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| TX: 10.07.03 - KIDNEY DIALYSIS PATIENTS HAVE DIED BECAUSE OF LONG JOURNEYS TO HOSPITAL CLAIMS DOCTOR |
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PRESENTER: CAROLYN ATKINSON ATKINSON News that kidney patients are having to endure longer and longer journeys to hospitals for their dialysis treatment. Rising numbers of patients, transport services - which pick up people across a wide geographical area - and road congestion can mean that these vital trips to the hospital can take 15 hours. Okay if that's once in a while but no fun at all if it's three days a week, as it nearly always is. One leading renal consultant attributes three recent patient deaths to these journeys. Well Tim Statham is from the National Kidney Federation, which represents Britain's 30,000 or so kidney patients. Tim, first of all, let's just establish the basics here. Can you just tell us what dialysis is? STATHAM Yes the body has kidneys - two kidneys - in their back and the purpose of kidneys is to purify the blood so that you don't get poisoned. And kidneys therefore purify the blood and also get rid of excess liquid. This comes away from the body as urine. Now what happens when the kidneys go wrong, they can either go wrong slowly or they can go wrong all of a sudden. There are people, probably a hundred thousand people in the country, with some form of kidney disease but the only kidney patients that the National Kidney Federation concerns itself with, at this time, are the ones with a condition called end stage renal failure. ATKINSON And there are then different types of dialysis aren't there, some people can do it at home, other people have to go to hospital. STATHAM Yes, you've got to realise that end stage renal failure affects about 34,000 people in this country and of those 15,000 are on dialysis and as you rightly say there is a sort of dialysis called haemodialysis where the blood is taken out of the body through a machine and returned to the body or there's peritoneal dialysis where a liquid is put into the stomach, the dialysis takes place in the stomach and it's then injected into another bag. The shortages in the country are in the haemodialysis area. ATKINSON Indeed. And the bulk of people on haemodialysis aren't actually on a transplant list at all are they? STATHAM No because there are far too few transplants available. ATKINSON What actually happens then if you don't get dialysis? STATHAM Well you will die very quickly. If your kidneys are not working well enough to support life you will die within days or weeks. And you stay alive by having dialysis three times a week for periods of up to four hours. But the problem, as you said in your introduction, is the fact that it isn't just four hours, for many patients it's a 12 hour day. ATKINSON Tim, we will come back to you in just a moment, thank you for the moment Tim Statham from the National Kidney Federation. Now about 40 patients from north Essex are currently making the journey into London because there are not enough dialysis machines in their area. Others go to Cambridge and Ipswich as well. Now patients are picked up by hospital transport for a journey which can take anything between three and a half to five hours. The dialysis itself then takes between four and five and then there's the journey home again. Well Dr Martin Raftery, a renal specialist with 21 years experience, claims that three of his patients have died because of the trauma of having to travel hundreds of miles a week from north Essex to his unit at the Royal London Hospital in Whitechapel. RAFTERY To get up at 5 o'clock, wait for transport, wait for that transport to pick up three or four more patients in north Essex, drive for three hours on the A12, passing a dialysis unit on the way, arriving here, waiting to go on a machine, spending four hours on the machine, waiting for transport to pick them up after dialysis, again dropping off the other patients and spending 17 hours on the road - for a disabled patient in their 70s it's intolerable and they do deteriorate and they do die prematurely because of it. ATKINSON You've had three people in your view have died prematurely in the last - since round about Christmas time. Can you tell me the sort of people that they were? RAFTERY One was just under 70, two were in the their mid to late 70s. They were very frail. At the time that they started dialysis I thought about putting them onto peritoneal dialysis because I thought that the journey would be intolerable, which means doing the treatment at home. But in each case I came to the view that either the patient or the spouse or both were not basically robust enough to be responsible for their own treatment. So they were put on to haemodialysis three times a week, three round trips. One of them, in fact, ended up, for the six weeks he was on dialysis, actually as an in-patient in Colchester Hospital being transferred by ambulance, he never got home. And I find it hard to believe that if these patients had had access to dialysis locally that they wouldn't actually have achieved a better quality of life and a longer duration of life. ATKINSON What would you say to people though who say that these patients would have died anyway because it was other things that killed them? RAFTERY And the answer is you could say that but I look after about 800 patients who've got kidney failure and you know when the treatment isn't going well and you know when it's not going well for a reason. And sometimes you can identify what the reason is. And the question is: did they die prematurely and was their quality of life seriously adversely affected such that they did probably die prematurely? That's a very difficult call but you know like I said one of those patients actually never left hospital and I saw him arriving week after week, exhausted from a three and a half hour ambulance drive, and I can't believe that it didn't contribute to his deterioration and death. And he was a patient of mine for two and a half years before he started dialysis, so I knew him very well. He became more and more immobile, more and more withdrawn and depressed and effectively just gave up. Dialysis is a strange treatment in that it makes the