Luxury break

Published: 07/02/2002, Volume II2, No 5791. Page 14 15

The battle of post-operative knee broke out last week, with the massed ranks of the national media fanning out across Europe. They were on the tails of the Lille Nine, the Essen Three - and, of course, retired Lancashire mill worker John McCumisky, ensconced in his bed at the Interbalkan European Medical Centre in Thessaloniki, Greece.

The hype surrounding the 69year-old Englishman recovering from his knee replacement in Greece's second city has been the most extravagant of all.Many column inches have been dedicated to the spanking-new private hospital treating Mr McCumisky. The marble pillars, splashing fountains and tinkling piano music, the general opulence, shininess and state-of-the-art equipment have been all over the press.

And along with Mr McCumisky's story - he has finally got his operation by 'going private' and flying to Greece - the papers have revelled in the damning testimony of the hospital's head of radiotherapy Louisa Vini, who has worked in our very own NHS, where she was 'constantly frustrated' by patients' 'unacceptable' waits for radiotherapy. Not like working at the Interbalkan European Medical Centre (IEMC), oh no.

It has been something of a reworking of the old 'third-world NHS' headlines, with the shiny Interbalkan putting Britain's health service to shame. The enticing hook is that English patients could soon be winging their way to Thessaloniki to sample its lavish care for themselves - on the NHS.

For Mr McCumisky's operation was arranged - privately - by Operations Abroad, subsidiary of a Stockport-based travel insurance firm. Operations Abroad is one of the companies touting for business with the NHS. It has had talks with the Department of Health in the wake of health secretary Alan Milburn's announcement that primary care trusts can commission services throughout the EU.

It is offering an all-in package:

operation, flight, accommodation, airport transfers and - although the NHS is unlikely to fund this part - flights and accommodation for relatives.

Operations Abroad is also acting as sole UK agent for Athens Medical Group, the IEMC's parent company.

So what lies behind the huge press interest? First, a declaration might be in order: the media - HSJ among them - have been flown business-class to Thessaloniki, plied with food and drink and put up in the five-star Hyatt hotel. In their rooms, each hack will have found a briefcasestyle goodie bag filled with rather more expensive than usual freebies: a video and CD-ROM about the centre, a jewellery box encasing a giant Athens Medical Group medallion and crystal paperweight among them.

They have been taken for a big night out at the taverna, a bus tour of the historic city, better known as Salonika, and an inch-by-inch tour of the gleaming hospital itself. They have been well looked after. They have also been subjected to some serious hard sell.

The sales pitch starts at Gatwick airport and proceeds onto the plane, where the legroom and meals offered by Olympic Airways, Operations Abroad's 'preferred carrier', are demonstrated.We get to hear a lot about how wonderful the hospital is, too.

At the other end we are spared Thessaloniki airport and whisked straight off the tarmac. Passports are checked on the special coach laid on to take us for a quick night-time peep at the hospital.

Apparently Olympic will arrange this handy airport bypass for NHS patients, too. The IEMC is only five minutes from the airport, just as it says in the brochure, a fact which is pointed out repeatedly.

And look, There is the hospital.

is not it lovely? Even cynics have to admit that it is an attractive bit of architecture, beautifully lit - especially the top-floor restaurant and terrace, and it has a pretty little helicopter parked outside for those hard-to-reach patients.

En route, senior players from Operations Abroad and Athens Medical Group talk about the glories of the hospital, and promise we can see any part we like in the morning - no restrictions, no waiting around. They compare this to what they claimed was poorer treatment of journalists who went with NHS pilot-scheme patients to Lille in France. It is clear that the competition for NHS money will be fierce.

The running sales pitch is pretty forceful during every waking minute of the trip.And though the happy hacks' five-star treatment demonstrates the type of care any patient might wish for, it feels a bit awkward - like getting an embarrassingly expensive present on a first date. There might be a bit of overkill here.After all, as one journalist remarked next morning, the place sells itself.

There is something that inspires awe, if not downright jealousy, about the newly built hospital. It is full of marble, an attractive material for corridors which cleans to an actual shine, unlike our more familiar lino and stained carpets.

