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Bexley scheme was fully discussed but was not favoured because in the opinions of the consultants,
the proposed premises would be virtually hospital units. The stringent regulations applicable to
such units would probably make them uneconomic from the local authority point of view.
The idea of a purely local unit as a satellite of a main unit had been discussed, planned and
tried experimentally. Experience showed however, that whenever two or three machines were to
be used by a number of different patients, a separate unit became necessary with its own establishment
of technical, nursing and medical staff.
Other contrary features were
(i) It would be necessary to employ night and day nursing staff. One house would
probably require at least three nurses for a six-day week, fifty-two weeks per year.
Even if patients did all the cleaning and preparatory work connected with the
machines, this would mean all night work for the nurses on a permanent basis, which
few might be willing to accept. In a unit of the type suggested some latitude of choice
in the times at which the patient dialyses himself would be lost.
(ii) There would be some loss of social and family freedom and also loss of the trained
members of the patient's family.
(iii) Nationally there is difficulty in recruiting staff of the right technical ability and
reliability to take on this type of work, which is essentially dull, but might spring an
emergency at any moment, and the known risk of infection associated with these
units might also add to this difficulty.
(iv) In the light of the considerable advances being made in the design of dialysis equipment
which would be associated with a marked reduction in cost, it might not be wise
in terms of either capital or revenue, to proceed with the scheme.
(d) MOBILE UNITS
The firm of Portakabin is now producing such units, but they require the usual foundations,
plumbing and drainage work which can be expensive items of the total cost. They would appear to
be of doubtful value in a London Borough.
(e) OTHER LONDON BOROUGHS
Arrangements vary considerably throughout the London area and even within a single
Borough, but generally as at February 1970, they were as follows:—
Number of Boroughs assessing and charging for instaltation
according to patient's income and capital 20
Number of Boroughs making no charge for installation 12
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