The NHS Consultants' Association

The NHS. Will it sink or swim?

In the business section of the Western Morning News on July 2nd it was reported 'CBI boss praises medi-park build'. Mr Digby-Jones looked happy in the picture as well he might. This multi-million pound orthopaedic treatment centre is another PFI (private finance initiative) scheme and these are proving lucrative to Mr Digby-Jones' members. One golden pathway is via 're-financing'. An extreme example would be the Norfolk and Norwich hospital which was built under an earlier PFI scheme and which is owned by Octagon Healthcare Holdings (chairman Richard Jewson). 'Re-financing' of this mortgage has produced a profit of £90 million pounds. Very healthy - but not for the taxpayer.

This 'medi-park' centre at Derriford will be staffed by South African surgeons, anaesthetists and nurses. The doctors will be coming across for four week tours and the nurses for one year. They will be coming from a country where there is an untreated AIDS epidemic and inadequate health care for its poor. The contract involves a great deal of surgery. Young surgeons and anaesthetists in training within Devon and Cornwall will not be involved with this, although there is an increasing need for such exposure. The project should certainly reduce waiting times but especially those patients having joint implants are unlikely to remain under the care of Afrox surgeons if there is a severe acute or long term complication. The staff in this centre will do their best but an air of anonymity and impermanence pervades the scheme. This is captured in the ghastly term 'medi-park'.

Mr John Reid would have us believe that 'orthopaedic treatment centres' are a new concept of New Labour. They are not. We had exactly that in the Princess Elizabeth Orthopaedic Hospital in Exeter, Mount Gould in Plymouth and less formally at St Michael's in Cornwall. The Princess Elizabeth was thought to be too far from the main Royal Devon and Exeter Hospital in event of emergencies (but no further than the 'medi-park' from Derriford) and had some old wards. A ten year old, £4 million operating theatre and a new £1.5 million ward were among the assets bulldozed to produce a building site for up-market homes for a grand sum of £3 million. Such is the profligacy of politicians.

We had specialist orthopaedic hospitals for several good reasons. A central one was that accident victims were excluded except for specialist secondary treatment. The numbers of people who are injured on the roads and of the elderly who suffer fractures increase by about 7% a year. It has become more and more difficult to find beds for them within District General Hospitals, especially with cuts in bed numbers. Some end up inappropriately on outlying wards and the pressure on beds means that planned operations cannot be done. The surgeons are finding themselves doing less orthopaedic work and more trauma work instead. In our specialist orthopaedic hospitals, we could almost always plan full lists and have few if any cancellations.

Because an infected joint implant might be disastrous for the patient, great efforts were made to minimise that risk. For instance, at the Princess Elizabeth, an infection control sister attended our monthly medical staff meetings where she presented written details of all infections, real or suspected. These were discussed and conclusions minuted. MRSA was an increasing threat in the 90's but the strictest protocols managed that. For instance, no patient was transferred from a District General Hospitals to the 'Princess' unless swabs had shown its absence. The cleaners were directly responsible to each ward sister and not to a 'Hotel Services Manager' or similar title.

What is the state now? When the Western Morning News reported rows over cleaning on July 16, an unnamed porter told us of lack of thoroughness in cleaning, especially at night and weekends. He went on to say that he advised doctors to wash their hands between wards. Whatever the facts, it is surely remarkable that a porter should feel that is a responsibility of his. The next day there was a full statement about cleanliness from the chief executive, Mr Paul Roberts, who is known to be a thoughtful man. He reiterated the importance of hand washing between patients and went on to say 'If you are a patient, don't be afraid to ask if they've done this'. Aside from putting the cart before the horse, this could hardly have boosted morale in a hard pressed hospital.

The foregoing are examples of an NHS in crisis but, as they say, there are as many diagnoses as doctors. One thing is certain. The NHS has been the victim of political whim and fashion from early on. Almost every convulsion of management that I worked under was injurious to it. The worst was the internal market which was forced through against the advice of the professions by Mrs Thatcher. This doubled the cost of administration from about 5% of total budget, wasting £1.2 billion extra per year on an enlarged bureaucracy. There were more desks and a proliferation of grand job titles. A lot of the present ills go back to that. Experienced professional voices are drowned out and pilot studies are 'rolled out' nationally before valid analyses are made.

The NHS is now being de-stabilised faster than ever. PFI, private contracts to UK 'providers' and to foreign nationals, Primary Care Trusts (also under great pressure and consumptive of professional time) are just some of currents in the maelstrom. A good deal of this is being driven by GATS - General Agreement on Trade in Services. This is warmly embraced by the unelected EU Commission and by all good Blairites. President Barrosa will be fervent in its pursuit, with the likely help of Mr Mandelson. It means the 'marketisation' and finally the complete privatisation of our NHS whilst our taxes lubricate that.

It is vital that the NHS is freed from the lead boots of political control. The NHS Executive which heads it should be reformed and made scrupulously independent. That body will disperse funds to hospitals and Primary Care Trusts on calculations based on population/social deprivation and they get on with it as best they can. The Executive will report and be responsible to Parliament alone. The writer has espoused this for a long time and was pleased to see a similar proposal come out of the King's Fund.

The NHS is precious to a majority. We need to inform ourselves and see to it that it swims. It is ours.

The article first appeared in the Western Morning News in July 2004