Stabbed in the back

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.”

Indeed, the hospital carries out as many if not more procedures, including 3,000 angioplasties and more than 1,000 bypass operations, than any other unit and delivers among the top five results in the country. Dr Duncan Dymond, a consultant cardiologist who signed the letter to The Times, argues that to drop the PFI scheme, which has been continually updated to account for changes such as patient choice and has still been judged as low-risk, flies in the face of common sense. This is the only teaching hospital in East London. To destroy it would create a “cardiac and cancer wasteland”.

“We are shellshocked, stunned,” he says, furiously, in his small office in the darkened bowels of Bart’s. “None of this makes any sense. Cancer and cardiac are the two flagships which generate 40 per cent of the revenue for the trust. If you pull the plug on those . . . then it goes belly-up because there’s no money to pay the mortgage to Skanska.

“There will be a haemorrhage of consultants, of nursing, technical and admin staff. You are talking about a helicopter and trauma centre being decimated. The medical school will become unviable. We have all seen what happened on July 7. It seems absolute sadism to take it away or to even threaten it.

“If this scheme unravels, then the whole trust is at risk. No one past Bow, Mile End and Tower Hamlets will ever trust a Labour politician on health matters again. It’s criminal. It’s obscene.”

Many more prominent names from across the board are standing full square behind the campaign. They include David Rampton, professor and chairman of the Medical Council; Richard Langford, professor of anaesthesia and pain medicine; David Oram, consultant gynaecological oncologist; and Dr Chris Gallagher, clinical director of cancer services.

But patients are also dismayed at the possibility of losing cancer and cardiac services on their doorstep. One is Audrey Rodda, 47, who was treated for breast cancer at Bart’s nine years ago. In 2004 she began suffering backache and it was found that the cancer had spread to her spine, chest and liver. The scan was performed at a Saturday clinic and when specialists at Bart’s saw the results on Monday morning they sent an emergency ambulance to her flat in Bow.

The tumour on her spine was located in such a way that it could have paralysed her at any second. Within an hour she was in Bart’s having a full MRI scan and being treated with steroids. This is one example of the difference it makes to have a centre of excellence on your doorstep. Today she is in the ward undergoing another course of chemotherapy. “I’ve read about the Government’s review and it’s very worrying to me. It’s not just cancer care — they have such a wonderful collection of specialists here. When you are having chemo, travelling back and forth to the hospital is wearying enough as it is. The further you have to go the worse it is. I have had fantastic treatment here. Whenever you pick up the phone there is always a doctor to speak to. Whatever the outcome, I’ve got my best chance by being here.”

Dr Chris Gallagher says it has taken ten years to build up the expertise and clinical relationships at the trust, and if they were disrupted and moved elsewhere it would take another decade to recreate. More pertinently for Whitehall, he believes that to do so would cost much more in the long run than the scheme which may be jettisoned.

There are other things which, even to the layman, do not seem to add up. Why, for instance, only three weeks before the Government dropped its December bombshell, did the Department of Health and Cancer Research UK carry out an inspection of the cancer centre and declare it a centre of excellence with a five-star research rating? What would become of the brand new, state-of-the-art breast care centre, situated in the grounds of Bart’ s and paid for mainly by charitable fundraising, a place where only in November the Health Secretary, Patricia Hewitt, posed for a photo opportunity? This is a population predicted to expand hugely thanks to the Thames Gateway. Why cripple its only teaching hospital?

There are many more huge logistical problems involved in moving services. Bart’s offers highly specialised radiation treatment; there are bunkers in the ground housing linear accelerators and other equipment. These cannot simply be picked up and moved elsewhere. The plans for the Royal London don’t and never did account for this, as it was always assumed that Bart’s was included in the scheme. Farcically, the constituents of Bethnal Green cannot even complain to their MP, George Galloway, as he is ensconced in the Celebrity Big Brother house with Rula Lenska and Michael Barrymore.

“We are being made victims of bad decisions made elsewhere in the health service,” says Dr Gallagher. “But this is a 30-year contract. It is not a decision that should be made on the short-term interests of the current political and financial climate.”

The trust’s chief executive is no less forthright. Paul White says the picture looks bleak if Friday’s decision goes against them. For years buildings have been starved of investment because new building projects were in the pipeline. Now they are in an appalling state and, if the trust is forced back to the drawing board again, they will remain so for many years to come.

“If this scheme doesn’t fly now it’s pretty grim for this part of London,” he says. “Credibility is at risk. Any significant private- sector player is going to be sceptical in the future.”

Might this ring the death knell for PFIs? Dr Dymond accepts that there are some who would welcome that. But to cripple a scheme so close to the finishing line that the plans show where the plug sockets go is, he says, madness. “If the Government feels that in the future it should think again about PFIs as a way of funding hospitals then a lot of people will agree that maybe it wasn’t the most sensible way,” he says. “But that doesn’t mean you should plunge this vast population into chaos for the next ten years.”

On Friday that chaos may begin.