Donor (4 page)

As discretion was important when dealing with the sensibilities of often powerful and influential professional people, Dunbar’s credentials had not been announced. He was officially present as a London civil servant attached temporarily to the Scottish Office, where only Neil Bannon had been informed of his true mission.

Dunbar had been treated politely but coolly by his hosts since his arrival the previous day. This hadn’t worried him. He was used to working on his own as an outsider. He preferred it that way. The fewer people he had to confide in the better. It made his job easier. The perfect mission was one where he arrived at the job, found out what he wanted to know and left again without anyone realizing what he’d really been doing. No one liked having a snooper around, particularly when, as it often turned out, there was no real problem to investigate.

Keeping an investigation secret was perhaps the most difficult aspect of Dunbar’s job but it was also probably the most important. Any suggestion of incompetence or malpractice brought out the worst in the medical profession. No other section of the community did a better line in self-righteous indignation or closing ranks. He had to be awfully sure of his ground before breaking cover. At this early stage he had only the unsubstantiated allegations of two former nurses at the hospital to go on. He would need a lot more than that before revealing who he was and why he was there.

Dunbar settled himself into the well-upholstered chair in front of his name card on the oak table. He poured himself a little water from the crystal decanter and sipped it as he watched the others take their places. The thickness of the carpet made it a strangely silent operation. He knew little of the circumstances that had brought the visiting party to Médic Ecosse, only that the hospital was in some kind of financial trouble and was requesting more government help. His masters had seen it as an opportunity to get him inside the hospital unannounced. It had all been a bit of a rush. He had had a minimal briefing from the Scottish Office and had also managed to pick up snippets of what had been going on through listening to conversations outside while people had been having coffee. He thought he knew who the important players were, so now he was going to observe the in-fighting and blood-letting he suspected might ensue.

James Ross, consultant surgeon and director of the transplant unit, was one of two senior members of the Médic Ecosse medical staff present at the table. The other was Dr Thomas Kinscherf, medical director of the hospital, urbane, smiling and generally very much at home in dealing with people. Ross was seated opposite Neil Bannon, listening politely to what was being said around him and smiling at intervals. An occasional glance at his watch betrayed a slight impatience for proceedings to begin.

Ross was a pleasant-looking man in his early forties, of average build and with fair hair swept back from his forehead. His skin was smooth and tanned and he wore frameless glasses with large, square lenses. He looked like a man at ease with himself, self-confident, successful in his chosen career and with nothing left to prove to anyone. His suit was conservatively dark but he wore a pink bow tie with matching handkerchief in his breast pocket. The typical, give-away flamboyance of the surgeon.

The admin secretary, Giordano, was exuding charm as he spoke to the Scottish Office contingent. Any word uttered by the visitors claimed his rapt attention, any suggestion of humour brought a large grin and a hearty laugh. It was clear that the Médic Ecosse people were on their best behaviour. The day was all about good public relations.

‘Shall we begin?’ asked Bannon. He was one of the few people not smiling.

Giordano brought the meeting to order and requested that the ‘financial parameters for debate’ be established. This translated into the reading of finance reports both from Médic Ecosse’s accountants and from the financial officials of the Scottish Office team.

When they had finished, Bannon looked round the table at the gloomy faces and said, ‘Gentlemen, I think we should cut the Gordian knot and come straight to the point. It’s quite clear that this hospital cannot continue functioning unless it receives an immediate injection of cash. It’s a question of where this cash is going to come from.’ He paused. People round the table exchanged glances. ‘I understand that Médic International feel that they’re not in a position to invest any more at this time. This leaves public money and, frankly, this too is quite unthinkable at a time like this when we’re urging restraint on public spending and cutting back on even essential services.’ He paused again to let the buzz die down before continuing. ‘But there again, the alternative is equally unpalatable. The hospital would have to close down, with the loss of money already invested and the accompanying human cost in terms of jobs. This leaves us, as our American cousins might say, between a rock and a hard place. Personally I think it would be an absolute tragedy if an almost brand-new, state-of-the-art hospital with a world-class medical staff had to close its doors, but these are the bare facts.’

