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Kidney Dialysis UK

1.30 pm

Mr. George Stevenson (Stoke-on-Trent, South): I am extremely grateful for the opportunity to raise the issue of dialysis services required by United Kingdom citizens on holiday in this country.

I requested the debate because my constituent Mr. Robert Huson, who was infected with hepatitis C through no fault of his own a few years ago, came to see me about it. Like many other sufferers, he wants to live as full and as normal a life as possible, which includes taking holidays. He has taken holidays abroad in Majorca, Malta and other sunny climes. Because of his condition, prior to booking a holiday, he has to ensure that dialysis facilities are available at his chosen destination.

My constituent tells me that he had little difficulty in securing dialysis services in Majorca and other places in Europe and no doubt his holidays do him the world of good. However, he cannot take such holidays unless he is sure that he can use a dialysis machine two or three times a week when he is away.

Mr. Huson wanted to book a holiday in the United Kingdom and he tried the Isle of Wight, south Wales, north Wales and the west country, but he was unable to secure the necessary dialysis services. That raises serious issues, to which I hope for a positive response from the Minister. First, why cannot the national health service provide those vital services to people who want to lead as normal a life as possible? Secondly, why can my constituent make arrangements for dialysis abroad, but not in this country? Mr. Huson was awarded a British Empire Medal for services to the community, but when he needs help it is not available.

Why can places such as Majorca provide the service? Is it because those places depend heavily on tourism and therefore recognise that dialysis must be provided for tourists who might need it? It appears that in areas of the United Kingdom that also depend heavily on tourism the NHS closes the door to people who need dialysis facilities.

During my representations on this issue, I met my noble Friend Lord Hunt, the Under-Secretary of State for Health. He understood the issues entirely and was very sympathetic and patient. However, the responses that I have received from him leave me dissatisfied. They revolve around two fundamental issues. In his letter to me dated 25 October 1999, my noble Friend openly took the view that although my constituent might feel that he was subject to discrimination because he had hepatitis C, which is a nasty blood-borne infection, he should not be. The letter stated that Mr. Huson

Mr. Huson is determined to fend for himself and to live as full a life as possible despite his infection. He takes care of himself and is determined to take on his full responsibilities. He wanted to take a holiday on the Isle of Wight, so he made inquiries at St. Mary's hospital in Newport, which was a responsible thing to do. The patient applied personally to the unit in early 1999 and was accepted--so far, so good. However, only a little later, when the unit found out that he had hepatitis C, it

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was decided that it could not treat him. My noble Friend Lord Hunt's assertion that Mr. Huson should not be refused dialysis because of hepatitis C does not appear to be backed up by experience.

The second reason given to me by my noble Friend for the unavailability of the services in question is a potentially significant cost element. In a letter of 9 May he said:

I know the North Staffordshire hospital well, and you, Mr. Winterton, may know it too. Its staff are highly professional and efficient and I have nothing but praise for them. What do the professionals say about the issue of significant additional staffing, additional costs and other procedures to prevent infection of other people as a result of dialysis? A letter from the clinical nurse specialist in the hospital's renal directorate states:

This week, I read an interesting report that suggested that hepatitis C is on the increase, so the issue is not just one of current concern but will grow in significance and importance. Why is it, therefore, that the flexibility that is necessary to deal with the issue, not only in relation to my constituent but potentially in relation to hundreds or thousands of other hepatitis C sufferers, is not being shown elsewhere? Why is it that the highly professional staff at North Staffordshire hospital can provide that service, yet we are told by my noble Friend Lord Hunt that it cannot be provided elsewhere because that would require significant extra resources?

There was a ray of hope following my meetings with my noble Friend, which is evident in his correspondence to me. I refer again to his letter dated 25 October 1999 in which he says:

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My noble Friend Lord Hunt went on to say:

I hope that I have demonstrated the significant issues that need to be addressed without undue delay. I and many other hon. Members enthusiastically welcome the Government's determination to resource and modernise the national health service to make it fit for the 21st century. The Government are taking a realistic approach. They have repeatedly said that much has been achieved, but that a great deal more remains to be done. Unless the issues that affect people directly in their daily lives are effectively and urgently addressed by the Government, I fear that we shall have a long journey in convincing my constituents and the general public that the NHS is there for them. I hope that I will be able to reassure my constituent on this important matter.

1.46 pm

The Minister of State, Department of Health (Mr. John Denham ): I congratulate my hon. Friend the Member for Stoke-on-Trent, South (Mr. Stevenson) on raising the issue of kidney dialysis treatment for patients who want to travel to other areas of the United Kingdom. As he said, he took his constituent's case to my noble Friend Lord Hunt. The problem affects the quality of life of perhaps 10,000 patients and their families in England. They are in end-stage renal failure and need constant high-quality treatment with haemodialysis.

