Jenny Ili was barely a teenager when she was diagnosed with a rare disorder that would fail her kidneys and tie her to a machine six hours a day, three times a week. Video / Dean Purcell
Some dialysis patients are driving for four hours a day, three times a week to access treatment because of a shortage of services in New Zealand.
And dialysis machines with capacity for four people a day are being used by six people a day in some regions, meaning some patients do not get their full treatment.
A report by Kidney Health NZ, released today, says dialysis services are at “breaking point” and urges the Government to address the gaps in the system.
Kidney Health NZ acting general manager Traci Stanbury said a survey of the 15 kidney dialysis treatment units in New Zealand found that all of them had capacity constraints. Half were chronically understaffed, had too few dialysis chairs or lacked physical infrastructure.
In all, the survey found there were 1980 patients getting long-term treatment at a hospital or facility outside their home, but the treatment centres only had capacity for 1764 patients a week. This meant many of the units were squeezing more than this number on to the machines a day.
Staffing was also a problem. To meet the preferred staffing ratio of five patients per staff member the service urgently needed 100 extra full-time staff to make up the shortfall.
Staff were doing an admirable job in the circumstances, said Professor Rob Walker, head of nephrology at Te Whatu Ora Southern.
“However, we cannot keep asking the workforce to carry on this way, day after day, week in, week out. As well as being unacceptable for patients, it’s also having a significant impact on staff morale, mental health, recruitment, and retention.”
Access to dialysis was also unequal, especially in rural areas where Maori were disproportionately represented. Maori and Pacific Islanders made up around 60 per cent of dialysis patients.
The survey found half of the centres had patients who travelled two hours each way, three times a week, for dialysis sessions which lasted between 4-6 hours. Patients in Tauranga and Whakatāne were driving to Hamilton and back for treatment.
Patients could also get dialysis at home, but this required intensive training by two staff members over a period of about two months. With staff working double shifts and overtime at the units, their ability to train patients and make them self-sufficient had been reduced. This led to further congestion in the system.
Jenny Ili has been trained to do her own dialysis. She admits it was initially scary because she was afraid of needles, but now loves the independence it brings. Photo / Dean Purcell.
Jenny Ili, from Auckland, was diagnosed with kidney disease at age 15. She had a transplant almost immediately but it failed after a year and she has been on dialysis three days a week for around 25 years. Initially requiring four hours of treatment, she now requires 6.5 hours.
Ili said she initially got dialysis at Middlemore Hospital. But as demand for the service grew, access became more difficult, with patients required to arrive at 6am for a morning session or sometimes stay late into the night.
She now gets treatment at a community dialysis house in South Auckland run by the Kidney Society and funded by Te Whatu Ora. She can turn up for treatment whenever she wants.
“It was way better,” she said. “It was freedom.”
Kidney Society CEO John Loof said he would like to see the community dialysis sector expanded to take pressure off hospital services and bring treatment closer to people’s homes.
“You might have people in Henderson, they have to travel to … the North Shore to get the treatment three times a week, for six hours, and then coming back with all the traffic and all that kind of thing. If there were some community houses in Henderson, or West Auckland, you imagine how that would take so much pressure off the system, and save money because you don’t have all the transport costs and the logistics and all the rest of it.
“There’s a huge amount to be gained by having more dialysis in the community. It’s also proven to be much better for their clients as well.”
One of Kidney Health NZ’s 27 recommendations was to shift some hospital-based services to communities such as rest homes, which would bring help closer to rural patients and Maori.
Loof said more patients should also be home-trained - an initiative that would require a boost to staffing.
“The patients feel more empowered, more in control of their destiny, if you like. And because they can then run their own schedule around treatment, many of these patients can still retain a job and connection to their family.”
Health Minister Ayesha Verrall has been provided with a copy of the report.
Asked to respond, she said: “As part of the health reforms, Te Whatu Ora wants to help clinicians to collaborate to fix these complex issues, provide excellent and accessible care and manage the pressures on workforce.
“That’s why a renal network is to be established to drive these changes.”
Isaac Davison is an Auckland-based reporter who covers health issues. He joined the Herald in 2008 and has previously covered the environment, politics, and social issues.
