Kidney Dialysis (Elimination of Waiting Lists) (Hansard, 22 October 1986)

§ Mr. Tony Favell (Stockport)

I beg to move, That leave he given to bring in a Bill to establish procedures for eliminating the waiting lists of patients who require kidney dialysis by contracting out the provision of such facilities. Experts have estimated that in England and Wales about 1,200 kidney patients are not being served by the dialysis transplant programme. It might help if I explain how that figure is reached. In 1984, in England and Wales, 35 new patients per million head of population received treatment. In many European countries — for example, in West Germany and Spain — the figure was 55 new patients per million.

Before anyone points the finger, I remind the House that, in recent years, my right hon. Friend the Secretary of State for Social Services has brought about an enormous improvement. Provisional data for 1985 suggest that in the past year alone the number of new renal patients treated increased from 35 to 40 per million. Data received from the United Kingdom transplant service show that the number of transplant operations performed in the United Kingdom during the six months from January to June 1986 increased by no less than 24 per cent. That is excellent news for those people awaiting transplants.

However, I regret to say that the number of patients awaiting transplants will not reduce until there are more donors. Despite regular and widespread appeals for donors, there is still a tragic shortage. There is a waiting list of 3,000. Many opportunities to donate kidneys are lost through the relatives of someone who had just died failing to appreciate that another's life could be saved. I realise how difficult it is for hospital staff to raise the question of transplants with grieving relatives.

There is therefore a great deal of sense in following the example of certain American states which are considering putting doctors under an obligation to raise the matter with relatives, in suitable cases. If doctors are under an obligation to raise the issue, they will be saved the acute embarrassment of suggesting a donation of organs on the death of a loved one.

My Bill deals with the shortfall in the provision of dialysis treatment for those patients awaiting transplants and those for whom a transplant is not suitable. In that sphere, much has been achieved in the United Kingdom. Almost a quarter of Europeans receiving continuous ambulatory peritoneal dialysis receive treatment in this country. The United Kingdom has a first-class record on home haemodialysis. Few European countries have more than 10 per cent. of their patients treated at home. Yet over half of our patients have that advantage.

It is in hospital dialysis where we lag behind many European countries. Those for whom CAPD, or home dialysis, is not suitable must rely on hospital treatment. What concerns me is that the shortage of those treated is not through lack of equipment. Doctor Alex Davison, a consultant renal physician of the department of renal medicine, and Professor Geoffrey Giles, a professor of surgery at St. James university hospital in Leeds, in an 1193 article last year, estimated that the number of patients treated by hospital dialysis could double without the purchase of one additional machine.

That finding is supported by a study which reveals that each hospital dialysis machine in the United Kingdom supports only one patient, while in Europe the corresponding figure is 2.9 patients. In other words, one machine in England supports one person, whereas a machine in Europe supports three. That is an appalling waste of resources. No doubt some will argue that the position arises from a shortage of staff. Whilst that may be true in a limited number of cases, it is my firm belief that hospital dialysis machines are not worked to capacity because of inflexible working practices in many Health Service regions.

The best way to explain this is by considering what is happening in Wales. In 1984, 33 new kidney patients per million received treatment. In 1985, just one year later, about 56 new patients per million received treatment. That was due entirely to a bold initiative taken by my right hon. Friend the Secretary of State for Wales. He invited tenders for the provision of two new renal units. In each case, the district health authority submitted in-house bids in competition with the private sector. In both cases, the private sector bids were successful. Within five months of the contracts being awarded, the units were built, equipped, staffed and receiving their first patients. In each case, there was a substantial saving to the health authority concerned.

The units were brought into operation so quickly simply because the successful bidders were experts in kidney dialysis. They had set up units many times before. That is not so with most district health authorities. Recently, one district health authority took as long as seven years from the date of the go-ahead to bring a unit into operation.

The savings, which can amount to as much as £6,000 per patient per year, are accounted for in a number of 1194 different ways. I shall give examples of what is done at the unit at Carmarthen which I visited. Firstly, administrative overheads are kept to an absolute minimum. Secondly, the staffing patterns are flexible to minimise loss of staff time. For example, the staff customarily work three 11-hour days a week, which accommodates two sets of patients within an 11-hour shift. Most National Health Service units accommodate one set of patients in an eight-hour shift. Thirdly, the unit does not employ technicians; rather, it trains nursing staff to perform technical equipment work. Modern equipment is so reliable that technicians are not required on-site to service equipment. It is far better to keep one or two spare machines in case of an emergency and to make use of manufacturers' service contracts. Fourthly, the unit contracts out all its housekeeping and maintenance services.

Health authorities in England have been urged to follow the Welsh example and to put the provision of hospital kidney dialysis out to tender, but alas with no success. My Bill makes that compulsory. If a health authority, by improved working practices, wins a contract, that is fine, but, if not, resources will be released to treat more patients. When I visited Carmarthen, I found a well-run unit with which patients and staff were highly delighted. The National Health Service renal consultant whom I met had no criticism whatever. Most importantly, lives are being saved. I commend my Bill to the House.