London regional director Nigel Crisp is to enter emergency talks with the capital's top renal specialists, following a public exposure of the 'worsening crisis' facing their units by senior clinicians.
Twelve renal specialists led by Dr Paul Sweny, chair of the North Thames renal group, moved to force the region to act on 'unsafe' staff shortages and underfunding.
The doctors' dossier of evidence - sent to Mr Crisp on 8 February and leaked to the press last week - revealed that some hospitals are denying kidney patients life- saving dialysis and are unable to meet national standards of care. In a letter to Mr Crisp, Dr Sweny dismisses the region's response to their concerns as 'inadequate'.
'It has proved near impossible to deliver this message to anybody able or prepared to take responsibility, ' he wrote.
The Department of Health followed the release of the report to the press by announcing an extra£10m for renal services, funding which - for the first time - will be ringfenced.' The doctors' complaints didn't lead to the£10m, ' a DoH spokesperson insisted.' The£10m is in response to our recognition that renal services do need this cash injection.'
Adrian Pollitt, director of the executive arm of the regional specialist commissioning group - who along with group chair John James will be included in the talks - said that a current review of the capital's renal services might have to be 'accelerated'.
Mr Pollitt said the problem of too few dialysis stations would be 'partly addressed by money'.
'The staffing issue is a more serious and intractable problem, but we can't just wring our hands and say there is nothing we can do.'
But group chair John James said he had already told the clinicians in an earlier meeting that he could not help them with staffing or force health authorities to increase funding of renal services.
'The first thing we have to do is establish where things are biting the tightest. If there is a money problem we will have to consider that with the regional office.'
He accepted the doctors' point that the current resource allocation mechanism needs to be changed to provide more generous funding to HAs with large Asian and black communities, where renal disease is most prevalent.
'But that's a matter for national decision-making.'
Dr John Scoble, one of the 12 signatories, said the shift from cost and volume contracts to block contracts had exacerbated problems in renal services because the new contracts, based on the previous year's activity rates, did not take account of annual increase in demand for dialysis.
'Everyone agrees that there is going to be an annual 7 per cent increase in dialysis required to the year 2010. That's a vast amount of money.'
Dr Scoble's unit at Guy's Hospital is anticipating a funding shortfall of£500,000. The unit is working to capacity and has had to limit the treatment options available to patients.
Healthcare assistants have had to be recruited from Denmark, and there are 27 nursing vacancies.
'We don't have any spare sessions at all, and have started to use, for the first time, private hospitals. As of today we are alright - as of tomorrow we may be in a terrible mess, 'Dr Scoble said.
Elizabeth Ward, founder of the British Kidney Patient Association, said it was a 'scandal' that doctors were selecting which patients would live or die.