patient well but what you try to do is you try to provide 48 to 72 hours worth of renal failure treatment in a four hour period, now by definition that's quite demanding. So some of those patients feel very washed out and quite frail at the end of a dialysis session and the last thing they need, frankly, then is a three and a half hour ambulance journey. ATKINSON And you have actually admitted people here because they can't cope with going back in the ambulance? RAFTERY Oh that would be a regular occurrence, it wouldn't just be patients who were coming a long distance but it is not at all unusual to assess a patient at the end of the dialysis and say that patient is not fit to go home and admit them to an in-patient bed. Now obviously if the trip was 30 minutes you might sort of say they'll be okay but if the trip was somewhere between three and four hours you might say well this is not safe. ATKINSON You're obviously extremely concerned about the whole situation, are you able to take this up with the authorities in a much more formal way? RAFTERY I have made my concerns known at all sorts of meetings with the health authorities in that area. I'm concerned because I feel that I'm a backstop - providing treatment which I regard as being of insufficiently good quality. I know that there have been discussion about putting dialysis facilities into Colchester General Hospital since 1992 and there are still no dialysis facilities present there, nor any projected to be there until, as I understand it, late in 2005. I think this is a matter that requires a more urgent approach than that. ATKINSON That's Dr Martin Raftery, a renal specialist at the Royal London Hospital. Well in fact there are currently only 15 dialysis machines in north Essex itself, where south Essex with the same population and the same rate of kidney failure, has almost three times as many, at 44. But north Essex is not alone in having poor facilities for kidney patients - the West Country has problems and for example people in Lincolnshire are sent as far afield as Hull, Nottingham and Leicester for their dialysis. Well Tim Statham from the National Kidney Federation is still here. Tim, is this issue, as we've been hearing there, of patients actually dying after doing these long trips something that you actually recognise? STATHAM Yes indeed we do and unfortunately the situation is worse than you say. It is a crisis at this point because there are not sufficient dialysis facilities in this country. We have a situation where patients are now being turned away and not being offered dialysis. The National Kidney Federation operates a telephone helpline and we get calls from distressed relatives who know perhaps their mother or their father has gone into renal failure, that they are not being offered dialysis and they don't want to die and the children ring us up and say what can you do to help? And it is so bad that we have now employed a specific officer - even though we're a small charity - we've employed somebody to go around the country to the hospital to argue the case of the patients. But the trouble is all of these renal units are stretched to the absolute maximum capacity, some of them are dialysing patients right through the night simply to try and keep level and they're not keeping level because there is a 10 per cent growth of dialysis patients every single year and there is not a 10 per cent growth in haemodialysis facilities. ATKINSON From what we've been reporting and from what you're saying the national standards of a 30 minute trip or a 20 mile journey are just way, way off aren't they? STATHAM They're way off. I mean the transport is another serious problem. But the most important problem is that unless we can increase the number of dialysis stations by 250 every single year for the next 10 years there is going to be more and more of our patients turned away to die. And in Britain, with an NHS, this is a disgrace, it's a national disgrace. ATKINSON We have a response from Colchester and Tendring NHS Trust, who are two of the trusts involved in the situation in north Essex at least. They agree that long distances are very bad news for patients and they say they're trying to do something about it, they accept there's a problem. But their argument is along the lines of they're a new primary care trust, they've only been set up, they're doing the best they can, you can't build units and staff them overnight. STATHAM Yes but three years ago on this very programme I warned a government minister, who was also on the programme, that there was a time bomb about to go off and there was an acceptance that, yes, there was a serious problem. And in fact very little has been done. Now the bomb has gone off and our patients are dying. It's all very well saying we've only just set up primary care trusts but there have always been people there to spend the money on renal services and it hasn't happened. I don't think that the new primary care trusts are better placed than the old system to spend money. The plain truth is they're not likely to be spending it in the quantities required. ATKINSON Okay Tim Statham from the National Kidney Federation thank you very much indeed. Well in fact we did ask the health minister, Rosie Winterton, to come live on the programme but she was too busy. The department though did send us a statement acknowledging that better access to dialysis is the best way to reduce the travelling times. It says there's a review of hospital transport and that 拢28 million worth of facilities have been established in the past three years, with another 拢32 million worth in the next three years. It says more than 350 dialysis stations have been established. And we've just had another statement from Colchester and Tendring PCT, they say they're surprised and concerned by Dr Raftery's claims that we were hearing just a moment ago in the programme claiming that three patients have actually died, they say they will contact Dr Raftery later today to find out more details and if these cases relate to Colchester and Tendring then they will investigate them thoroughly. Back to the You and Yours homepage The 成人论坛 is not responsible for external websites |
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