Orthopaedic specialisation is one of the great advances in health. The risk of death and / or complication is much less than it was after major surgery. Unfortunately, some of the second world Hospitals (India and Indonesia) are now attracting private paying patients from the UK. Old plant is a recipe for cross infections and although the rate for Stanmore is probably better than a DGH (District General Hospital) because it has no gut and open wound (dirty) surgery, it is not as good as it might be….. Although the public in rural areas would choose convenience over improved chances, they will have to be educated to accept the inconvenience of travel for better outcomes. This cannot be achieved without investing in specialist cold orthopaedic centres – and access/choice for all. This is another disgrace, and the result of perverse decisions to avoid spending as a result of the political system. No wonder the consultants are disengaged.
Leaving aside junior doctors for the moment, may I raise a much longer running scandal in NHS England? It’s called the Royal National Orthopaedic Hospital.
The RNOH, in Stanmore, northwest London, offers world-leading skills and includes the national centre for spinal surgery. It treats 10,000 patients a year from across Britain yet exists in a maze of Nissen huts put up in the 1930s and 1940s. The buildings are a disgrace, a shanty town slum, officially not fit for purpose. The corridor between the wards and operating theatres is so steep that an electric buggy is needed to tow beds up it. An ancient heating pipe blew up two weeks ago, losing three days of surgery and costing £1 million of income.
Thirteen attempts have been made to relocate or rebuild the RNOH in the past 35 years and more money — £75 million — has been spent on these reviews than it would have cost to rebuild the hospital. In the RNOH’s Kafkaesque world, new buildings were due to start in 2012, then 2014, then 2016. Last March, in a flurry of publicity, £20 million was promised towards a basic orthopaedic hospital to be fully operational by 2018 — but, surprise, surprise, there has not yet been final sign-off.
I am told by an exasperated consultant that on the day King Edward VII granted the royal charter for the RNOH, in August 1905, there was discussion about a new hospital.
Today, 110 years later, and several millennia on in terms of medicine, it’s still being talked about.
Disillusionment, thankfully, has yet to set in for those bright young people seeking to train as doctors. Entry to medical school is an increasingly cut-throat competition, the annual seal-clubbing of thousands of A-starred hopefuls.
But what can a university do when 3,000 equally well-qualified young people apply for fewer than 200 places? In the UK, most medical faculties whittle them down to feasible numbers, then interview.
In Denmark, applicants are entered into a lottery, the lucky few chosen at random. In Austria, Switzerland and Italy up to 12,000 students are accepted into the first year, then set ferocious exams that 90 per cent fail. Which is even crueller.
And for those who make it through, the reward for all the suffering may be to work in Stanmore’s Nissen huts.