National Renal Advisory Board Meeting 13 May 2016

National Renal Advisory Board Meeting

MEETING DETAILS Date and time: 9.30am to 2.15pm Friday 13 May 2016 Venue: Ministry of Health, Room 2-06, 1 The Terrace, Wellington

Committee Members Murray Leikis (Chairperson), Rachael Walker, Tonya Kara, Kay McLaughlin, Fredric Doss, John Schollum, Ian Dittmer, Chris Hood, Nick Cross, Max Reid, Annette Pack, Kimberley Reimers, Mardi Thompson Apologies Nick Cross, Kimberley Reimers By Invitation Minutes Taken By Annette Pack

No. Item Discussion/Action Responsibility Minutes

General Business 1 Review of the Board minutes recorded at the previous meeting held on 11 March 2016 The previous NRAB minutes were accepted as true.

2 NRAB Structure, Composition, and Two applications were received Function through the EOI process for a Service Leader/Manager to fill the vacancy due to the resignation of Jo- Murray Leikis Anne Dean.

Catherine Tracy was elected to the vacancy following a close vote.

Action: Advise both applicants of the outcome of the process and invite Catherine to attend the next NRAB meeting in August (Murray)

Regional Roundup 3 Northern Counties Manukau DHB’s new 30 Chris Hood station dialysis unit in partnership with Diaverum has been opened in the Mangere town centre. The new unit is in a convenient location and dialyses a relatively stable patient group.

The service model is operating well. The unit’s dialysis workforce are Ian Dittmer employed by Diaverum (mainly recent graduates), with medical staff provided by Counties Manuka DHB. A MOU between Diaverum and Counties Manukau DHB sets out the Murray Leikis service agreement levels for both parties, including criteria for patient acceptance, patient:dialysis staff FTE ratios and KPI reporting. The Tonya Kara services provided at the new unit do not include increased independence or home dialysis.

Waikato Auckland DHB’s Renal Service Max Reid continues work to identify a suitable site for a new in-centre dialysis unit. The Service continues to experience a growth in activity, although staffing levels are unchanged. John Collins has retired.

Central There have been organisational Max Reid changes in Waitemata DHB’s Renal Service

Action: Write to John Collins to thank him for his services to NRAB Southern and the renal community (Murray). John Schollum There continue to be shortages in paediatric nephrology in Starship Hospital. A SMO role remains vacant, although it is understood there has been some interest with a potential short term appointment possible by the year end. A nurse specialist position also remains vacant. The Chair has written to ADHB on his concerns about the impact of unfilled vacancies on remaining staff and national outreach services and is awaiting a reply.

In the absence of a representative from Waikato, Max reported on the launch a couple of months ago of the BPAC decision support tool that provides primary care with up-to-date clinical support for management of patients with chronic kidney disease. The tool has been well received by Waikato GPs. The roll-out will continue on a DHB-by-DHB basis.

Telehealth has also been implemented in Waikato and is working well in a region with a geographically dispersed population.

MidCentral DHB’s Renal Service continues to be stretched with increasing demand for in-centre dialysis and a decrease in the number of people on home dialysis. The DHB has commissioned an external review of its Renal Service, looking in the short term on managing increasing demand and longer term on capital options. The review includes dialysis services for Whanganui DHB’s population.

Demand for treatment and dialysis in 3 Southern DHB continues to increase, including assistance for home care.

Southern DHB has been accredited for two year Advanced Training for Nephrology.

Earthquake risks associated with Christchurch Hospital’s in-centre dialysis unit will be addressed as part of the campus redevelopment.

The vacancy for a clinical psychologist to support the DHB’s transplantation programme has been filled. New Business 4 Correspondence Pharmac is seeking nominations for a member of the Transplant Immunosuppressant Subcommittee which Murray Leikis provides expert clinical advice to both PTAC and Pharmac. The Chair will seek nominations through an EOI process.

Action: Seek interest through an EOI process to New Zealand Renal Group on nominations for the Transplant Immunosuppressant Subcommittee. 5. National Viral There was discussion on developing national standards for isolation and cleaning procedures after dialysing Murray Leikis Screening and patients with infectious diseases (eg HBV, HCV and HIV), to ensure there are nationally consistent protocols Protection in and practices. This work should have input from viral disease specialists. Haemodialysis Murray Leikis / Action: Murray to begin scoping work with Frederic. Fredric Doss 6. ANZDATA There was a good response to the online survey, with 48 responses received. The responses showed that Annette Pack ANZDATA’s services and the registry are highly valued by the renal community in New Zealand.

Recommendations for improvements are online submission of data rather than the current paper based process and the capability for DHBs to have online access to their data (the latter is understood to be close). The results of the survey will be shared with ANZDATA.

The need for ANZDATA to include apostrophes and accents for the correct spelling of patient names was noted.

Prior to the expiry of the current contract between ANZDATA on 30 June 2017, the Ministry will consult with NRAB on the development of a new service specification for ANZDATA services.

7. Nurse Prescribing There was discussion on prescribing systems in place in Counties Manukau, Auckland and Capital & Coast Chis Hood / and Transcribing DHBs. All

Practices must comply with the Medicines Act and the Nursing Council’s guidelines on prescribing.

General 8 NZ Chapter of the The annual meeting will be held in Whangarei on 13-14 October, with the venue to be advised. ANZSN The meeting sponsored by Baxters was held in May.

