A few days ago a young man was airlifted to the Royal London Hospital, in Whitechapel, unconscious and bleeding heavily after suffering a ferocious assault. The injury list was grim; he had serious head injuries and multiple stab wounds but, over the next crucial hours, four eminent surgeons at the hospital’s trauma centre managed to repair his broken body.
This story, heroic though it is, may not seem particularly relevant to the row now raging over the threatened closure of cardiac and cancer services at St Bartholomew’s Hospital a mile or so away. But it is key to the debate and something that ministers might care to remember as the clock ticks towards a final decision on the future of Bart’s on Friday.
This is why: the maxillofacial surgeon who spent 14 hours rebuilding this man’s face specialises in cancer surgery; the cardiothoracic surgeon who worked on the five knife wounds to his chest is a heart specialist; another surgeon who operated on his ruptured liver deals with cancer patients; ditto the neurosurgeon who tended to his head injuries.
All of these highly skilled people were here and ready to operate at the Royal London’s trauma centre because its sister hospital, Bart’s, is a centre of excellence for cardiac and cancer care. The two institutions, part of the same NHS Trust, rely on each other to provide comprehensive healthcare for the population of East London. If, as is being considered, cardiac and cancer care are dispersed to other parts of London, those surgeons go with them. So the capital’s premier trauma centre, with other flagships such as the medical school, effectively falls apart. It would, to use a pertinent metaphor, be like stabbing this unit in the back. This is the only dedicated trauma ward in London and this young man would otherwise have been taken to the nearest big hospital, where there would not be the same level of dedicated specialist care.
The frustration in Dr Gareth Davies’s voice is palpable. He is the consultant in charge of the Royal London’s A&E department, which treated more victims of the 7/7 bombings than any other London hospital and says that this young man’s case is just one example of why the loss of cardiac and cancer at Bart’s would be so devastating. “The whole of this man’s care was delivered by people who provide cardiac and cancer services,” he says. “If they go, there is no one here to operate on patients, so there is no trauma centre. There’s no point in us airlifting a patient back if there are no surgeons to operate on him . . . I don’t think people understand how the healthcare system works.”
By the end of this week the Bart’s and Royal London Trust will learn whether its £1.15 billion Private Finance Initiative (PFI), which has taken seven painstaking years to prepare and will rebuild the dilapidated sites of both hospitals, is saved or scuppered. Staff at both hospitals were dumbfounded when just before Christmas, at 4pm on December 23, the Department of Health told the Trust to consider excluding Bart’s from the scheme and ordered an 11th-hour review of the plan. The review will be delivered to the department on Friday and its contents revealed to the trust. A final decision on whether to proceed with the existing scheme must be made by the end of January. If this deadline lapses and the issue drifts into February Skanska, the PFI partner, can either walk away demanding its fees so far, or demand to renegotiate its terms and costs. This, however, would almost certainly be unaffordable as the entire scheme was costed on the basis of work being under way. Unless the deal is signed off by January 31, the plan is likely to collapse.
Dismayed senior staff point out that if the PFI with Skanska is not approved on Friday, terms of the contract collapse and the Trust will be back at square one, “staring into the abyss” and liable for a £100 million bill from Skanska. Some 1,000 doctors, including 450 consultants, this week wrote a letter to The Times protesting at the Government’s plans to renege on the plan. Each month that it prevaricates costs the Trust another £500,000.
The talk at Bart’s is that the Treasury has got cold feet over the scheme because there is a predicted NHS overspend and other trusts’ PFI schemes have run into deficits. The rumoured jitters at Bart’s have implications for other PFIs nationally. Ministers are considering scaling back or cancelling about ten schemes, including redevelopments in Newcastle, Bristol and Liverpool. It is suspected that they want to kick the ball into the long grass and worry about it later.
But the more one looks at the implications of pulling Bart’s out of the scheme, the more nonsensical, medically and financially, it seems. A day spent within the dingy, bedraggled environs of the hospitals shows why something must be done, and fast.
It is 9am at Bart’s, the oldest hospital in Britain, but already the air in the scuffed, arid consulting rooms is thick with tension. Senior doctors have marshalled their anger into retaliative action at what they see as a “deplorable betrayal” of the people of East London. Out of their own pocket the cardiac group has paid for the services of a media strategy group to take on the Government.
They are emphatic that this is not a campaign like the one in the 1990s to save Bart’s Hospital. What infuriates them is that the 1.9 million population of East London, which includes some of the country’s most deprived people and has a mortality rate 20 per cent above the national average, will suffer.
Dr Richard Schilling, a consultant cardiologist at Bart’s, says: “We as doctors work in this area because we believe in the NHS and looking after the most underprivileged people. If it closes then, to be honest, it’s no skin off our nose at all. We are in short supply; we could walk into other jobs very easily. But the people in this area deserve better.”
In a small theatre the ghost green blips on a computer screen indicate that a patient is undergoing a procedure called ablation, which corrects the rhythm of the heart. The hospital carries out hundreds of these operations a year, enabling patients to return to work often the next day. Tony Blair, who gave his personal commitment to this hospital eight years ago, underwent this operation himself after suffering cardiac rhythm problems. “Tony Blair had this procedure and returned to work the next day,” says Dr Schilling, “but his Government is going to deny patients (here) the opportunity for the same care. For the middle classes it’s fine because they can pay for it if they need it, but the poor don’t have that option.”
