There
was a low murmuring which might have indicated disapproval of the question, but I could appreciate his point. He was at the sharp end and, I knew, had had this question put to him.
‘
That’s a pertinent question,’ replied Miss Shenstone. ‘Of course, at the moment our policy does result in an imbalance, but somebody has to lead the way. As to steps to redress this, I am at present preparing a report for the Department of Health, setting out our policy and urging that it be followed in the rest of the country. Does that answer your question?’
‘
Is your report likely to be acted upon?’
‘
I certainly hope so.’
‘
Thank you.’
Another
hand, then I recognized Deborah Hillard’s voice.
‘
I’d like to ask about the tissue typing of patients’ samples. Are we to understand that every patient in this hospital has a sample of their blood tissue typed for the purposes of possible transplant?’
‘
I think I’d better answer that one myself,’ said Dr Cannock with a smile. ‘Nearly every patient is tissue typed, yes, and if the sole reason was for possible transplant, it would be no more … ghoulish than carrying a donor card. But it isn’t the sole reason. Miss Shenstone and I are engaged in a piece of research at the moment trying to establish the frequency of certain rare tissue types in this country. This happens, occasionally, to coincide with Miss Shenstone’s other requirements. Does that answer your question?’
‘
Most of it, yes. Are the patients aware that their blood is tested in this way?’
A
spasm of irritation crossed Dr Cannock’s face. ‘Yes, in that it is covered by the consent form they sign when admitted to hospital. Dr North, I believe you had a question …?’
When the questions had dried up, Dr Cannock thanked the sponsors, urged us to go to the reception and mini trade show they’d put up in the display hall next door, and then closed the meeting. There was a further round of applause and then the audience drifted away, some to the display hall.
‘
D’you want to go to the trade show?’ I asked Jones.
‘
I certainly do.’
I
shrugged and led the way through. We picked up a glass of wine and some sandwiches. ‘Do you actually want to see it?’
‘
No, we’ll just stand here for a moment.’ He took a bite of sandwich. ‘What did you think of it?’
‘
The talk? Excellent. Didn’t you?’
‘
Oh, yes. She’s an eloquent speaker.’
‘
Is that all you can think of to say? What about the content?’
‘
Oh, it seemed sincere enough, but …’
‘
But what?’
Before
he could answer, we were joined by Stephen. Deborah Hillard was following in his wake.
‘
Hello, Jo. Mr Jones, I’m surprised to see you still here.’
‘
Oh? Why?’
‘
It
is
Friday. I’d have thought you’d have wanted to get back home.’
‘
Miss Shenstone suggested I come to her talk when I saw her this afternoon. I’m glad she did. It’s been most interesting.’
‘
You enjoyed it, then?’
‘
Very much. As I was saying to Sister Farewell, she puts her point of view very eloquently.’
‘
Yes, she does. She made a very convincing case, I thought.’
‘
You would describe yourself, then’ — this was said with a smile — ‘as a disciple of hers?’
Stephen
hesitated. ‘I don’t think I’d use the word disciple. It suggests a … closer relationship than exists.’
‘
Forgive me, Dr Wall, but I’d formed the impression that the relationship was fairly close.’
Stephen
stared at him. ‘What on earth makes you say that?’
‘
From my talk with her this afternoon, it seemed to me that the question you put to her in the meeting was very much a question she would have wanted put.’
He
smiled unwillingly. ‘That is rather perceptive of you, Mr Jones. In fact, she was a contemporary of my father’s at medical school and she’s been a family friend ever since.’ He turned to me. ‘Are you feeling better now, Jo?’
‘
Thank you, yes. The restorative powers of sleep are remarkable.’
‘
I’m so glad. We were worried about you, weren’t we, Debbie?’
Debbie
said, ‘I still think you should have gone to the police. That man Sutton is dangerous.’
‘
Didn’t you go —?’ Stephen began.
‘
Good evening, Dr Wall’ — We looked round to see Mr Chorley — ‘Dr Hillard, Sister.’ He was accompanied by Miss Whittington.
‘
Good evening, Mr Chorley,’ we chimed, almost as one. ‘Miss Whittington,’ I added.
‘
And you must be Mr Jones.’ He held out a hand. ‘Richard Chorley. I’m consultant in ITU.’
‘
How do you do, Mr Chorley.’
‘
Miss Whittington has told me about your visit,’ Mr Chorley said. ‘Are you finding it useful?’
‘
Very much so.’
‘
I must confess that I’m still somewhat in the dark as to its exact purpose.’
‘
We’re conducting a study into the relationships between intensive therapy units and other departments throughout the country.’
‘
Yes, but to what end?’
‘
As you must already be aware, the present government attaches great importance to the costing of every single service rendered, in order to bring costs down.’
‘
I imagine you’re referring to cross-charging, which we’ve already begun.’
‘
I’m sure you have, but to what extent …?’ Jones began, but at that point, we were joined by Miss Shenstone.
‘
Ah, Marie,’ Mr Chorley greeted her. ‘May I say how much I enjoyed your talk?’
She
smiled. ‘Of course you may, Richard.’
‘
That goes for all of us, I’m sure,’ put in Miss Whittington.
‘
Thank you.’
‘
You’ve already met this young man, I understand,’ said Mr Chorley, indicating Jones.
‘
Oh, yes, indeed. I’m so glad you could come,’ Miss Shenstone said to him.
