ARTIFICIAL KIDNEY MACHINES

HC Deb 08 February 1967 vol 740 cc1559-64

10.5 a.m.

The Minister of Health (Mr. Kenneth Robinson)

With your permission, Mr. Speaker, and that of the House, I wish to make a statement about the development of facilities for treatment of patients suffering from chronic renal failure by intermittent dialysis on artificial kidney machines.

On 7th March last year, I said in answer to Questions by the hon. Member for Aldershot (Sir E. Errington) and my hon. Friend the Member for Dewsbury (Mr. Ginsburg) that 95 National Health Service patients were being treated in England and Wales and that I hoped to provide facilities for not less than 100 additional patients within the next 12 months. At present, 116 patients are being treated either in National Health Service hospital centres or in the home under the supervision of a centre. In the next few weeks I hope that new units will be opened which are designed to treat about another 60 patients. Home dialysis will also be extended. The service is growing slowly at present, but will grow more quickly as schemes on which we are pressing ahead with the highest priority come into use. Three main causes have conditioned the rate of growth; the need to recruit and to train staff, the time unavoidably taken to plan and build or adapt specialised accommodation, and outbreaks of infection in existing units.

Training of staff inevitably takes time, especially while working units in which they can be trained are comparatively few. But more doctors, nurses and technicians must have the opportunity to acquire the experience that is vital for this kind of treatment, to enable the service to grow more rapidly. The present planned provision for training accommodation and equipment is not governed by availability of money.

The medical profession recognises that this treatment carries with it the danger of spread of disease carried in the blood—particularly jaundice which can be infectious and can be serious; and it is difficult to control. In recent months there have been outbreaks of jaundice in hospital dialysis units affecting both patients and staff, and there were deaths among staff. It was necessary to close one unit and to make emergency arrangements for patients already being treated: it was not possible to accept new patients. In another case, expansion of the service has been unavoidably delayed.

These setbacks reinforce the view of medical experts in this field, which my advisers accept, that it is most important that units should not start treatment of patients until adequate facilities are available. Otherwise we place in danger not only the patients, who will doubtless be willing to accept the risks, but the staff on whom many lives may depend.

I want to emphasise that the rate at which this service can develop, whether in the hospital centres or in the home, is not at present governed by considerations of money. Funds raised privately cannot, therefore, make a significant contribution, at the present time, to the more rapid expansion of facilities for intermittent dialysis in the National Health Service. I appreciate, however, that many generous people wish to express their support for the development of this service by giving money or by organising collections.

I welcome these manifestations of people's concern for the welfare of others, and I am anxious only that their gifts should be used to the best effect. This can be ensured if organisers of appeals would inform the regional hospital board for their area before any appeal is launched and then arrange that the terms of the appeal enable the money to be used at a hospital at which intermittent dialysis is to be carried out. Alternatively, the money could be used for research into the cause, detection and treatment of diseases which can cause chronic renal failure.

Miss Pike

I am sure that the whole country will welcome the Minister's statement and his assurance that the development of this treatment is not being held up by financial considerations. Do we understand that, within 12 months, facilities will be provided to treat about 220 patients in all, and is it not the fact that there are between 1,500 and 2,500 people in the country with serious kidney complaints? In that context, therefore, I am sure that the Minister will agree that a great deal of extra money will be needed in the long run to extend the facilities and the training of people needed in this service. We accept the right hon. Gentleman's assurance that this will be done, and the House welcomes his statement.

Mr. K. Robinson

I am grateful to the hon. Lady for her comments. I think that she slightly under-estimated the number of people suffering from chronic kidney disease, but the number she quoted represents very roughly the range of the present estimates of those who could be treated by intermittent dialysis. The initial aim in the development programme is to establish up to 20 main centres, each having at least 10 beds, capable of maintaining 25 to 30 patients on twice-weekly dialysis. This service is certainly not at present being held up by lack of money.

