A consultant writes: anti-PFI letter in Herald

from The Herald letters page, Friday 8 Dec, a letter by a hospital consultant on why PFI is rubbish, and is destroying the NHS:

FOR students of the NHS in Scotland the renascent arguments over PFI are disappointingly familiar. The decision to finance Edinburgh Royal and the Lanarkshire hospitals by a PFI was taken before the Scottish Parliament was reconvened, by the Scottish Health Ministry in Westminster. Sam Galbraith, an old Labour Minister and surprisingly a former NHS doctor, drove this decision through against widespread contrary opinion. A contemporary series of articles in the British Medical Journal comprehensively destroyed any argument for PFI and predicted widespread financial harm to other NHS services as PFI costs rose disproportionately. The present situation was clearly foreseen, but ignored by the Labour government first in London and later in Holyrood. It must be clear where the blame lies.

The present Scottish Executive are "encouraged" to continue with PFI by the Labour government in London, despite the process in England being widely discredited and leading to the present financial catastrophe facing the NHS in England, leading eventually to full privatisation. It may be that the only way to resist the advance of PFI and privatisation in the NHSiS is to decouple the Scottish Executive from the malign influences of the UK Labour Party and government.

It is unfortunate that the people of Lanarkshire are suffering the consequences of PFI, but not all of the present concerns over A&E provision in the county are consequences of that process. Fifteen years ago it was apparent that Law and Hairmyres Hospitals had to be replaced. A sensible and financially affordable option of a new large Lanarkshire hospital was proposed on a site at or near Strathclyde Park, close to major roads and at the "sick centre" of Lanarkshire. This hospital would have been able to support all acute clinical services, a large and modern A&E department and could have been a major centre of excellence. But the politicians, public and press local to the old hospitals could not be persuaded to give up "their" hospitals and the health board gave in to such local pressure, and under orders from Galbraith and the Treasury chose two PFI hospitals on the the wrong sites with unsustainable clinical services.

Within three years of opening, Hairmyres Hospital has lost several major surgical specialities to Wishaw, and one Lanarkshire hospital may be closed. No excuses of the effect of the European Working Time Directive, changes in junior doctors' hours and training, lack of staff, etc, can be sustained as all of these processess were known and their effects predicted from the mid-nineties. The public and politicians, and their appointed health board, are all culpable in the decisions which have led to the present situation. Medical advice was ignored and no analyses of future developments were made or considered. No real thought was given to anything beyond very short-term electoral gratification.

As Professor Allyson Pollock and colleagues have illustrated, the people and politicians of Lanarkshire will have to live and possibly die with the consequences of their decisions for the next 30 years, after which who knows? The NHS will not own either of the two Lanarkshire hospitals after paying £41m annually. PFI is not a mortgage. The argument from politicians that the NHS will be free to give up these then out-of-date hospitals and go elsewhere is incredible. Which of us would pay a mortgage and not expect to own our house at the end of the term?

What can be learned from this debacle? Local politicians cannot be trusted with the hard decisions about the facilities for the provision of health care. The public must try not to be seduced by hysterical stories of "death in the ambulance", but must try to understand the whole picture of emergency and elective health care.

I know many do but their voices are often drowned out. Professor David Kerr has recently expressed disappointment that when the crunch comes public and politicians will not listen to reasoned argument from professionals whom they trust with their lives, but whom they do not trust when those professionals plan the bigger picture. Many of the public and press are blinded by scare stories about A&E, and can be mobilised by these but seem unwilling to consider future healthcare provision in total.

If we in Scotland cannot face up to the realities of the provision of health-care in the 21st century we are destined to see the privatisation and breakdown of the NHS as we have known it, and all of us will be the poorer.

Gavin R Tait, FRCSG, Consultant Orthopaedic Surgeon, Crosshouse Hospital, Kilmarnock