JRSM >
Volume 97, Number 5 >
Pp. 248-249
Musculoskeletal Research Unit, Medical School, University of Edinburgh Teviot Place, Edinburgh EH8 9AG, Scotland, UK
Correspondence to: J S Huntley
E-mail:
jimhuntley{at}doctors.org.uk
Squealer addressed the meeting at the Farmhouse: ‘The Animal Health Service is in decline and needs redevelopment. Our decrepit old hospitals—many in awkward areas like town centres—need urgent modernization. After discussion of future Service requirements with doctors from a wide range of species—feline, equine, bovine—we intend to build a specially designed flagship state-of-the-art hospital on previous farmland. We will develop local infrastructure and provide integrated transport networks. As for the old hospitals, these hazardous defunct buildings...’ Squealer paused and wiped a tear away, ‘are an immense financial liability. But rest assured...’, another pause, ‘the pigs will bear this burden’.
He continued, ‘Our monumental enterprise is ambitious—but the new funding arrangement, the Pigs Financial Imperative, or PFI, will meet the glorious challenge of "Health for all, for all health".’ The animals were not sure what Squealer meant by this last remark, but they were swept along by his enthusiasm and cheered loudly.
The animals were unanimous in their support of the low field being used for the PFI. It was, in any case, poor land, flooded most winters. Soon a major planning initiative was underway, with extensive consultation between the pigs and other animals. The pigs were at pains to emphasize the ‘all-win’ nature of the enterprise, and the integrated approach to planning. As time went by, however, the hospital did not seem to be emerging quite as originally intended. The lower animals could not work out just why, and when they compared the building with the plans (which were surprisingly pristine and glossy) there was no obvious discrepancy; it just seemed rather small for the purposes intended. The murmurings of discontent grew, so the pig executive called a general meeting.
Squealer, now chief-spokespig of the trust, addressed the assembled animals, ‘We harnessed medical experience to design and build a hospital with a unique blend of care, cleanliness and efficiency. However, the service that we inherited was immensely inefficient, a drain on all tax-paying animals. Some of the idealistic expectations of the doctor-animals proved unfeasible—for example, maintaining the regional number of acute inpatient beds and increasing downstream capability’. Squealer turned to smile at the clinicians as they huddled together in a corner surrounded by the dogs. The dogs barely showed their teeth and the clinicians nodded nervously. Once it had been explained in these simple terms, the other animals saw where the fault truly lay. The clinicians, many of feline origin and prone to waywardness and self-indulgence, could hardly have been expected to have the wisdom of the pigs. They were easily forgiven these faults.
In spring came the Great Move. Before this there had been a Great Debate over what the new hospital should be called. One of the sheep suggested ‘New Hospital’, to distinguish it from the old hospital, which henceforth could be known as ‘Old Hospital’. Upon this suggestion, the others bleated in chorus: ‘New Hospital good. Old Hospital, baaad’. Who, after this, could have persuaded the sheep to accept an alternative? The other animals looked at each other, shrugged their shoulders and accepted the naming.
Services at Old Hospital were gradually run down, and some were restarted at New Hospital. There was much sentimentality about the closure, and rumours began to circulate about troubles with New Hospital—restrictions on staff cart-parking, lack of pallets, nursing shortages, stagnant air, power failures. Such was the concern that the pigs determined to address the issues with a special Conference. Squealer raised a trotter and brought the meeting to order.
‘You will have read about "teething problems" at the Flagship New Hospital. There are indeed problems—but these were to be expected, even though they were entirely unpredictable. Fellow animals, there is no one as upset by these issues, such as they are, as we pigs. Some of us have given our own health striving for the greater good. Let us see these start-up problems not so much as mistakes as opportunities and challenges for the future.’ His usually well-modulated voice quivered: ‘How much more would the pigs have liked to do the feel-good work of our medical brothers, saving lives and healing the sick? But who then would do the unglamorous drudgery that keeps New Hospital alive? A greater duty calls us.’ Squealer waited, allowing his words to sink in. ‘The pigs work night and day to shore up the flawed and deteriorating system we took over. Despite this, senior pigs stand accused of incompetence. These areas of complaint relate only to services such as cart-parking which we had subcontracted out to lesser animals, believing the jobs to be well within their capabilities. Malicious accusations have placed an immense strain on my poor fellow pigs, some already at the point of exhaustion.’
He sighed, and looked directly into the audience. ‘When we feel that things are bad, or at least not as good as they could be, let us remember the days before PFI—the days of the prize Middle White boar Old Major, who himself remarked, "What is the nature of this life of ours? Let us face it, our lives are miserable, laborious and short".’
Mr Boxer, an orthopaedic surgeon of pure carthorse stock, cleared his throat and remarked, ‘The solution as I see it, is to work harder’. Squealer smiled benevolently. It would have been impossible for Mr Boxer to work harder, as his ward had been closed and the operating theatre shut. ‘Mr Boxer, my old and trusted friend, that is how we pigs feel too. But the harder you work, the more you cost the hospital. Key spending areas will have to undergo detailed review and reprofiling before institution of an action plan designed to deliver even higher quality care, but in a more efficient manner.’ The assembled hordes were greatly reassured. The pigs had such clever solutions.
‘This will be no simple matter and will necessarily involve contracting a pig consultancy team to develop and implement a rescue package. Reduction in costs will be accomplished with efficiency savings rather than cuts, and certainly patient care will never be jeopardized.’ The lower animals breathed a collective sigh of relief. Although they had understood little, it was clear that the pigs had matters in hand.
‘In response to the length of the waiting-lists,’ Squealer declared, ‘the Pig Executive has already proposed to set up a new Flagship unit, which we will call a Diagnosis and Treatment Centre, or DTC. These are already operative in other parts of the country.’ Freddy the flamingo, who had been released from the zoo on Liberation Day some ten years previously, remarked: ‘A DTC sounds remarkably like a...’. He had been going to say ‘hospital’, but was cut short by the snarl of a neighbouring dog. He switched legs, shivered and instead muttered ‘good idea’.
Squealer smoothed over the awkward moment, redirecting the audience's attention. ‘And so Mr Boxer, for the good of PFI and for the good of your patients, we would ask you to take unpaid leave, and work in one of the new DTCs’. Mr Boxer neighed his enthusiastic agreement and a waiting DTC removal van whisked him away. The conference erupted into rapturous applause. It lasted three-and-a-half minutes, which was a record even for Squealer.
Only Dr Benjamin, the old donkey ruminating in the shadow of the ruined castle above the New Hospital, remembered the dreams of long ago.
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