Dr. Winstanley

I welcome the right hon. Gentleman's important and valuable statement. May I ask three brief questions? First, will he assure the House that no limit will be placed on the facilities for dialysis of patients requiring it purely for short-term use in the course of an acute illness? Secondly, will he see to it that all possible publicity is given to his valuable statement about donations? Thirdly, will he increase the priorities for home dialysis in view of the very much lessened risk of infection of staff using the apparatus?

Mr. K. Robinson

I am very glad to assure the hon. Gentleman that facilities for the treatment of acute renal failure are perfectly adequate, and of course this is a treatment of much longer standing than intermittent dialysis for chronic renal failure. I hope that my statement will receive the greatest publicity, because I think that there is a great deal of misunderstanding about the problems involved in this treatment, and certainly misunderstanding which has led to a number of appeals being made all over the country.

As for home dialysis, as the problems are successfully tackled, I think that inevitably home dialysis will play a considerable part in the expansion of the service, but there are special problems here which it is important to evaluate before its widespread extension can be commended.

Mr. Archer

So that my right hon. Friend's statement shall not be misunderstood, will he confirm that where the organisers consult the regional hospital boards in advance some of the generous donations being made privately may accelerate the provision of these machines?

Mr. K. Robinson

I think that I have explained the position with regard to the acceleration of the programme, but certainly I would not do anything to discourage these expressions of generosity, provided that they are done in association with the regional hospital boards which can ensure that the money is directed to the object for which the contributors give it.

Mr. Edward M. Taylor

Can the Minister say whether any advice of a general nature is given to regional hospital boards about the allocation of these units in view of all the competing claims which there must be? Secondly, is he aware that there is a desperate and critical shortage of these units in Scotland? Are discussions going on between his Ministry and the Secretary of State for Scotland to make sure that a similar advance takes place throughout the country, and the shortage is equally shared?

Mr. K. Robinson

There is the closest consultation on this, as on other matters, with my right hon. Friend the Secretary of State for Scotland. Any question relating to Scotland should be asked of him.

As for the development of these units, there is certainly no hesitation on the part of the regional hospital boards to co-operate in the first stage programme which we have laid down, and which I have described to the House. They certainly do not need any urging to provide this service. They are only too anxious to do so as soon as trained staff and accommodation can be made available.

Mr. Onslow

On a point of order. Mr. Speaker. May I ask whether, in your opinion, hon. Members have been given sufficient notice of the Minister's intention to make this statement this morning? I know that a memorandum was published on page 7,206 of the Notices of Questions and Motions, but there was no notice in the Lobby until this morning. It seems to me that more hon. Members might have been present to question the Minister on this important subject if it had been possible to place a notice in the Lobby at, say, 6 o'clock last evening so that hon. Members would have been aware of this before they went home. Hon. Members do not necessarily read all the papers put before them, but I think that they take note of notices in the Lobby, and there is more chance of their doing that at 6 o'clock in the evening than at half-past nine in the morning.

Mr. Speaker

That is an interesting point, but Ministers usually do not have to give notice that they are going to make statements. I find it rather curious that the hon. Gentleman should complain when the notice is in fact on the Order Paper. This is the first time that I have seen a notice on the Order Paper about an intention to make a statement. Perhaps it is the fact that this is a morning sitting which has complicated things a little.

Mr. Boyd-Carpenter

Further to that point of order. Was it not understood, and were we not told by the Leader of the House, that only unimportant statements would be made at morning sittings, and is not this a statement of a quite different category?

Mr. Speaker

Order. That is certainly not a matter for Mr. Speaker.

Mr. K. Robinson

Further to that point of order. I said at Question Time on Monday that I proposed to make a statement on this subject later this week. At the time I did not say I would make it on Wednesday morning because it was not then certain that it would be made today.

Mr. Boyd-Carpenter

Surely that does not meet the point, Mr. Speaker. We were told that only unimportant statements would be made. The fact that the right hon. Gentleman said he was going to make a statement at some unstated time does not meet the objection, which ties up with the objection put by my hon. Friend the Member for Woking (Mr. Onslow).

Mr. Speaker

That is an interesting point, but it is not one for Mr. Speaker.