The late John Biffen was treated in dialysis units here and in Cape Town. He believed we can learn much from the South Africans about patient care...
Some 17 months ago I suffered total renal failure and entered the unknown world of dialysis. I experienced four different units in my first year. My initial treatment was at The London Clinic, where I stayed until an NHS slot became free at Guy’s Hospital. Since then I have divided my time between Guy’s and the Royal Shrewsbury, Shropshire. I attend the House of Lords when it is in session and stay at my house near Oswestry during the recesses. On holiday in Jersey last summer I was treated at the Kidney Patients Association unit. Recently my experience was expanded significantly when I was advised to seek winter sunshine in Cape Town. The Kidney and Dialysis Centre in Kingsbury was my fifth renal unit and an unexpected pleasure. I make no comparisons between healthcare in the NHS and in South Africa. The state service there seems more financially constrained but there is a growing private sector. There are no reciprocal arrangements between South Africa and the UK, so I went private. It was an inspired choice.
The Kingsbury unit was opened last year and is run by Professor Charles Swanepoel, a graduate of Edinburgh University. His wife runs the administrative side almost single-handed (do I hear a chorus of disbelief from NHS administrators?). The dialysis room is capacious, with eight chairs/beds for two daytime shifts and one twilight shift. It is policy to underuse the bed potential and I never saw them fully occupied - in contrast with the crowded facilities at Guy’s and the Royal Shrewsbury.
Everything at Kingsbury is new. The dialysis machines were made by Fresenius, imported from Germany, and the ancillary equipment was mostly locally manufactured. But it was the weighing machine that caught my eye. At Guy’s I stand on an electronic platform and record my own weight (always rounding down). At Shrewsbury I sit on an electronic weighing chair and a nurse reads the figures (no cheating). At Kingsbury I was confronted with a Heath Robinson machine with a measuring arm and weights which were nudged into place by the nurse until the arm was balanced. I inquired why this museum piece was retained. &lduo;We decided the electronic machines were not sufficiently accurate,” I was told. During my six-week treatment I lost 3kg but I suppose it was dehydration and not the machine.
My dialysis times were 7.30am until 11am, and these were enforced with split-second accuracy. Any dialysis patient will confirm that getting to the unit and being “needled” is a crucial part of the exercise. In Cape Town the hired car always arrived on time. The journey took five to ten minutes, cost £3 and conversation was devoted to rugby (my Afrikaaner driver’s son plays for Leicester Tigers) and cricket.
This was a contrast with the Battersea/Guy’s trip which lasts up to 45 minutes, costs £8 and has a background of evangelical radio. At Kingsbury you would be needled and start the three half-hour sessions of dialysis within 20 minutes of arrival. At Guy’s the wait can be up to an hour. At Kingsbury three nurses looked after eight patients. They were a cheerful crew but not as ebullient as at Guy’s and the morning passed in sepulchral silence. Guy’s, with 30 beds and non-stop Radio 5 Live, is much more noisy and the nursing is more subject to stress.
There was a sharp contrast in the approach to names, too. I am at home with the NHS practice of using Christian names and at Guy’s I answer to John or “my dear” or even “darling”. The Kingsbury centre must be the last home of deference; it was “Lord Biffen” from the start. In what was a kind attempt to make me feel at home, I was told that Lord Tennyson had once been a patient. Politely I inquired what had happened to him. “Oh, he’s dead,” they replied.
An uncertain factor about dialysis is the quality and quantity of food. At Guy’s the tea lady comes round like clockwork twice during the morning, first with two slices of buttered toast, then with three biscuits. At the Royal Shrewsbury you have the option of marmalade on your toast and a full two-course lunch served at midday. The lemon sponge is star quality. At Kingsbury I chose breakfast from a wide menu. After some experimenting I settled for oats with a mountain of sugar, bread and butter and a fruit platter of grapes, pineapple, melon, pawpaw and lettuce.
Contrary to folklore, dialysis is not painful, but it is immensely tedious. Reading and the radio are means of passing the time but Kingsbury excelled with a personal TV set at each chair. Initially I was dismissive of this facility, believing it would be Tom and Jerry and endless advertisements for flashy domestic appliances. I was mistaken. Station E showed episodes from The World At War and the mornings slid away.
Behind every caring nurse is the spectre of the accountant. The dialysis fee at Kingsbury (excluding drugs but including breakfast and TV) was £70 a session. My six-week stay required 18 sessions. The fee was assisted by the sharp fall in the rand. In Britain, private dialysis can be three times this figure. I left Cape Town feeling that I had benefited from high clinical standards and efficient administration which limited my waiting time. I am now growing weary of being told how well I look.
I am not an NHS critic and I continue to have a close friendship with the nurses at Guy’s and the Royal Shrewsbury, but the visit to Cape Town has confirmed two judgements. One, there is a need to have many more organs available for renal transplant. I know that Tam Dalyell has included this issue among his many campaigns, so I live in hope. Second, I am anxious to see the expanded use of satellite kidney units. I would like to know the true costs of smaller units of 20 beds or less.
Guy’s recently established a unit at Forest Hill and Shrewsbury will soon open one at Telford. How tragic that the dialysis unit at St Thomas’ has been closed.
Meanwhile I sit at Guy’s and look at the wind and rainswept, leaden sky, thinking of a fruit platter and hoping that Alan Milburn will get it right.
Lord Biffen was vice-chairman of the All-Party Parliamentary Kidney Group and Patron of the NKF - National Kidney Federation (UK).