‘Not to mention politically embarrassing and bloody expensive for the Tory party,’ muttered the Labour councillor.

‘If it’s so state-of-the-art and world-class, why is it losing money?’ asked a distinguished-looking man who, unlike the others, favoured a light-coloured suit. He was a representative of a major Scottish insurance company which had invested at the outset in Médic Ecosse.

‘We feel it’s a problem we can deal with,’ replied Thomas Kinscherf. ‘We simply don’t have enough patients at this moment in time.’

‘Why not?’

‘It appears that would-be clients still prefer London hospitals, although we believe that with the right marketing this problem can be overcome. It’s just a geographical thing that we didn’t consider seriously enough at the outset and still haven’t taken the appropriate steps to remedy.’

‘There are plenty of patients not more than a mile from here,’ interjected the councillor. ‘It’s just that they don’t have the money to pay for all this fine treatment.’

‘I think we’ve been through all that,’ said Bannon rather testily. ‘The hospital’s being run as a business for foreign clients who bring money into this country. It’s a service industry, just like hotels and theme parks. There’s nothing wrong with that. It benefits us all in the end.’

‘Not if it doesn’t actually make any money.’

‘It will, sir,’ interjected Kinscherf. ‘We just need a little more time.’

‘And a lot more public money,’ added the councillor.

‘Frankly, there is no question of further unconditional funding,’ said Bannon. ‘Our people have carried out an in-depth analysis of the figures from each department and come up with projected figures for the next three years. Based on these we will be prepared to offer funding at a suitable rate of return but with conditions attached.’

Giordano and Kinscherf exchanged glances. Neither man was smiling any more.

Bannon continued, ‘Our money people have highlighted a certain problem area which we’d like to see dealt with. In fact, we would insist on it.’

‘I’m sure we would be willing to consider your findings,’ said Giordano.

‘We are disturbed at the very low profit margin being shown by the transplant unit,’ said Bannon.

James Ross looked surprised. He shifted uneasily in his seat. ‘Are you suggesting my department doesn’t pull its weight?’ he asked. His surprise was obviously shared by many at the table.

‘Far from it,’ replied Bannon, ‘Your unit is clearly a success story. Unfortunately, at the moment, it’s the only one.’

‘So why pick on us?’

‘Frankly, and not to put too fine a point on it, it’s more of a medical success than it is a financial one. Your overheads seem uncommonly high.’

‘We have to do our best for our patients,’ said Ross, taken aback. ‘Transplant surgery is an extremely expensive business in terms of both equipment and staff but our results are second to none.’

‘And this is reflected in the fees charged by the hospital,’ countered Bannon. ‘No one is disputing your expertise, Doctor. The excellence of your department is why you’ve been so successful in attracting custom. As I understand it, the survival rate shown by your patients is extremely good.’

‘Quite outstanding,’ interjected Giordano.

‘So what is it you want from me?’ asked Ross. ‘I can hardly cut staff.’

‘It’s not a case of cutting staff, Doctor. The money is coming in to your unit but investors don’t seem to be seeing the returns they should from it. We have pinpointed the problem as being your very high research-budget costs.’

Ross seemed to search for words before replying calmly, ‘My contract states that research funds at an agreed proportion of income will be made available to me. That’s why I agreed to come here in the first place.’

‘We understand that,’ said Bannon. ‘But if more public money is to be found to support the continuation of Médic Ecosse, this arrangement simply cannot continue.’

‘But my research programme is absolutely vital to me if we are to go on increasing our knowledge and improving patient care,’ Ross appealed.

‘I understand how you feel, Doctor, and it does you credit but this is not a research institute, it’s a commercial enterprise. It’s a private hospital and it’s a business. It treats sick people. It treats them and then charges them accordingly. It’s that simple. The universities and research councils provide funding for research. Médic International and its co-investor, Her Majesty’s Government, do not.’