‘
My pleasure.’
‘
It seems that his masters don’t feel we go far enough with our cross-charging,’ Mr Chorley said to her.
‘
So I gather. I’ve already made him aware of my view — that we already go quite far enough.’
‘
It’s not really as simple as that,’ said Jones.
‘
Is it not?’ put in Stephen, who’d been following the conversation closely. ‘Perhaps you’d like to explain why not?’
‘
By all means. Let’s take the case of ITU and Transplant. There are two quite separate issues. Firstly, the fact that ITU is used for transplant patient recovery in some instances. That’s a relatively easy cross-charging exercise, but not so the other issue, the keeping of patients on life support after death for transplants that are of benefit only to other regions.’
‘
That, if I may say so, is a classic example of your tunnel vision,’ said Stephen. ‘I refer to your department, of course, not yourself,’ he added mendaciously. ‘The fact is, UK patients benefit from our policy, so it must, by definition, be cost effective.’
‘
My view entirely,’ agreed Miss Shenstone.
‘
I can see that there is a difference,’ said Mr Chorley. ‘But not an insurmountable one in terms of accountancy, I’d have thought.’
‘
Perhaps not,’ said Jones, ‘but it should nevertheless be addressed. It goes further; is there not a difference, in cost implications, between a patient who dies in ITU and is put on life support, and one who dies in another ward and is then brought to ITU for life support?’
‘
I must say,’ said Miss Shenstone, ‘I regard such distinctions not only as esoteric, but morbid and rather distasteful.’
‘
Hear, hear!’ said Stephen.
Jones
ignored him and turned to Mr Chorley. ‘It’s possible that the only way to get to the bottom of it will be a full financial audit. Is any effort made to keep such figures?’
Mr
Chorley regarded him thoughtfully for a moment before turning to Miss Whittington. ‘Are such figures included, Ann?’
‘
Not as such, no, although I daresay they could be extracted from the figures we do keep.’ She turned to me. ‘What do you think, Sister Farewell?’
‘
I — er — I don’t know. I expect it would be possible.’
‘
Morbid. Distasteful,’ said Miss Shenstone.
‘
Mind if I join you?’ It was Dr Cannock. ‘What’s morbid and distasteful, Marie?’
Succinctly,
she told him.
‘
If I were you, I’d regard it as further evidence of the interest your talk has generated,’ he said smoothly. ‘It really has gone down extremely well. Our sponsors are very pleased with the success of their display as well. A most successful evening.’
‘
Thank you, John,’ said Miss Shenstone. ‘In no small measure due to your own efforts.’
He
turned to Jones. ‘Have you found it interesting, Mr Jones?’
‘
I certainly have,’ he replied rather fulsomely. ‘A most useful insight into the relationships between hospital departments.’
‘
If you’ll excuse me,’ said Mr Chorley, ‘I really must go. Thanks again, Marie.’
Stephen
said, ‘I’ll come with you if you don’t mind, Mr Chorley.’
As
they left, Dr Cannock said — rather maliciously, I thought — ‘Insights into relationships? Would you care to give us an example of that, Mr Jones?’
‘
I think we’ve had quite enough —’ Miss Shenstone began, but Jones said, ‘Certainly,’ and turned to Debbie, who’d been wondering whether to follow Stephen. ‘Dr Hillard …?’
‘
Yes?’
‘
I was interested in the point you raised earlier with Dr Cannock — about blood samples being taken from patients for tissue typing tests.’
Her
face showed how unwilling she was to be drawn into this. ‘It was only a small ethical point.’
‘
But one with both interdepartmental and cost implications.’
‘
I wouldn’t necessarily have agreed with you there,’ said Dr Cannock. ‘The samples are taken anyway; I simply do an extra test on them which is of benefit both to my own research, and to Miss Shenstone in those unfortunate cases in which a patient dies. Dr Hillard’s point was, as she said, ethical.’
Jones
turned to her. ‘How so?’
Her
tongue touched her lips. ‘There have been cases in the last few years in which patients have sued for assault when their blood has been tested for something without their knowledge. That was my sole concern.’
‘
But surely,’ put in Miss Shenstone, ‘that’s only on cases of tests for AIDS or venereal disease.’
‘
My point exactly,’ agreed Dr Cannock. ‘There can be no social stigma attached to a person’s tissue type. Besides, as I indicated in my answer, permission is covered by the consent form.’
‘
But is there not a cost implication?’ Jones persisted smoothly.
‘
A small one, yes, in terms of laboratory testing. But that is covered satisfactorily in my research budget.’
‘
Ah, yes, the research budget …’
‘
You’re not intending to include that in your calculations, I hope,’ said Cannock, who was clearly regretting having ever invited him to the meeting.
Miss
Shenstone said firmly, ‘I really think we should bring this discussion to a close. I, for one, wish to speak to the sponsors, so if you’ll excuse me …’
‘
That’s what I came to see you about, Marie,’ said Dr Cannock. ‘I’ll come with you.’
‘
I must be going too,’ said Debbie, which, after shooting Jones a poisonous look, she did.
I
was expecting Miss Whittington to go as well, but she didn’t.
‘
I must say, Mr Jones,’ she said conversationally, ‘I find your technique for getting information from people … unusual, to say the least.’
‘
Really, Miss Whittington? Look, can I get you some more wine? I think there’s still some left …’ He took her glass before she had a chance to answer.