There are three modes of treatment for end-stage renal failure. The first is haemodialysis, the second is peritoneal dialysis, and the optimum treatment is transplantation. Unfortunately, for familiar reasons, transplants are not available on request, so the majority of patients continue to be treated by dialysis to remove the waste products from their blood. Dialysis allows waste products to diffuse across a membrane into dialysis fluid, which is then disposed of. Haemodialysis means that the patient is connected to a dialysis machine for four to five hours three times a week. That process usually takes place in a hospital unit although some patients have an appropriate machine at home.

The alternative to haemodialysis is peritoneal dialysis. A fluid is introduced into the peritoneal cavity, or abdomen, where dialysis occurs. That takes 30 to

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40 minutes, three or four times a day, every day. The patient is not connected to a machine. Patients on peritoneal dialysis have more flexibility about where they carry out their treatment and therefore find it easier to organise holidays. Once a holiday destination has been decided, patients can ask their renal unit to arrange for their supplies of dialysis fluids to be delivered to their holiday address. They can continue their treatment in the same way as they do at home.

My hon. Friend referred to patients who wish to travel to other areas of the UK. As in the case of his constituent, the most common reason is to take a holiday, but there are other reasons, not least to deal with family and business matters. I am grateful for this chance to contribute to a practical debate on issues that affect everyone who requires haemodialysis. It is a life-saving treatment. Patients are completely dependent on it and cannot take a holiday from it, much as they may wish to do so. We are very conscious of that. They have a right to a quality of life that includes everyday pleasures that most of us take for granted and expect. Patients with end-stage renal failure are no different from the rest of us in that they expect to be able to participate in such activities with the minimum of fuss.

Holidays for patients on haemodialysis are complex to organise. Once a patient has decided on a UK holiday destination, his or her hospital trust will usually arrange holiday dialysis. The arrangements are made through hospital trusts because they can provide the clinical information required by the host trust for the patient's visit. There is no obligation on health authorities or trusts to provide holiday dialysis for their patients. People who care for patients with kidney failure are sympathetic to their need for a holiday and will do their best to make the necessary arrangements, but treatment of their own local patients must come first when facilities are limited.

Mr. Stevenson : Will my hon. Friend comment on the fact that my constituent was accepted when his arrangements for the Isle of Wight were made through the North Staffordshire hospital? It was only later, when it was discovered that he had hepatitis C, that the door was closed.

Mr. Denham : I shall deal with that point in a moment.

In April 1999, we introduced the system of out-of-area treatments to replace extra-contractual referrals. In that system, a patient's usual NHS trust will make arrangements for holiday dialysis with the chosen holiday trust and will also agree the funding. Service agreements between patients' health authorities and their home trusts will reflect those other agreements. There is a cost to the home trust in that patients pay for the holiday dialysis, but the saving is only minimal as patients' usual dialysis slots cannot be used during the holiday period.

In the past, some renal units have run an exchange system for patients so that they swap dialysis slots for the period of the holiday. That practice has been diminishing because renal patients are more susceptible to illness and may have to cancel their holiday at short notice. If that happens, one unit will find that it has an extra patient to accommodate and, with the growing pressure on services, it will not always be able to provide that care.

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Hospital trusts may find it more difficult to arrange holiday dialysis for patients who have blood-borne infections such as hepatitis. Such patients create extra demands on nursing care and special equipment. For example, patients with hepatitis B should be cared for on dedicated machines by different staff from those who care for non-infected patients. Furthermore, dialysis machines that are used by patients with hepatitis C should not be used by patients who do not have that infection. Those standards have been accepted as those towards which the NHS should be working. They were drawn up by the Renal Association and the Royal College of Physicians and were set out in a document entitled "Treatment of Adult Patients with Renal Failure".

As I said, it is recommended that machines used for patients with hepatitis C should not be used for uninfected patients. Some people believe that each patient should have a dedicated machine, but that is not usually possible. It is recommended that carriers of hepatitis C should be dialysed where possible in separate or single shifts and that, whenever possible, staff should care only for infected or uninfected patients during one shift. If that is not practicable, the more experienced staff should be assigned the task of caring for a mixed group of patients.

My hon. Friend asked about North Staffordshire hospital. I cannot respond to the matters to which he referred in this debate, but I shall look into them. The procedures in place in English units to control the transmission of such viruses make them among the safest in the world. Renal units that do not have their own patients with blood-borne infections will be unlikely to be able to accept infected patients, as that can restrict the service that they can offer to their own patients. Likewise, if their facilities for infected patients are under pressure they may not be able to accommodate holiday dialysis at a particular time. That goes to the heart of the issue raised by my hon. Friend. Bearing in mind the guidance on best practice, I believe that it is practical constraints that have caused particular problems with constituents, such as the one to whom my hon. Friend referred, who are infected with hepatitis C.

