National Nephrology Seminar dinner speech
Speech by John Horvath, Chief Medical Officer, at the National Nephrology Seminar, Sydney, 10 February 2006.
- Distinguished guests:
- Dr Paul Snelling, President of the Australia and New Zealand Society of Nephrologists
- Associate Professor Philip O’Connell, President of Transplant Society of Australia and New Zealand
- Ms Anne Wilson, CEO of Kidney Health Australia
- I am very please to represent the Minister, the Hon Tony Abbott, this evening.
- As a former head of a renal and transplant service, I have a very real understanding of what the many challenges that confront you in trying to deliver high quality services to all who would benefit.
- Patients with renal disease and those health care professionals working will then have greatly benefited from the contribution of hard working volunteers and community groups such as the Kidney Foundation (now KHA) Transplant Australia, Australian’s Donate and a large number of other organisations. I am sure I have left a lot of people and groups out and I don’t want to offend anyone but the list is too long, not to mention the valuable role Industry plays through research, development and sponsorship.
- The advocacies of all these organisations are vital to improving the outcomes of care.
What are the challenges
- Chronic diseases currently represent 80% of the burden of disease in Australia. With the ageing of our population, this will become an even more critical area for action at all levels of the health system. The valuable work done to describe the burden of disease with the Ausdiab Strategy was a very important contribution. Prevention is the key to a future wherein older Australians can live both longer and healthier lives. The Absolute Risk Project done together with Diabetes/HF is an important advance and the Department will be looking at how to progress this work.
- Ten years ago the Government created cardiovascular disease as a National Health Priority which now also includes chronic kidney disease. Five years ago, we established a special strategies group, bringing together a "brains trust" of jurisdictional, consumer, general practice, public health and clinical expertise. Kidney Health Australia is part of this group that helps us generate national guidelines and recommendations as well as coherent strategies to achieve improvements in care.
- In July last year, we funded Kidney Health Australia to develop an education program for GPs on the use of Glomerular Filtration Rate estimations. The education campaign, targeting GPs, will ensure they are fully aware of the implications and limitations of the new tests to assist with earlier diagnosis and management. There continues to be a number of programs that we are working together on.
- In November 2005 Health Ministers endorsed the Chronic Disease Strategy. This is an overarching document with the aim to better co-ordinate and manage chronic illness from prevention to palliation.
- As you will know, organ donation rates have varied considerably over the past decade. There were 204 donors in 2005, compared with 218 in 2004; and, as you will all be aware, only a small number of potential donors are deemed as appropriate medically to donate. In 2005 there were 623 patient transplants from kidneys donated in Australia. This included 377 cadaveric donor and 246 live donor kidney transplant. The Minister asked me to stress that this is an area of major concern to him.
- A major concern to the Minister is that every avenue to maximize donor rates would need to be explored. The Government is prepared to look at proposals that realistically can improve donor availability and that are practicable and feasible.
Strategies - what are we doing?Three key strategies are being adopted by the Australian and State and Territory governments to increase organ donation rates.
- Maximising Organ Donor Register numbers:
- During April to June 2005, there was a national mail out to all Australian households to coincide with the introduction of the ‘consent’ registrations on the Australian Organ Donor Register (AODR). The aim of the consent based register, as opposed to the original ‘intent’ register is to ensure that explicit consent to donation after death is recorded and to reduce the rate of family objections.
- Medicare Australia has received over 720,000 registrations for the new consent based register in addition to the existing 4.8 million intent registrations on the AODR.
- Policy development on living organ donation:
- The National Health and Medical Research Council through the Australian Health Ethics Committee is reviewing their national guidelines on organ donation over 2006. This project will include public consultation on possible changes to protocols for living organ donation for different types of organs, including kidney. This will help guide clinical practices across the donation and transplant specialities.
- The Australian Health Ministers’ Advisory Council is also working on a national living donor liver transplantation policy. This is being developed as one response to the shortage of donor organs. It aims to balance the potential benefits of this procedure for individuals with end stage liver disease with concerns for donor safety.
- Supporting clinical initiatives to maximise organ donation:
- The Australian Government funds the Australasian Donor Awareness Programme (ADAPT) to run 38 training courses in 2005-06 for health professionals (including clinicians, donor coordinators and nursing staff). This program assists hospital staff to maximise the identification of potential organ and tissue donors and improve techniques for discussion and consent with donor families. The ADAPT training courses have been endorsed by ANZICS as a core component in specialist training for Intensive Care specialists. This is a step forward from the unit previously being an elective specialist unit.
- Australians Donate, with ANZICS and TSANZ, will trial a Transplant Procurement Management (TPM) pilot course in Australia. This course builds on the Spanish model for organ procurement and is being tailored for the Australian environment. Spain has the highest organ donation rate in the OECD and provides an interesting model for initiatives in this area. The first trial will be held in May 2006 with 36 participants from across Australia.
- Some States and Territories are implementing specialist in-hospital donor coordinators to provide better liaison between ICUs and Emergency Departments with donor families and the State organ donor coordination agencies. Western Australia and Queensland employ specialists to focus on organ donation, as a process quite separate from transplantation.
- The Australian Government’s aim is to better involve clinicians through ANZICS and TSANZ in setting the policy agenda for organ and tissue donation in Australia.
- Finally the major theme of tomorrow’s conference is an important one. That is how to best manage the complexities of your Departments.
- We are in a competitive environment at all levels - be it between dialysis versus transplantation versus prevention inside of the Unit to portfolio rivalry at State and Federal levels.
- I am quite sure that the Minister Nelson, despite his former life as a GP can mount a convincing argument for a new plane or destroyer ahead of more money for renal services.
- We need to have good management skills to plan our Departments and the strategies skills to position ourselves for the future.
- Thank you and again I am sorry that I am a late fill in for the Minister.
- I wish you well for the rest of the meeting.
When accessing large documents (over 500 KB in size), it is recommended that the following procedure be used:
- Click the link with the RIGHT mouse button
- Choose "Save Target As.../Save Link As..." depending on your browser
- Select an appropriate folder on a local drive to place the downloaded file
Attempting to open large documents within the browser window (by left-clicking) may inhibit your ability to continue browsing while the document is opening and/or lead to system problems.
To view PDF (Portable Document Format) documents, you will need to have a PDF reader installed on your computer. A number of PDF readers are available through the Australian Government Information Management Office (AGIMO) Web Guide website.