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Most London Boroughs were experiencing some difficulty in providing this service and
generally it was being found that conversions were taking from four to five months, although it
was realised that with the maximum co-operation of all concerned an adaptation could be effected
within two months from contract to completion of work. Attainment of the shorter period was
highly desirable because most patients were becoming fully trained within three months of
admission to hospital. The commonest problems were of a legal and financial nature although
spiralling building costs and contracting difficulties were contributory factors. Often the comment
was made that geographical locality rather than the patient's need determined the outcome. In
varying degrees Bexley was affected by these problems.
The Housing Working Party dealing with this proposition considered alternative schemes and
recommended that Council property should be let permanently to the Social Services (and
Children's) Committee and thereafter adapted on a multiple-user basis. Interpretation of home
dialysis as a type of community care pointed to some form of concentration of effort. It was
agreed at the Social Services (and Children's) Committee however that further enquiries on the
medical and legal aspects of the scheme should be made.
The Acting Medical Officer of Health conducted the enquiries which are summarised below.
(a) GENERAL
As applied to the population at large, dialysis is a new phenomenon not yet old enough to
yield accurate statistics. There are many variables such as the age groups treated and the availability
of organs for transplantation. In one recent report the shortage of organs was given as the most
serious impediment to the efficient use of the unit. Eventually a balanced integration of hospital
and home dialysis and renal transplantation must be reached.
It has been estimated that the initial capital cost is £3000 per patient plus £1,000 per year
thereafter. In a group of patients dependent on artificial organs at the Royal Free Hospital, two
thirds were able to return to their usual full-time employment with a few minor adjustments.
(b) SIZE OF PROBLEM
On present estimates the London Borough of Bexley might expect to have anything from
six to thirteen new cases per year, of which approximately three quarters might be suitable for
kidney transplantation. Some of these cases might fail and again require home dialysis pending
one or more further attempts at organ transplantation. If one takes an average of ten new cases per
year, then one might expect a residual 15% to 20% to remain on home dialysis. Being cumulative
there might be an increase of one or two cases per year until an "undefined ceiling" had been
reached at some time in the future.
(c) THE MULTIPLE-USER UNIT
A meeting of the consultants concerned was convened by the Acting Medical Officer of
Health and a representative of the Department of Health and Social Security was also present. The
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