Some of the glossiness of the surroundings is because the 445bed IEMC opened only in September 2000, and some departments have been up and running for just a few weeks.Wear and tear is visible only in one door's malfunctioning magnetic catch - it has had to be propped open with a fire extinguisher.

Nor, as a private hospital, has it been trampled over by half of Thessaloniki. Its pitch at Britain is part of a general international orientation. 'The hospital was built specifically to treat not only Greek patients but also patients from abroad, ' says Vasilis Apostolopoulos, Athens Medical Group vicepresident. It treats NATO officials, the military and politicians from the surrounding Balkan countries.

He adds: 'We can duplicate British care. . . or at least a lot better than the French or Germans can do.'

The tour includes a look at many pieces of expensive equipment, whose functions are explained, although the much quoted head of radiotherapy, Louisa Vini, admits that her equipment is similar 'to all radiotherapy departments in England'.

But administrative director Yannis Kokolinakis says the hospital equipment is all the latest models, and points out, 'If you want to attract and retain the top doctors, they want the top toys.'

The circular intensive care unit is the 'heart of the hospital', Mr Kokolinakis adds.And, unlike private hospitals in England, IEMC has an accident and emergency department of its own. NHS A&E managers might not recognise it, though. With 35-45 patients a day, it is more or less empty. You couldn't film Casualty here.

Up on the wards, Mr McCumisky is very comfortable in his single room. His main aim, after a 17-month NHS wait, was to get his operation done. 'I used to have to hop all the way to the toilet, I couldn't put my foot down, ' he says, adding that the IEMC is more like a hotel than a hospital. He likes having the window open and his view of the Thermaic Gulf.

His wife Joan is also happy. 'Well It is Greece is not it?' After Thessaloniki, she wants to see some of the islands.

But while this is all very nice, is it something that the NHS should consider investing in? The data primary care trust commissioners might be interested in is somewhat lacking.

First, the price: Mr McCumisky, who - like Operations Abroad - is from Stockport, has paid the company 12,500 - about£7,500 - for the operation, travel and his wife's accommodation.

But Mr McCumisky is a one-off patient who made his own arrangement with the company at just the right time to be a guinea pig for the package. Operations Abroad general manager Ken Taylor says: 'That doesn't mean It is the ongoing price.'

As far as the possible charge to the NHS is concerned, Mr Kokolinakis says: 'We are working on the offer at the moment.'

Athens Medical Group organisational development and quality assurance director Tony Rapp is not much more precise when asked how much a knee operation might cost a Greek patient. 'There is lots of variables. The physician [the surgeon] brings the patient to us and negotiates his fee independently of what the hospital charges.'

Pressed, he says the cost of medical treatment only would 'run between 10,000 nd 12,500 (£6,000-£7,500). 'It depends on the kind of device. . . the surgeon, on how long you anticipate the patient is going to stay.' He admits: 'We are all slippery about that. It is sensitive corporate information.'

Mr Rapp says the mortality rate in the intensive care unit is 1.58 per cent and readmissions within 30 days stand at 0 per cent - none at all. But the eerily quiet A&E case-mix is unlikely to match that of NHS hospitals. And, as Mr Rapp points out, the hospital has only been open a little while.

Mortality and morbidity are monitored by an internal review group. Mr Rapp adds:

'Government auditors come once a year to review our operations under the law. There is no accrediting body.We are showing our dedication to quality by pursuing the ISO 9002 qualification. We do not have anything else.'

The ISO is an international standard for business practices, with a category for healthcare, but it does not measure doctors' clinical work.

These are not the only areas about which questions have been asked. The NHS Confederation has cautioned against treatment abroad being driven by 'affluent middle-class' individuals - those who can afford the costs of bringing their relatives to Greece for a fortnight. And British Orthopaedic Association president Malcolm Macnicol has warned of the dangers of transporting patients too soon after surgery abroad.

As for the wisdom of channelling NHS funds into the Athens Medical Group, it is interesting that private hospital providers have expressed unhappiness that investment could go to their - possibly cheaper - overseas competitors.

And Mr Macnicol says:

'Resourcing is being leached out of the UK system and there is no return on that. If you restrict patients to going through a British hospital, there is equipment bought and trainees trained.'

There is something about the sheer opulence of the IEMC that suggests your local NHS hospital might be in more desperate need of the cash. Marble floors, anyone? l