Opt out, opt out, shake it all about

A national centre for rehabilitation has been put at risk through plans by an orthopaedic hospital to go self-governing.

Mary Marlborough Lodge, in Oxford, is renowned for pioneering work, offering independence to people with severe disabilities. But its future is now in doubt after the hospital to which it is attached, the Nuffield Orthopaedic Centre (NOC), expressed an interest in going self-governing. The final decision was being taken by managers at the hospital, without a ballot of staff, as healthmatters went to press.

Orthopaedic surgeons are in favour of the change, and it looked certain that the move would go ahead despite strong opposition from physicians and some nursing staff.

The general manager of the NOC, orthopaedic surgeon John Spivey, argued that Oxfordshire health authority restricted its budget and its ability to expand as a specialist orthopaedic hospital.

But Mary Marlborough Lodge was planning to make an application to opt out of the opt-out — asking to stay with Oxfordshire health authority.

The Lodge receives two thirds of its patients from outside the Oxford region, and it is recognised by the Department of Health as a national referral centre.

The Lodge’s director, Dr George Cochrane, said in a staff bulletin: ‘We help very severely-disabled people that other people pass by. You can turn lives around. It would be very difficult to maintain the responsibility we have to the region in the form of a self-governing hospital.

’I have requested that in all his representations Mr Spivey will make plain my opposition and that Mary Malborough Lodge should not be part of it. I have made an application that we should be funded separately.’

Under the hospital’s self-governing plans, the Lodge would focus almost entirely on orthopaedic rehabilitation, which at present is only part of its work.

Cecily Jones, sister in charge of the Lodge, said: ‘I am very concerned about what is going to happen when money follows the patient. The emphasis will be on profitable areas. The NHS patients will be cancelled and private work done.

’Our work can be cost-effective in the long run. We help people live in the community and teach carers to cope. We are preventing people going into institutional care.’

Staff Nurse Robin Wagg said: ‘I would like an assurance that Mary Malborough Lodge is not going to cease to exist because people in charge of a budget in the north of Scotland say there is this wonderful place in Oxford, but I can’t afford to let you go’

Senior registrar Dr Jim Unsworth said: ‘I don’t know that the work in this unit is compatible with going self-governing. If the district had a choice of getting someone back to work with a hip operation, or improving the skills of someone who has cerebral palsy so that they can attend school, there would be pressure on them to do the hip operation and get them off the list.’

The Nuffield is one of the top orthopaedic hospitals in the country and the only hospital in the Oxford region to express an interest in self-governing status.

The hospital has a turnover of about £10m, including £1m from private patients. It has been forced to reduce the number of hip operations this year. My Spivey says that quality would be a prime factor in the hospital’s plans, but staff at the Lodge believe they will lose their national role if they are forced to become a self-governing trust against the will of patients and staff.

The Oxford region is likely to offer a short consultation period for the local community to have its say. But the region already has a senior planner on the committee drawing up the Nuffield’s business plan and it is expected to back the project whatever the public and patients say.

Now the government could find itself in the embarrassing position of facing an opt-back-in demand from an important unit of a hospital on the self-governing road. If it fails to preserve the Lodge as a national referral centre, it would be accused of having a dual standard towards the way that hospital should decide their fate.