nhs-major-new-report-reveals/ (Accessed March 2024)
[2] Kidney Research UK (2018). Kidney health inequalities in the UK: An agenda for change. Available at: https://www.kidneyresearchuk.org/wp-content/uploads/2019/09/Health_Inequalities_lay_report_FINAL_WEB_20190311.pdf (Accessed March 2024)
[3] CSL Vifor (2023). Data on file. Available upon request
[4] Warrens (2022). Cardiovascular Complications of Chronic Kidney Disease: An Introduction. Available at: https://www.ecrjournal.com/articles/cardiovascular-complications-chronic-kidney-disease-introduction (Accessed March 2024)
[5] NIHR (2023). Multiple long-term conditions (multimorbidity) and inequality- addressing the challenge: insights from research. Available at: https://evidence.nihr.ac.uk/collection/multiple-long-term-conditions-multimorbidity-and-inequality-addressing-the-challenge-insights-from-research/ (Accessed March 2024)
[6] NHS England (2022). Roadmap for integrating specialised services within Integrated Care Systems. Available at: https://www.england.nhs.uk/wp-content/uploads/2022/05/PAR1440-specialised-commissioning-roadmap-addendum-may-2022.pdf (Accessed March 2024)
