London Facing Kidney Crisis

By Jo Revill

For five years, Robert Fulton has been waiting for a new kidney. His greatest fear is that by the time he reaches the top of the nationwide queue for a donor organ, he will be considered too old. "My consultant has told me not to worry, but you can't help thinking that a younger man will be put first," said Mr Fulton, 66, from his home near Grays, Essex. "I know a man of 30 who has five children, and he's waiting just like me. In some respects, perhaps his need is greater than mine."

Mr Fulton's situation reflects that of thousands of people who have serious kidney disease or failure and need a new organ. There are currently 4,814 people in the UK queue, but last year only 1,367 kidney transplants were carried out.

He underwent a transplant in 1991, but the kidney failed after four years. After such a long time on dialysis, he is finding it increasingly hard to walk long distances and gets out of breath visiting the shops. "There are so many more patients like myself these days," he said. "When I went to Southend General Hospital five years ago there were 60 of us on the transplant list. Now there are 120."

The shortage of donor organs is having an enormous impact on the rest of the service, because it means more patients are having to rely on haemodialysis to stay alive. Dialysis does the work of the kidneys, by removing excess water and waste products from the body. Three times a week, for four hours at a stretch, the patient's blood is circulated through a cellophane tube, on the other side of which is a liquid that returns the blood to its normal, healthy state.

Such a technique saves the lives of patients who are at end-stage kidney failure, who would otherwise have at most one week of life. But it doesn't work indefinitely, and patients gradually get weaker and sicker as the heart comes under pressure.

Dialysis was at first inevitably rationed, so younger patients were given priority. During the Eighties and Nineties, more and more units were set up to meet the growing demand. But rationing is coming back, because the resource and staffing problems of the London renal units are so great.

Senior renal experts in London have warned the head of London's NHS, Nigel Crisp, that rationing is now occurring, and patients who would have received care a year ago are being turned away.

Apart from the shortage of donor organs, the other major problem lies in the haemorrhaging of senior nurses to the private sector. In confidential documents leaked to the Evening Standard (and shown below) hospital after hospital says it has watched senior staff going into private hospitals. This means several have had to purchase dialysis care from the private sector as they no can longer offer it in their own units. Nurses have been recruited from South Africa, the Philippines and Denmark, but this is an expensive, temporary measure.

There is also a real cash shortage, which means that charities such as the British Kidney Patient Association are left to find the money to set up satellite units where patients can receive dialysis. Elizabeth Ward, president of the association, said: "Patients should be receiving dialysis three times a week, but we know of areas that are rationing this to just twice a week, which can be harmful.

"It is so awful that Britain should be going back to the bad old days of the Seventies, when patients over the age of 50 were turned away. This is not the sort of thing that should happen in a civilised society."

Professor David Oliviera of St George's Hospital, Tooting, told the Standard: "We have done particularly badly compared with some other European countries over the last 10 to 20 years." Another of those who alerted the NHS to the "worsening crisis" is Professor Hugh Cairns, of King's College Hospital. "We don't turn down anyone for dialysis based on age, but the problems are probably less severe here. It is expensive, though: it costs £25,000 to £30,000 a year to dialyse someone," he said.

Other doctors are worried that the funding is not there for the annual seven per cent rise in numbers needing dialysis. Dr John Scoble at Guy's said: "It feels as if we are on a knife-edge right now. So far I have not turned away anyone needing dialysis, but it could happen tomorrow."

The Problems At London's Renal Units

The stark truth about London's renal units, according to the confidential document:

• UCL/Middlesex: there is a shortage of haemodialysis machines, six nurse vacancies, and senior nurses have recently left for private hospitals. Plans to build a satellite centre at the Whittington Hospital appear to have been frozen.
• Charing Cross: there is a shortfall in funding, but the nursing shortage is so severe that they have had to recruit nurses from abroad, at £5,000 a time. A "considerable number of patients" are having insufficient amount of dialysis for their needs.
• Hammersmith: for the first time, there is "a significant waiting list" to go on to haemodialysis. Patients cannot be admitted in time for non-urgent surgery, and the reduction in junior doctors' hours has led to a shortage of staff.
• Royal London: this hospital has actually seen a reduction in the number of new patients it is taking on to dialysis, despite the fact that there is enormous demand from the multi-racial community. There is an estimated £600,000 shortfall for the work. There are 29 nursing vacancies, and the unit cannot now meet the proper medical standards.
• St Mary's: there is a waiting list to start haemodialysis, the buildings at the hospital are in "a dismal state of repair", exacerbated by a critical lack of future planning and no commitment to funding for next year's patients.
• The Royal Free: the enormous pressure on beds means half the planned operations for surgery preparing patients for dialysis have been cancelled in recent months. The hospital has sent 24 patients to private hospitals, and this number is likely to increase in order to meet the demand.
• Guy's: has 20 healthcare assistants, when it should have 135 to run its satellite centres, and has brought in more from Denmark. It is having to refuse acute emergencies from district general hospitals because of pressure on beds.
• St George's: patients who need "access procedures" are being admitted as emergencies as it is impossible to admit them as routine cases. Only an expensive recruitment drive in the Philippines averted a serious nursing shortage.
• King's College Hospital bed shortages are so severe, patients have to wait two months before dialysis. Despite the two-fold increase in workload, bed numbers have stayed the same for five years.

Copyright © Associated Newspapers Ltd. March 2000.