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.
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.