‘But my contract—’

‘I think if you re-examine the exact wording of your contract, Doctor, you’ll see it states that the percentage of funding you refer to is only valid if other departments in the hospital are doing equally well.’

‘I don’t think I understand,’ said Ross, leaning forward slightly in apprehension. He looked to Giordano and Kinscherf for support.

‘Your agreement for research funding is that fifty per cent of net profits from your unit be returned to you to carry out your research programme,’ continued Bannon.

‘Exactly,’ said Ross.

‘But,’ said Bannon, holding up his index finger, ‘only if the receipts from the transplant unit amount to no more than twenty per cent of the total income of the hospital. As it is, income from your unit currently amounts to sixty per cent of profits.’

Ross slumped back in his seat and looked towards Giordano. Giordano was whispering to the Médic Ecosse accountant by his side but his expression told everyone the question. The nod he got in reply told everyone the answer.

‘But any adjustment in line with these figures would effectively bring my research to a halt,’ said Ross, obviously upset.

‘I’m sorry, Doctor,’ said Bannon. ‘But I repeat, this is a hospital not a university.’

‘In that case, gentlemen, I may have to consider my position very seriously,’ said Ross, gathering his papers together.

There was general discomfort at the way Ross was being singled out by Bannon. Everyone bar him seemed to realize that Ross was the hospital’s main asset. Without Ross and the transplant unit the hospital would be doomed to closure anyway, but the government side seemed determined to take a hard line.

Dunbar, as an outside observer, could only assume that the Scottish Office, riled by rumours of Médic International trying to put something over on them, had decided to take a tremendous gamble. He suspected that the ultimatum was really a bluff and they would back down if it looked as if Ross was going to resign. As Ross was head of the unit he was interested in, he was keen to see how things were going to turn out.

Bannon watched Ross prepare to leave the table before saying, ‘Doctor, I sincerely hope that you’ll find it possible to continue performing the marvellous feats of surgery you’ve been doing over the past few years.’

Ross acknowledged the words with the merest hint of a smile. He had obviously been totally unprepared for what had happened. He cleared his throat and asked, ‘Is there any room for compromise in the figures?’

‘I’m afraid not,’ replied Bannon.

Ross swallowed, then rose from the table, ‘If you’ll excuse me, gentlemen,’ he said. ‘There are things I have to do.’

Bannon said, ‘Believe me, Doctor, if there was some way we could continue funding you we would. I know how strongly you feel about your research and it does you credit. I urge you not to make any rash decisions. Things might be very different should this hospital start to give returns worthy of its potential.’

The Labour councillor, sitting opposite Dunbar, leaned across and whispered to him, ‘Bloody hypocrite. They don’t give a damn about research. Profit’s the only thing that lot understand.’

Dunbar smiled at the man’s volte-face in now defending Médic Ecosse, but he took his point. Ross did seem to be getting a raw deal. He could feel the tension round the table. People knew how high the stakes had gone. It was like watching a high-roller at the roulette wheel.

‘Would there be any other conditions?’ asked Giordano as Ross left the room. He said it tongue-in-cheek, clearly expecting a negative reply.

Bannon took the question at face value. ‘Yes,’ he replied. There would. We’d like to do something about the public perception of the hospital. There will be deep resentment at further public funding of a private institution, whatever the circumstances. If we were to reach agreement and the public were to inject yet more cash into a facility that for the most part they have no access to – even if it is just for long-term business reasons – I think Médic Ecosse might have to make some kind of popular altruistic gesture in return.’

‘Some kind of public relations exercise you mean?’ asked Giordano.

‘If you like. I thought perhaps you might consider offering free treatment to a reasonable number of Scots NHS patients who would benefit from your highly specialized equipment and professional expertise.’

Giordano had recovered his cool. He smiled and said, ‘Minister, I think that’s a splendid idea. We’ve taken a few patients in the past when approached, but I think I can safely say we would have no objection to taking a few more. It’s always good publicity for us.’