1. Timely Listing West Midlands, July 2015 ‘Transplant First’ NHS Kidney Care NHS Blood and Transplant 2011/12 Lisa Burnapp Lead Nurse-Living Donation NHSBT

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

3. Timely Listing West Midlands, July 2015 UK Pre-emptive Kidney Transplantation* Kidney only Tx. (n) Pre-emptive Tx. (%) Adult DDTx14097.6 Adult LDTx95831.8 Paediatric DDTx7319.5 Paediatric LDTx6939.4 * NHS Blood and Transplant April 2009-March 2010

4. Timely Listing West Midlands, July 2015

5. 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)

6. 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

7. 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

8. 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

9. 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)

10. Timely Listing West Midlands, July 2015 Transplant Centres* Derriford, PlymouthSingle centre Southmead, BristolSingle centre Imperial, WLRTCSingle centre ‘network’, Lister** Manchester Royal InfirmarySalford Royal Nottingham CityDerby The Freeman, NewcastleJames Cook Queen Elizabeth, BirminghamShrewsbury, Wolves., North Staffs.,Heart of England Liverpool for North WalesAintree Cardiff UniversitySwansea Royal Infirmary, EdinburghRegional Belfast CityRegional *(n=11) ** participating referring centres

11. Timely Listing West Midlands, July 2015 Similarities Overall aims & objectives Nursing support/MDT approach Finance (pro-rata) Sustainability Recruitment challenges

12. 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

13. 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

14. 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

15. 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

16. Timely Listing West Midlands, July 2015 Findings* *http://www.odt.nhs.uk/pdf/Transplant_First_Timely_Listing_for_Kidney_Transplantation_Marc h_2013.pdf

17. 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

18. Timely Listing West Midlands, July 2015 How are we doing?

19. Timely Listing West Midlands, July 2015 UK Pre-emptive Kidney Transplantation* Kidney only Tx. (n) Pre-emptive Tx. (%) Adult DDTx188115.4 Adult LDTx105034.3 Paediatric DDTx7323.3 Paediatric LDTx6939.1 * NHS Blood and Transplant April 2013-March 2014

20. Timely Listing West Midlands, July 2015 Adult Pre-Emptive LDKT

21. Timely Listing West Midlands, July 2015 Pre-emptive LDKT by Centre RFH

22. Timely Listing West Midlands, July 2015 What are we doing now?

23. 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

24. 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

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

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

27. Timely Listing West Midlands, July 2015 Thank you.