9 Nephrology As advised under agenda item 3 above, Southern DHB has gained accreditation for two year Nephrology Advanced Training Advanced Training.

10 Tier 2 document Amendments to the Tier 2 Renal Services specification , including Purchase Unit codes to capture Renal Ian update Service activity were discussed as follows: Dittmer/Tonya Kara/All  The definition of the PU codes for Renal Services First Attendance and Subsequent attendance need to be changed to include house officers and nurse specialists.

 New codes for paediatric haemodialysis and supportive care are proposed

 Possibility of codes for management of patients on plasma exchange?

 Some PU codes that are no longer being used will be removed.

Action: Send final version to NRAB (Ian/Tonya). 11 RRT access in NZ The current draft including all the feedback received to date was tabled. Murray Leikis

Some DHBs favour strengthening the document to include exclusion criteria from in-centre dialysis because of anti-social behaviours. Other DHBs are less supportive of this approach. There is also concern that a service specification is not the appropriate mechanism to identify the specific behaviours that will warrant exclusion from dialysis services.

The reference to requirement to provide in-centre dialysis will be changed to “independent and supportive” dialysis as Southern DHB does not offer in-centre dialysis.

Action: Ask Nick Cross to contribute wording on transplantation as a renal replacement therapy, including expected outcomes from deceased and live kidney donation and access to the deceased donor waiting list.

5 9 PTAC Nephrology Cinacalcet is now available under special authority. Tonya Kara subcommittee And Medicines 12 11 CKD National The roll out of the programme has been slower than expected, but as noted in agenda item 3, the BPAC tool Max Reid / All Strategy has been officially launched in Waikato, following the pilot in Southern DHB. There is flexibility in tailoring the tool by district. KHNZ is being funded by the Ministry of Health to help with PHO education. The availability of a nephrologist to attend after-hours meetings for primary care education could be a limiting factor in some areas. Dialysis 12 Holiday Dialysis An update was provided on KHNZ’s meeting with GMs Planning and Funding on its proposed project to improve holiday dialysis services. One suggestion is that all DHBs should fund an additional dialysis chair for Max Reid/ALL holiday dialysis. The GMs will nominate a representative to work with KHNZ on the issues.

KHNZ tabled advice from Health Legal on access to holiday dialysis provided by DHBs in New Zealand for overseas visitors covered by Reciprocal Agreement.

Action: Investigate whether advice on access to publicly-funded holiday dialysis in New Zealand by people who are covered by Reciprocal Agreements should be included in the OPF (Annette)

The situation of publicly-funded Australian hospitals charging New Zealanders for dialysis while on holiday in Australia is variable across states. KHNZ is working with KHA to gain clarity about policies in place in each state.

13 PD Registry Progress continues with more centres coming on board. There is ongoing work to provide new formats for Ian Dittmer Update / PDOPPS local centres to review their own data online to enable analysis and audit for each unit and a monthly PD unit update report.

Work continues to integrate the ANZDATA dataset into the PD Registry.

PDOPPS is underway in two centres, Middlemore Hospital and Auckland District Health Board.

There have been recent NZPDR presentations in Melbourne this year and Korea in 2015.

14 Disaster Planning, No developments to report. Kay patient and service McLaughlin preparedness 15 Health Alliance Health Alliance has moved to align all PD contracts by the end of June 2017. They are open to working with Ian Dittmer Contracts clinical staff to ensure clinical parameters will be met in the contract negotiations. Transplant 16 National Tx activity A record number of transplants occurred in 2015 (147), due to an increase in deceased donor transplants. Ian Dittmer

17 Kidney Exchange Collaboration with Australia on kidney exchange is progressing with administrative and funding issues being Ian Dittmer worked through. Standard Report Updates 18 Report on Kidney The Health Committee continues to seek further advice on the Financial Assistance to Live Donors Bill which Max Reid Health New will likely be referred back to Parliament in September 2016. Zealand Auckland DHB is unable to send out KHNZ’s consumer survey as it does not have a comprehensive database for pre-dialysis patients. 19 Subcommittee reports

1. Standards & The NZ standards and audit report will be finalised by next month. There will be versions available for dialysis Tonya Kara Audits and transplant patients. Graphs and powerpoints will be included to facilitate greater use of the data.

2. RSA / Nursing The workforce survey has been sent out to Nursing Advisory Group members. Advisory Group

3. NZ Board of The last Board meeting was in February. Dialysis Practice MIT has accepted a second intake of 10 students, nine of whom are local students.

20 Ministry of Health The Ministry’s Policy team is leading a Review of Deceased Donation and Transplantation. The Minister of Health has been provided with initial advice on proposals to increase deceased donation and is seeking approval to undertake wider consultation on these proposals.

As part of the Review, further work will be done on the capacity of, and funding implications for, DHBs to perform more transplants in response to increased organ donation.

Final advice is expected to be provided to the Minister of Health in October 2016. Other Business 21 Terms of The terms of reference will be reviewed to determine which members’ terms are due to expire. Ian Dittmer / Reference Murray Leikis Action: Add expiry of membership terms to the agenda item for November 2016 meeting (Murray) 7 Next Meeting Date: Friday 12 August Time: 9.30am Venue: TBC 2016