Patients across the State are being put at risk of infection by having to attend overcrowded kidney dialysis units, according to a new report for the Health Service Executive (HSE).
It says congestion is a problem at six units in particular - those at Dublin's Beaumont Hospital, Cork University Hospital, Waterford Regional Hospital, the Mid Western Regional Hospital in Limerick, Tallaght hospital and Merlin Park Regional Hospital in Galway.
The report of the National Renal Strategy Review Group says many dialysis facilities "are operating at above the recommended level of activity" and the consequences of overcrowding are "stark". It says it results in patients receiving dialysis at unsociable hours, patients at increased risk of transmission of infections, and patients at increased risk of receiving an inadequate dose of dialysis.
The report, promised since 2001, has been with the HSE for several months now but has not been published.
A copy of it, seen by The Irish Times, says 101 extra haemodialysis stations need to be provided "in the immediate term" to address overcrowding in existing stations.
It recommends half of these should be provided by the end of this year, with the remainder provided by the end of 2008.
The report estimates that an additional €50 million will have to be provided in funding over the next three years to implement its recommendations.
"The haemodialysis population is projected to increase by 50 per cent in three years, 100 per cent in six years, and 150 per cent by 2014. Projections imply a requirement for 335,000 haemodialyis treatments per annum by 2010 and 485,000 by 2015 . . . additional haemodialysis stations to provide capacity for this growth will be required," it says.
The report also refers to the distances people have to travel for dialysis, an issue which caused controversy in Limerick recently when it was suggested new patients travel to Tullamore, Kilkenny, Tralee and Galway, as the local unit was unable to deal with any more patients.
"Ideally haemodialysis facilities should be located to be within a one-way drive time of less than 60 minutes for 90 per cent of the population," the report states.
It illustrates by way of a map the various tracts of the country where patients have to travel for more than an hour to get dialysis. These include parts of Donegal, Mayo, Galway, Clare, Kerry and Wexford.
Renal disease services have, the report claims, developed on an ad hoc basis. "Service plans have been developed at local level and the enormous variability in service planning, configuration and resource utilisation that has existed between different areas is striking" adding that in the future services should be provided through four networks, one in each HSE area.
It says some units have single-handed consultant nephrologists. "This is not a desirable scenario and will need to be addressed in future expansion plans."
It also claims that in parts of the State there are waiting times of six to 12 months for the provision of a fistula through which many patients on long-term dialysis receive their treatment. It points to the urgency of the development and expansion of a living donor transplant programme.
Mark Murphy, the chief executive of the Irish Kidney Association (IKA), has criticised the delay in publishing the report in the IKA's latest newsletter. "The hard work from all concerned to make a fresh, up-to-the minute report is rapidly going stale . . . various timelines in the review are also gone out the window," he wrote.