Wealth Is Health; Modern facilities and colourful carpets Edinburgh's

MARY Davies's NHS experience is not a typical one. She boasts about the comfort of the electric bed in her single room then invites me to have a "quick peek" at the ensuite facilities provided, as if too long an inspection will result in their disappearance. As we speak further, 66-year-old Mary casually mentions that she enjoyed lunch with her consultant orthopaedic surgeon before the knee operation which has resulted in her hospital stay. She tells of the taxi sent to pick her up from home, and her only complaint is that the flat-screen, state-of-the-art television and telephone unit installed in her room don't seem to be working.

Mary is not suffering from some bizarre anaesthesia-induced, post- operative delusions. Instead she is one of the first four elective orthopaedic patients to be treated in the new Royal Infirmary of Edinburgh (RIE) at Little France on the outskirts of the capital. After years of wrangling and debate, the doors finally opened last Sunday. Half a century in the planning, opening trade has been slow given that only one department is ready for business. Next month, things will change as maternity services - being transferred from the Simpson Memorial - also take up residence, with the first baby due to be born shortly after 8am on March 2. Around 1400 staff will move to the hospital in phase one, where there will be four orthopaedic theatres, three maternity and gynaecology theatres, and one day-bed theatre. The second phase will open in spring 2003. When completed the hospital will have 869 beds, 25 operating theatres and employ around 5000 staff.

The development of the project has been highly controversial as the (pounds) 184 million pristine white facility was funded by a private finance initiative (PFI) and Consort Healthcare, a consortium made up of Balfour Beatty, the Royal Bank of Scotland, and Morrison Construction. Today, concerns about the financing of the infirmary are muted. Instead, the first tranche of patients and staff members welcome the new resources.

It's easy to see why. Most of those who are receiving treatment in the new wards and rooms will have previously attended clinics at the old Princess Margaret Rose hospital (PMR) near the Liberton area of the city. The buildings were from a different era in which TB was more of a concern than PFI. Large wards meant little privacy and facilities were sparse. Patients are describing their new surroundings as "luxurious" with more than one observing that "it's like a hotel". Other comments include "no complaints at all", "absolutely lovely", and "it's a privilege to be here". It could be because of the press officer who never leaves my side, or it could be that there are few words readily available to those who are more used to Victorian set-ups and pre-operative trolley dashes past gawping visitors.

For those more used to fighting for a parking space at the old PMR or Royal Infirmary Edinburgh (RIE), the first change is the easily accessed car parks. The siting of the new hospital was hotly debated because Little France was thought to be difficult to reach for those who do not have their own transport, but for every argument which can be raised there is an equally valid opposing point. Edinburgh is only following in the footsteps of other European cities by moving older hospital facilities to the outskirts where populations are increasing. Furthermore, there seems to have been widespread amnesia over the fact that the old building was just as inconvenient for just as many people as this one will be.

As you enter the reception of the first 185-bed phase, it is the light and space that is most noticeable. Carpets are colourful and comfortable, although one member of nursing staff complained it was agony to walk on them all day. As construction continues, there will be shops for patients and staff, including a Starbucks instead of a WRVS canteen. It is a million miles away from what most of us are used to on the NHS - but is that enough?

Orthopaedic consultant Colin Howie moved to Lothian University Hospital Trust four years ago from Inverness, and part of that decision was based on the resources promised at Little France. "Professionally, it was clearly an attractive prospect," recalls Howie. "One of the main problems with British city-based hospitals is that you are forced to work in large Victorian buildings which are inappropriate for modern medicine.

"Practice has changed, expectations have changed but health care settings don't always reflect that. What we have here changes things. It's not perfect, but the whole building has been designed around recognising what has happened in medicine since hospitals such as the old Royal Infirmary were established."

Howie was part of the 26-member team sent to the US in order to look at the possibilities for good practice. "In the States, you simply don't have hospitals that are so antiquated. Few are older than 10 years, and they cannot understand how we manage to achieve what we do with what we have.

"We took lots of inspiration from that visit, and saw something in most places that we could willingly adopt. In Cleveland, we got the notion of maternity units in which a woman would have a single labour, delivery and post-partum suite to stay in throughout."

The new ideas seem to be working. Patients going to theatre will no longer suffer the indignity of being wheeled along public areas. All rooms are for single occupancy, or patients will be put in a ward of four. Private bathrooms with showers are commonplace and there are assisted facilities for arthritis sufferers. Sister Lori Hall believes that, while the commitment of staff has always been assured, the new provisions will give them added enthusiasm for their work. "I was at the PMR for 10 years and they have always been talking about this happening. It really is marvellous that it has finally come about. To be honest, the surroundings don't really matter if you love your job - but I can't see me ever moving from an environment like this. What we need to work towards in all health care is a more holistic approach and this is part of that movement."

Hall, like everyone else, bristles when the question of finance comes up. "I suppose to some extent, the PFI worries don't matter so much anymore," she admits. "It's a means to an end, isn't it?" This seems to be the prevailing attitude. PFI may be a contentious issue for politicians but the health service staff who now have a modern, well-equipped hospital to work in are reluctant to criticise it too loudly.

Amid the gloss and shades of blue, green and lilac that characterise Phase 1, there are a few reminders of what went before. The incongruity of old furniture from the clinic's previous manifestation at the PMR is substantial. The slightest thing which jars with the colour co-ordination of Little France stands out a mile - even bedpans are a tasteful shade of teal as they are whisked by.

Grace McMurray is waiting for a knee replacement and conveys an air of enthusiasm which is hard to reconcile with the operation she is about to undergo. Her hands are twisted with arthritis, and she has a list of previous procedures, but she can't stop smiling. "It's amazing, really amazing. When I came in and saw the carpets and the lights and the space - it's a treat to be here, it really is."

Sixty-five-year-old May McFarlane is waiting to have pins taken out of her toe. "You're always nervous coming into hospital, and they can't do anything about that, but you do feel better when you see that they have the best of everything and that it is all so beautiful."

Of course it will take a lot more than some paint and a matching carpet to fix the NHS. But there is an infectious air of professional enthusiasm that could not be generated by the delivery of a few parcels from an office furnishings catalogue and a quick visit to the Ikea lighting department.

"Staff moral is definitely up," says Colin Howie. "Last year in the PMR we were told that 23 ceilings needed replaced - here we have had a wish list to compile. There's no comparison. Everyone can see the benefits and everyone will get a better service from this. There is no doubt that old hospital buildings do generate a feeling of history and loyalty, but that can never be a substitute for a custom- made, specifically designed new hospital.

"The next part of the project is ours - we have to build new loyalty among patients and we have to develop commitment through teamwork. If you're in one of the best environments in Europe, that has to be achievable."

Copyright 2002
Provided by ProQuest Information and Learning Company. All rights Reserved.