that’s the case, then perhaps you ought to be thinking about pensioning a few of them off,’ had been David Howarth’s cold response. ‘It appals me to see how much money we’re wasting paying top salaries to people who could quite easily be replaced by someone younger—and cheaper.
‘The whole area health system needs reorganising and rationalising. We’ve got far too many small specialist units competing with one another. It would make much more sense to nominate specific hospitals to deal with specific areas of expertise. Out of the eighteen hospitals in this area, a good number of them have specialist heart units, and both your hospital and the Northern have specialised microsurgery units. Older surgeons like Richard Humphries …’
‘Richard Humphries was the first local surgeon to specialise in his field,’ Brian had protested defensively. ‘He really pioneered the treatment in his area …’
‘But Richard Humphries is a man not far off sixty who, no matter how excellent a surgeon he might be, has made it plain that he just isn’t equipped to deal with the financial implications of working in an independent hospital. Christopher Jeffries at the Northern, in contrast, has already shown that he has an excellent grasp of the way we’re going to need to operate in future to make sure we’re financially viable, and he’s twenty years younger than Richard.’
Brian hadn’t repeated their conversation to Richard. Richard and David had taken a dislike to one another virtually at first sight, and Brian already knew from past experience that Richard was simply not a man to compromise on what he believed were the best interests of his patients for any mere financial reasons.
Richard epitomised all that was best in the Health Service, its principles and its goals, while David on the other hand represented the new financial cutting edge that was being imposed on it to try to counteract the burden of a growing population and the rapid advances made in medical technology.
He sighed to himself, knowing that the problem was one thing, but finding the answers to it was something else again, and while David and his like believed that the answer was a far more hard-nosed response to the provision of health services, and while publicly Brian might feel it was politic to agree with him, privately he couldn’t help but sympathise with Richard’s totally opposite point of view.
Sympathising with him was one thing, failing to get across to him the message that if financial restraints were not self imposed then they would be imposed from outside was another matter, and one that could potentially prejudice the whole hospital’s future.
‘Our accountant was on the phone yesterday,’ he told Richard now. ‘It seems that she still hasn’t received your budget forecasts for the next quarter …’
‘What exactly is the hospital paying me for?’ Richard countered irritably. ‘Filling in forms or operating on patients?’
Brian sighed again. ‘Richard, I know how you feel, but try not to make too much of an enemy of people like David.’ He moved uncomfortably in his seat. ‘There are areas where savings can be made. The Northern——’
‘The Northern has a far lower post-operation recovery-rate than we do here,’ Richard interrupted, and added bluntly, ‘And you already know my opinion on the reasons for that …’
‘You’re getting too old and too idealistic, Richard,’ his GP son-in-law had told him drily the last time they had met. ‘And if you think you’ve got problems you should sit at my desk for a couple of days.’ Too idealistic he might be, but too old … Richard frowned, wondering why the thought should make him feel so edgy and defensive. He wasn’t even sixty yet. No age for a surgeon. Heavens, he could remember when he’d got his first internship: the senior surgeon had been close to seventy and everyone apart from the matron had gone in awe of him. It hadn’t mattered that you had to shout to make yourself heard because he was going deaf; watching him operate had been a privilege. In those days age and experience had been things to honour and respect—not like today, when the moment you got past forty-five you were considered to be past your best.
Back in his office, he found that his secretary, Kelly, had already sorted his mail into urgent and non-urgent piles. On the top of the urgent pile was a GP’s report on one of her female patients. As he studied it he pushed aside his conversation with Brian, frowning as he read the doctor’s findings.
A lump had been detected in the patient’s breast and an immediate operation would be necessary to perform a biopsy and removal if the lump was found to be malignant. She was a relatively young woman, only in her mid-thirties, and he knew from experience the trauma she would experience over the potential loss of a breast, but given the choice between that and losing her life …
His frown deepened as he reached into his jacket pocket for his diary, flicking it open until he found what he was looking for.
‘Kelly, how much emergency space have I got left on Thursday?’ he asked his secretary.
‘Thursday,’ she repeated, studying his lists. ‘None …’
‘Well, then, we’ll have to make some; Mrs Jacobs needs surgical attention straight away.’
‘But Thursday’s just two days away; you could afford to hold on until early next week.’
‘No, it has to be Thursday the tenth; the date is crucial,’ he told her. ‘Let me see the list, will you?’
When she handed it to him he studied it thoughtfully.
‘We’ll cancel Sophie Jennings’ non-urgent operation and put that in the beginning of next month,’ he announced.
Kelly pulled a small face. ‘We’ve had to cancel it once already due to another emergency, and you know how much she complained then …’
‘It can’t be helped,’ Richard told her. ‘Get her file out, will you, and I’ll write to her? Oh, and get me Mrs Jacobs’ file as well; I’d better phone her and speak to her personally.’
‘Problems?’ Elizabeth asked later that evening as they sat at their table in Mario’s and she watched Richard pushing his food unenthusiastically round his plate.
‘No more than usual,’ he told her drily. ‘All I ever seem to hear from Brian these days is money and budgets. What the hell is happening to the world today, Liz, that we judge the success of a hospital not on how many lives it saves, or on how much it improves the quality of its patients’ lives, but on how much money it can save?’
Elizabeth shook her head sympathetically. It was a familiar argument and very much a sore point with him at the moment.
‘The Health Service is under a great deal of financial pressure,’ she reminded him gently. ‘Look at the way you’ve had to go to the public to raise money to help fund this new Fast Response Accident Unit. At least that’s one cause that you and Sir Arthur are united on.’ She smiled. ‘He’s every bit as keen and determined to get the unit for the General as you are.’
‘Yes,’ Richard growled. ‘Someone ought to tell him that he’d be doing everyone a better service if he concentrated more on his fund-raising and less on finding fault with everything we do … Everything’s changing, Liz—good men being pensioned off for no better reason than the fact that …’ He paused, shaking his head. ‘I feel so out of step somehow. Am I wrong to believe that we should put our patients first?’
‘No, you’re not wrong,’ Elizabeth assured him. She put down her knife and fork, feeling her way as tactfully as she could. ‘But knowing you’re right isn’t always … you can be very stubborn,’ she told him gently. ‘There are circumstances when it’s sometimes easier to get your point of view across by being a little more flexible.’
She knew what was really bothering him; she and Sara and been discussing it earlier.
‘How’s Dad going to feel if the General amalgamates with the Northern and they offer him early retirement?’
‘Offer him early retirement?’ Elizabeth had queried ruefully. ‘Your father is far more