Stitched up and thrown out

ON THE DAY Virginia Bottomley made her speech predicting huge cuts in hospital beds thanks to the advances of modern medicine, I met up with one of her statistics. The elderly woman was sitting under an umbrella, feet up on a sun lounger, next to the swimming pool in her daughter's garden.

With sunglasses, mobile phone and newspaper on her knee, she seemed the picture of prosperous serendipity. The only clue that she had undergone cataract operations on both eyes two days before, as a day patient, was that her housewife daughter was in constant attendance.

They recounted in astonishment an exchange with the eye specialist. He had told them that he felt happy about discharging Chinese and Indian patients on the day of their operations, because they so obviously had families prepared to take them to hospital, stay with them, collect, and nurse them at home. But with black, and increasingly with white elderly patients it was the reverse: they seemed to be quite alone, with no one to care for them. They needed to be kept in overnight.

The conversation crystallised the anxiety that the Government's health service changes and this week's new star ratings arouse: on-the-day operations for conditions such as hernias and cataracts are one of the categories that win stars, a measure of how well hospitals are run. Yet Britain needs a health service that meshes with society, and the inequitable conditions of our real lives.

Hospitals are not about putting people in bed, says Mrs Bottomley. But they are about making people well, not just about dishing out cost-effective treatment and chucking miserable post-operative patients out on to the streets to catch a bus home in the rain. It is quite clear that there should be a health dividend somewhere around the corner as the increased use of less intrusive surgery reduces the trauma and pain of routine operations and the success of new drugs cuts out the need for bed rest.

But before the Government goes ahead with its plans to cut 45,000 acute beds (equivalent to 90 district hospitals), Mrs Bottomley's prediction that 60 per cent of operations will be done on a day basis by 2002 needs to be challenged.

The public may not have understood fully the revolution in treatment just around the corner but they do know about social trends and the dispiriting experience of living in a dislocated society. Thirty-one per cent of babies are born outside marriage, one in three marriages break down, the nuclear family has fractured, single parents scrabble for an existence and extended families capable of taking the strain and carrying out on-the-spot caring are a rarity.

Inconveniently, for an efficiency obsessed government, the population is ageing. Many older people have conditions such as chest infections, heart conditions and broken bones that need careful long-term nursing, not one- off fixes.

People are not prepared to take the Government's pronouncements at face value because they have seen through its sham 'community care' programmes for mentally ill people. Jayne Zito's campaign after Christopher Clunis randomly knifed her husband, Jonathan, to death has emphasised the cruel lack of care that this policy can result in.

Every now and then the very real strains of modern life are captured in the spotlight. Remember the case of the single mother of Leamington Spa, desperate to work but on low wages, who was briefly jailed for leaving her two-year-old daughter alone all day? Suppose that little girl had needed to have her tonsils out? How would she be cared for during the week-long recovery?

Doctors, well versed in the gamut of human misery, have to consider if there is anyone at home to look after a patient when performing even the simplest of operations. The Audit Commission has reported that only half of in-patients needed a doctor's attention, but they were prevented from going home because of a lack of community support. But it does not go further and ask if those patients needed professional hospital nursing, or help with mundane things such as reaching the lavatory, top-ups for pain-killers, a glass of water in the night. Mrs Bottomley's proposed cutbacks must be placed in context, and someone must start asking tough questions about who is going to carry out the post-operative caring that puts a sick person back on their feet; and where that caring should take place.

Even after less invasive operations such as keyhole surgery, you feel shaky and under par. There are invariably night time crises. People need time to recover after operations - we all know the feeling of being washed out and lacking in energy after an illness. Mrs Bottomley has to be told firmly that before cuts in acute beds are made, other reliable nursing services and centres should be boosted. There should also be a revival in convalescent homes, both locally and in seaside and country retreats, where patients young and old can be transferred. When we're old and ill we can't all expect to sit in sunlit gardens with dutiful daughters to sugar the medicine.