As long as you’ve got your health

LEVEL PLAYING FIELD
The Hindu, 26 August

St. Bartholomew’s Hospital – known to Londoners for generations simply as
Barts – has a claim to being the world’s longest-established provider of
free medical care to the poor. It was founded by a penitent Norman courtier
in 1123 as a priory hospital on the edge of the then walled City of London.
Following Henry VIII’s dissolution of the monasteries in 1539, the citizenry
of London petitioned the king to save the hospital. He granted it to the
Corporation of the City of London and it continued as a municipal
institution until 1948, when it was absorbed into the new National Health
Service.

Having been diagnosed some months ago with an illness that requires frequent
visits to hospital for complex treatments, I’ve been spending much of my
life these days at Barts. Not far from St Paul’s Cathedral, I enter via the
1702 gateway – a little gem of English baroque – past the unadorned solid
square tower of the 13th century priory Church, under the North Wing with
its Hogarth murals, and into the compact eighteenth century square designed
by James Gibbs to provide a cloister-like retreat for patients and staff.
It’s now an unprepossessing carpark, but will shortly be pedestrianised and
returned to its former sober elegance, with the bubbling mid 19th fountain
as light-hearted centrepiece.

The architectural legacy reflects a remarkable medical history. The 17th
century scientist William Harvey was a surgeon at Barts when he discovered
the circulation of the blood. In the century that followed Barts became a
major medical school, and its staff led the way in breaking from the old
barbers’ guilds and establishing surgery as a modern science. It was one of
the first hospitals to employ anaesthetics and pioneered developments in
ophthalmology, surgical techniques, pathology, radiotherapy, and the
treatment of thyroid disease and cancers. On the negative side, the hospital
resisted the introduction of antiseptic procedures and excluded women
students until 1947.

The school’s most famous student was not, however, renowned for surgical
prowess. WG Grace studied here between 1874-1876, years when he was busy
revolutionising the game of cricket and had already become one of the most
famous names in the realm. Teachers and fellow students expected little from
the young celebrity, for whom the medical profession was mainly a sinecure
that protected his otherwise dubious status as an amateur cricketer.

Historical intrigue aside, what counts for any patient in any hospital is
the quality of treatment. When I was transferred from my general
practitioner to Barts I feared I might fall through the cracks at such a
large, multi-faceted institution. I was not reassured by the fact that at
the moment Barts is something of a building site, as a long delayed and
often controversial refurbishment finally gets underway. Despite the
confusion caused by temporary access, diversions and scaffolding, the
coordination and integration in the inter-disciplinary care I’ve received –
from doctors, nurses, technicians and support staff – has been exemplary.

Here I have benefited from recent sea-changes in best medical practise. The
glibness and arrogance for which some sections of the medical profession are
noted and resented – across national and cultural boundaries – has given way
in some quarters at least to a commitment to transparency and patient
involvement. Doctors share with me all the information about my case on
their computer screens, from lab reports to x-rays and MRIs. They copy me
into correspondence. The various nurses and specialists treating me are kept
up to date with all the details of my condition and, importantly, my
medication regime. At each stage, I’ve found an openness to questions and a
willingness to address anxieties. Given the pressure on resources, there are
sometimes delays, but every effort is made to keep me informed of these and
to minimise inconvenience.

All this is delivered with a quiet, caring, un-panicked but thorough
efficiency by a staff drawn from all over the world. Only 36% of Barts staff
are British and white; 13% come from the Indian subcontinent; 10% from
Africa, 7% from the Philippines and 4% from the Carribbean. In my experience
the diversity is anything but an obstacle to the impressive teamwork.

Most importantly, I am not treated as a lab rat or an ambulatory statistic
but as an intelligent and autonomous human being. The more democratic
practise yields more effective treatment. I am able to benefit from the high
tech and clinical advances that in other contexts can tear patients into
pieces as they cope with uncoordinated, sometimes contradictory information
and the diverging dynamics of various specialisms.

My entire treatment, including medication, is free and I receive it by
right. It’s not charity and it’s not conditional on anything but my need for
it. I’ve not only never been issued a bill of any kind for all the numerous
services provided; I’ve never had to fill in a claim or an application or a
form (except for consent forms). We take this for granted in Britain but
friends in India and the USA learn of it with envy. The complete alleviation
of the burden and anxiety of finance is an obvious boon for all concerned,
and it transforms the ethos with which care is delivered and received.
Medical care is surely a human right, like primary education, and India and
the US are both societies that can afford to make it a reality for all their
citizens. That they have failed to do is the result of vested interests and
wrong priorities.

Not that Barts is safe from the relentless pressures corroding the social
democratic principles of the NHS. In the early 90s, the Conservative
government threatened it with closure (it occupies a piece of prime central
London real estate). As in Henry VIII’s day, London’s populace rallied to
Barts’ support; more than one million signed a petition to save the
hospital. In 1997, the new Labour government promised to refurbish Barts on
its historic site. Years of consultation and delay followed. The government
insisted that finance for the project should be provided exclusively from
the private sector, in keeping with its favoured Private Finance Initiative
(PFI), through which consortia of banks, building firms and developers
finance, build and supply hospitals which are then leased back to the NHS
over 30 or more years at a handsome and guaranteed rate of profit.

As the projected PFI costs for the Barts project soared, in early 2006 the
government once again renewed threats to the venerable institution’s
existence. And once again popular resistance, including an appeal signed by
1000 doctors, prevented the worst, though at a cost. The scaled-back
redevelopment involves a 20% loss of planned bed capacity (250 beds) plus
leaving empty several floors of the new buildings, presumably for commercial
lease. This will still saddle the Trust that runs Barts with annual
re-payments to the PFI consortium of some ?55m – more than 11% of its total
income – for 35 years. Inevitably, the patient will pay, as staff and
services are squeezed to ensure risk-immune private investors get their
promised return.

So the quality of care I’ve received at Barts is by no means guaranteed for
the future. That will depend, as in the past, on the willingness of the
people of London and the staff at the hospital to fight to sustain (and
expand) its democratic heritage.