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Last Updated: Friday, 29 July 2005, 10:34 GMT 11:34 UK
Then and now: A hospital's story
By Ollie Stone-Lee
Political reporter, BBC News website

Previous x-ray film at Princess Margaret Hospital, Swindon (photo from Great Western Hospital)
It is not technology which has changed in Swindon

Swindon had the first large general hospital to be built under the NHS - and its current hospital was in the first wave of the controversial private finance initiative. What has changed in almost 60 years of the health service?

If patients wanted a cup of their own tea before going to bed in a 1950s Swindon hospital, they could forget it.

On doctors orders, they were banned from anything but a late night milk drink. A Dr O'Donovan said a "kind but firm" ward discipline was important in view of the "psychological features of tuberculosis and the long stay or patients".

At least when a patient's relative complained action was taken.

They decided to stop patients using their own tea and said the hospital would make tea available - but only during the day. This ensured the supremacy of the night-time milk drink by default.

It is hard to imagine such restrictions in the 21st Century NHS, where "personalised" service is increasingly a watchword.

BUSIEST DEPARTMENTS NOW
Trauma and orthopaedics
General Medicine 13.3%
General surgery
Gynaecology
Ophthalmology and orthoptics
Source: Swindon and Marlborough NHS trust figures for 2004/5

The milk complaint came in 1957, the year the foundation stone was laid at Swindon's Princess Margaret Hospital (PMH), the first to be built under the NHS, itself formed in 1948.

The hospital was not officially opened until 1966, although some parts of it began work in 1960.

Malcolm Morrison, an orthopaedic consultant at the hospital from 1967 to 1991, says attitudes towards doctors have certainly changed.

Mr Morrison says: "In the beginning, doctors were held in high regard: they were God on a pedestal, the patients came touching the forelock and accepted what God told them."

That culture has waned through a growing litigation culture, greater expectations and patients having more medical knowledge, partly though watching TV programmes like Casualty, he says.

Transformation

Alf Troughton is clinical director of radiology at PMH's replacement hospital, the Great Western, which was officially opened in 2003.

He suggests the internet has also increased the trend for patients to think they know what is wrong with them.

Doctors nationally have 90%-plus satisfaction rates in Mori opinion polls, but a survey in 2001 suggested 36% of people believed doctors paid too little attention to the rights and feelings of patients.

One suspects opinions might have been different in the 1950s, when many people were getting free hospital care for the first time.

In a sign of the times, the Great Western Hospital now has a Patient Advice and Liaison Service, part of listening to patients more.

BUSIEST DEPARTMENTS 1966
Casualty
Trauma and orthopaedics
Sight tests and orthoptic
Physiotherapy
Obstetrics
General surgery
Source: Figures for Swindon hospitals and clinics, January-March 1966

Since then, treatments have been transformed.

Malcolm Morrison began work at PMH as total hip replacements were beginning to catch on - and knee replacements followed about a decade later.

Bone tumours in a thigh could only really be treated through amputation - something the advance of chemotherapy began to counter.

And surgery was really only contemplated for arthritis if somebody was in really agonising pain and could not work or sleep.

"Now it's 'I can only play 17-and-a-half holes of golf, fix my hip," says Mr Morrison, admitting slight exaggeration.

'Have a look see'

Mr Morrison points to the technological advances seen in his time in the NHS, particularly the advent of new types of scans in his field.

But he says that from its beginning, the NHS suffered from demand outrunning supply.

"We, the profession, in a way have exacerbated things by creating a bigger demand by developing all these new treatments," he argues.

Alf Troughton at the Great Western Hospital
Dr Troughton has the bonus of digital x-rays

At the Great Western, Alf Troughton recalls the frequent attitude for difficult diagnoses in the early part of his career was: "Let's take them to theatre and have a look see."

Such exploratory operations are now very rare simply because of the quality of the scans, he says.

Film-less

In his office, Mr Troughton sits by a double-screened computer which underlines another major change: the hospital is one of the few in the country which has already moved to digital x-rays.

Not only does the change save 280,000 a year on x-ray films, it allows doctors anywhere in the hospital, or outside it, to examine scans simultaneously and compare notes.

And gone are the treks to dig out the scan prints, with doctors suggesting about a third of them went missing.

Malcolm Morrison
Malcolm Morrison reflects on a long NHS career
Such high-tech healthcare masks the fact that the departments in Swindon with the biggest work loads are strikingly similar to the busiest units in the 1960s.

Trauma and orthopaedics, general surgery, births and eye treatments (though no longer sight tests) produce the most patients for both eras.

The Princess Margaret Hospital (PMH) was already serving more than 191,000 people in 1966. The Great Western Hospital now serves 300,000.

In fact, the number of hospital beds is now slightly lower, something the Great Western says reflects the fact that more patients are now seen through day care or at community centres.

The archives of the Swindon hospitals show that cash squeezes are nothing new to the NHS.

In 1967, just a year after PMH was officially opened, the regional health board told hospital managers to make economies without damaging either services or staff morale.

Princess Margaret Hospital (photo from Great Western Hospital)
PMH was officially opened in 1966

Mr Morrison suggests concerns over staff pay and status caused disillusionment and by the end of 24 years in the service people were no longer willing to work all hours.

And critics of the private finance initiative (PFI) claim allowing companies to make profits out of the NHS is at odds with the original ethos of a nationalised health service.

Unison has previously criticised parts of the Great Western development as part of its campaign against PFI.

The sight of private firms in the hospitals is not new, however, as shown by the advertisements for contractors in the back of the brochure which marked the opening of PMH.

The Great Western Hospital
The Great Western was funded through the PFI
Dr Troughton says: "The original PFI for building a hospital has not really affected us other than it's a really nice hospital."

As PFI contractor Carillion Services knows it must look after the hospital for 26 years, the proper repairs are done, he says.

Hospital staff say the scheme may be 7% more expensive overall than a state-funded hospital construction but they argue it just would not have been built without PFI.

With the health service in constant flux, Swindon's hospitals may notch up more "firsts" in the waves of transformation likely to break in the next 60 years.




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