Oral - Renal Services and Transplantation

I am grateful for the opportunity to make this statement setting out my plans for renal services and transplantation in Wales.

I have recently spoken with renal patients, clinicians and carers in Wales to listen to their experiences. Those discussions have reinforced my commitment to ensuring that renal patients receive their care as locally as possible as part of a comprehensive, well organised service. Wales has a good record on both renal dialysis and transplantation rates in the UK, but more needs to be done to meet present and future demand.

The background to this work lies in the Welsh renal national service framework, which was widely welcomed on its publication in April 2007. It sets standards to ensure that renal care becomes more patient-centred and available to all, irrespective of age, co-morbidity, gender, race or locality. The standards cover renal care for children and adults, from prevention through to palliative care. The implementation of the NSF is overseen by the all-Wales renal advisory group, which comprises representation from kidney patients, doctors, nurses, others involved in the care of patients with renal disease, those responsible for commissioning and delivering renal services, and community health councils. Together, this effort is beginning to reap the benefit of early management, particularly in primary care, which helps to delay the progression of renal disease and the need for dialysis.

For those patients who do require dialysis, improvements to the way in which we can respond to renal problems means that we need to increase further our capacity in Wales over the next three years. Patients in Wales currently have their dialysis in one of the five main renal units at Cardiff, Swansea, Wrexham, Rhyl and Bangor, or one of the seven smaller satellite units at Newport, Merthyr, Llantrisant, the University Hospital of Wales, Cardiff Royal Infirmary, Carmarthen and Aberystwyth. Patients also have dialysis at home where it is clinically appropriate.

I have asked my officials to provide me with a costed plan to address the shortfalls in dialysis capacity in Wales. We need a systematic approach to expand provision in the areas of greatest unmet demand, with an emphasis on reducing travelling times. Work is already underway to open a new dialysis facility in Carmarthen in the new year. I will have a business plan for a linked dialysis service in Pembrokeshire in December. Other areas identified as priorities for additional dialysis facilities are north Gwent, Baglan, Powys, south Gwynedd and Deeside, and I look forward to seeing the business cases for those developments make progress over the next three years.

However much we improve these services, I appreciate that for many patients who currently depend on dialysis a kidney transplant represents the best option. I met Cardiff and Vale NHS Trust and Health Commission Wales last month to discuss the development of a new renal transplant unit for Wales at the University Hospital of Wales. The planning process for the proposed unit is already well advanced, and I have asked to see the full business case by the end of November. Nevertheless, however quickly we are able to get such a unit up and running, it will only be a success if sufficient organs are available.
I turn now, therefore, to the second main theme in my statement this afternoon, that of organ transplantation. Organ transplants are one of the most miraculous achievements of modern medicine. There is a serious shortage of organs in the UK and the gap between the number of organs donated and the number of people waiting for a transplant is increasing.

The current system of organ donation depends entirely on the generosity of donors and families who are willing to make this life-saving or life-enhancing gift to others—what Richard Titmuss so famously called the 'gift relationship’ on which our national health service is founded. There are many different ways in which individuals can express their wish to become donors: by registering on the organ donation register, carrying a donor card, or by discussing their wishes with loved ones. I have made it clear that I am in favour of considering presumed consent as a way of increasing the number of organ donations. However, I am also clear that, in the end, this is a matter which must be led by lay rather than clinical opinion and informed by a wide-ranging public debate. I have therefore commissioned a consultation document about presumed consent, which I intend to launch in the spring of next year. I want to see a series of public debates all around Wales to ensure that everyone who wishes to participate has an opportunity to do so.

We must remember that, while we have this vital debate in Wales, the critical shortage of organs remains and we must continue to maximise organ donation. That is why I have also decided to hold a Welsh publicity campaign in the new year that will raise awareness about the need to register as a donor. This campaign will be undertaken with the various charitable groups in Wales that have an interest in organ donation. I will also be focusing part of the campaign, with the help of the Welsh Local Government Association, on our public sector workers to enlist their support.

Additionally, a UK-wide organ donation taskforce report will be published in the new year. The taskforce was set up to identify ways of improving organ-donation rates, and, as a consequence, the number of patients who benefit from a life-saving transplant. It will also examine the potential impact on organ donation of introducing an opt-out or presumed consent system in the UK, including the views of the public and stakeholders on clinical, ethical, legal and social issues. The Welsh public debate on presumed consent will contribute to this work. I look forward to some practical recommendations from the taskforce that will help us to improve the services available for Welsh patients. This is the key to raising donation rates. I will, of course, ensure that Assembly Members are kept informed both of the contents of the taskforce report and of the response of the Welsh Assembly Government.

There is a great deal that can be done to improve the future for renal patients in Wales. Some of this lies directly in the hands of the NHS and the services that it provides, and I began my statement today by outlining some of my plans in that regard. However, so much of what needs to be done lies beyond the boundaries of the hospital and the doctor’s surgery, and depends instead on the sense of reciprocity by which we make a gift to others, because we know that, one day, our futures and those of our families may depend upon receiving a gift in return. That is why I am committed to the public debate that I have set out this afternoon. I am confident that, by working closely with clinicians and voluntary organisations, and by meeting and listening to patients, we will move forward with this important agenda in Wales.