Death on the health service
William Wigmore
A few weeks ago assorted doctors, politicians and health service officials stood around sipping wine on the lawn of St Mary Abbott's Hospital in Kensington to celebrate the remarkable achievement of Mrs, Shirley Nolan, who set out to change the appalling situation she found herself in when her son Anthony was discovered to have a rare bone marrow disease. The only thing that can keep six year old Anthony alive is a bone marrow transplant, and for the last two years the child has been living on borrowed time.
The battle to keep him alive started in 1974, when Mrs Nolan was horrified to discover that although a bone marrow donor was the only hope for her son, there was no way of finding the right one because the National Health Service could not afford to pay a technician to tissue-type any volunteers. Over the next two years the same health service managed to find enough money to increase its own bureaucracy by 22,000 jobs, but was still unable to find the 160 a week to pay one useful man who might offer the hope of new life for the twenty or so children a year who suffer from Anthony's disease. And so Shirley Nolan set out to raise the money herself.
Over the next four years, with the help of Dr David James of the Westminster Hospital bone marrow transplant unit, Mrs Nolan turned her scheme to fund one technician into a money raising venture which went on to pay for the most modern tissue-typing unit in Europe. The capital equipment alone came to £100,000. The running costs at the moment amount to another £50,000 a year. And yet the Anthony Nolan Appeal, with fetes, sales, sponsored walks and collections, came up with all the cash that was needed. On Friday. 15 September, Mrs Nolan's triumph was almost complete. Her son was still dying, but the laboratory that bore his name was tissue-typing forty samples a day and feeding the results into t" e Westminster Hospital computer. The NI S had access for the first time to the medi ,a1 records of an army of would be volui teens who could hold the gift of life for her son and for many others. The information in that computer could mean fresh hope for people suffering from a variety of illnesses, from aplastic anaemia to cancer of the blood.
What Shirley Nolan did not know was that a report, called the South District Operational Plan, was about to suggest that the entire Westminster Hospital bone marrow transplant unit should be cut, although this is the only unit in London which specialises in curing children like Anthony. Because the unit, like Mrs Nolan's own laboratory, relies so heavily on private funds and donations, the saving involved is a paltry £65,000. It represents, in other words, the income for just fourteen weeks of the ten pay beds that the Westminster has been forced to axe in the name of socialist dogma over the last two years. Doctor James estimates that, if his unit is axed, twenty children who would otherwise have had a chance of life will die. Each death, and the human misery surrounding it, will save the health service £3,250.
To make matters worse, the second of London's three bone marrow transplant units is also under threat. The Hammersmith Hospital has a debt of a quarter of a million pounds so far this year, and the projected debt for the entire twelve months could be as high as three quarters of a million. And so, like the Westminster Hospital, the Hammersmith faces a cut in its budget next year. Its bone marrow transplant unit specialises in treating the victims of aplastic anaemia and although Dr Gordon Smith who runs the unit points out that there are already transplant candidates whom he can't afford to treat because of shortage of funds, one hard-pressed committee at the hospital has already suggested that the unit should be axed —which would leave the capital with just one transplant team at the Royal Marsden Hospital.
The problem, as Dr Smith pointed out, is that all three hospital units specialise in different diseases. If his unit is saved, he couldn't possibly treat children like Anthony Nolan unless the health service were prepared to invest precisely the same amount of money into the Hammersmith that it is planning to save at the Westminster. And if his unit is disbanded as well, between twenty and thirty patients who might otherwise have lived will die. Meanwhile, although there is no suggestion as yet that the Royal Marsden Bone Marrow unit should shut down, Dr Ray Poles who works there is distinctly uneasy about its future. His unit specialises in treating leukemia victims and, like his collegues at the Hammersmith, he can't treat as many patients as he would like. And so a hospital which has a specialist cancer unit cannot afford to treat cancer patients.
Part of the problem, of course, is the very complexity of the health service bureaucracy. If you tell a hospital, which has overspent in one year because of inflation and rising costs, that it must manage on even less money in the next year, clearly something has to go. And if you go on to insist that hospitals only exist to serve the needs of their own 'catchment-area', and are funded on a system based on the number of people living near them, then specialist units must be first in the firing line. By their nature they attract patients, but not cash. If the Westminster and Hammersmith units do close down, the work being carried out by the Anthony Nolan Laboratory will still be of use to doctors in the health service, and the donations in time and money by members of the public who were moved by the story of Anthony and his mother will not be entirely wasted. But for Anthony, living on borrowed time, and for his formidable and courageous mother, the name of the laboratory itself will be a bitter coinmentary on their efforts.
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