I was asked to comment on the provision of facilities overseas, but I do not feel able to do so now, certainly in respect to any particular country. I have set out the standards that are being sought and which we are trying to achieve in this country. As I understand it, in most holiday destinations, dialysis is purchased under private medical arrangements. Understandably, my hon. Friend's constituent seeks a service under the national health service as a citizen of this country.

Mr. Stevenson : Is my hon. Friend saying that the Department will consider private provision if the NHS is not prepared to provide such treatment in such cases?

Mr. Denham : I was referring to the arrangement between the patient and the service provider, which is a private one. The Government have recently made it clear that we do not wish to be dogmatic about provision, but I should not like to be drawn further on the specific point raised by my hon. Friend.

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I come now to wider issues affecting holiday travel. Some NHS trusts have dedicated hospital facilities for patients able to arrange for dialysis unassisted by medical staff. That is obviously not suitable for all patients. Apart from NHS trusts there are private hospitals that provide general renal services, and there are some private facilities for dialysis, many in holiday destinations in the UK. We know that some NHS patients have already been able to utilise such services, such as the dialysis service offered by a private hospital in St. Ives. The Dialysis Travel Company Ltd. provides dialysis at the Butlins resorts of Bognor Regis, Skegness and Minehead. The resorts can dialyse six patients a day, and another such unit has recently opened at Warner's Lakeside centre, near Portsmouth.

I commend the National Kidney Federation, the major voluntary organisation for kidney patients, which is currently constructing a website on holiday dialysis in the UK and abroad. Unfortunately, private facilities do not usually accept patients with blood-borne viruses such as hepatitis. As with the arrangements between NHS trusts, there is no obligation for the home renal unit to pay for patients to attend private holiday facilities.

I acknowledge that the existing renal services are under immense pressure to accommodate the growing number of patients with end-stage renal failure. Holiday dialysis can really be made more available only by expanding dialysis provision generally. We have taken several steps to ensure that patients will have access to high-quality services. I have spoken about the recommended standards for the treatment of patients with renal failure. We identified renal services as a priority in the new arrangements for regional commissioning of specialised services, which came into force last year. The arrangements will facilitate planning on a wider and more long-term basis. The first reports of the regional commissioners will be available in August and we will have the opportunity to reflect on what has been achieved so far and to identify the areas to be addressed in the next year.

Later this year we will also have the results of the updated national renal survey and the renal chapter of the health care needs assessment. Both documents will be important in helping us to model renal services. They will enable us to see how far we have progressed, how steep the growth rate is and how far there is to go. All evaluations will be based on best available knowledge and will be fed into the work of the regional commissioners.

Renal services have benefited from the Government's overall increase in NHS funding. In the Budget we announced significant increases in NHS funding for the next four years, which were confirmed yesterday. In addition, we have made £10 million available this year from the capital resources allocations specifically for haemodialysis services. That will provide facilities for at least 500 more patients to be treated. Each region will be able to demonstrate an increase of at least 15 dialysis units or capacity for at least 60 additional patients. We announced approval of the regions' plans on 12 July and renal services and provision will expand in the next 12 months. Regions have added to the centrally

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allocated capital so that £18 million capital investment in total will be spent, supported locally by the revenue consequences. That money will be spent on 53 schemes in 42 trusts.

My honourable Friend has asked about holiday facilities in Portsmouth, the Isle of Wight and Plymouth. All three of those health authorities have benefited from the allocation of new money, and a total of 20 new dialysis stations will be provided in their units, which in turn will improve the possibility of holiday dialysis. However, I am afraid that I cannot make a firm commitment with regard to Mr. Huson, my hon. Friend's constituent, on the information that I have.

There is a real issue concerning the shortage of nurses, which constrains several aspects of the development of the NHS, and renal services are no exception. I am sure that my hon. Friend is aware of the strenuous efforts that the Government have made to increase the number

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of nurse training places, to encourage former nurses to return to the national health service and to encourage wider take-up of nurse training courses. It is good news that applications for nursing and midwifery diploma courses rose by 73 per cent. last year. Several thousand nurses have already rejoined the NHS, and that will help us to meet needs in renal care and in other parts of the health service.

In conclusion, the issues raised by my hon. Friend on behalf of his constituent are important. At root, they do not reflect a discrimination against hepatitis C sufferers; they reflect the fact that we need to expand our renal services so that we can offer the best possible care to patients, whether they seek it at home or on holiday. The Government have embarked on that programme of work, although I accept that there is still a considerable way to go.

Question put and agreed to.

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