IT is one of the most emotive accusations to get thrown into rows about the National Health Service – queue-jumping. The idea that someone, somewhere is getting preferential treatment for any reason other than clinical need is guaranteed to create no
isy protests.
So when the Royal Bank of Scotland made a £4 million gift of one of the world's best scanners to test heart patients in the Capital – with the proviso its staff get 25 per cent of its use – it was perhaps inevitable there would be a fight.
One of Scotland's leading health experts, Edinburgh University's Professor Allyson Pollock, has raised concerns the "gift with strings" will undermine the principles of equal access to the NHS.
The Aquilion One scanner has been donated to the Queen's Medical Research Institute – part of Edinburgh University – to research conditions such as heart disease.
The RBS donation will not only buy the scanner, but also pay staff costs and maintenance for five years. After that, it's hoped grants will be found to keep it operating, if it has not become outdated.
As part of the deal, around 4000 NHS patients a year are likely to undergo tests on the scanner, alongside about 1000 RBS staff.
Prof Pollock fears that introducing such a system of public/private partnership means some people may get better access despite having lesser needs than others.
Independent Lothians MSP Margo MacDonald is to call for a Holyrood debate on the issue, concerned new ground rules need to be set out for future donations.
Labour health spokeswoman Margaret Curran MSP sums up the concerns, saying: "We would need a guarantee this will not lead to any queue-jumping and that access to this equipment will be determined by clinical need. It's obviously a very significant precedent.
"Health spending is going down in Scotland compared to England. We could never get ourselves into a position where corporate sponsorship filled that gap. That would not be acceptable."
But NHS Lothian's medical director Dr Charles Swainson is clear that it is NHS patients who will be the winners.
"It's really important when you get something new like this to do the research properly to determine who will benefit from it in future. I'm quite clear that no NHS patient is going to be disadvantaged.
"First of all this is not part of the NHS service (The scanner is being gifted to Edinburgh University and will be operated by its staff ]. We've already got a perfectly good service for patients with heart disease, good current scanners and there are no waiting lists for people requiring investigations for heart disease."
The main benefit will come in the long-term as the scanner is essentially to be used as a research tool – but some patients with highly complex cases could also see immediate dividends.
The scanner is expected to make a major contribution to Scotland's efforts to cut heart disease and cancer deaths.
Unlike conventional scanners, the Aquilion One can capture an image of the whole organ in just 0.35 seconds, meaning radiation exposure is reduced by 80 per cent compared with a CT scan.
It is also hoped the scanner will reduce the need for invasive procedures on patients, as well as help research on the internal workings of the body.
"The kind of ratio we've got, which is up to 25 per cent of time for RBS, is quite reasonable because three quarters of the time or more it will be used for research," says Dr Swainson.
"I have no doubt there will be cardiologists around Scotland who will put good clinical reasons why particular unusual patients might be better off being put through this scanner than having a conventional cardiac catheterisation.
"In that case we would be pleased to put those patients through the scanner, but I think those will be very few and far between.
"The big use will be for research on people who may be at higher risk of heart disease than usual, for example people from the Asian Subcontinent, particularly India and Pakistan.
"Heart disease is also more serious in poorer people so there's a real opportunity to address that problem in Scotland.
"What the machine does is give you a diagnosis and an assessment of whether somebody has heart disease and how bad. Professor (David] Newby (director of QMRI's clinical research imaging centre] has already done fantastic research using existing technology that demonstrates that if you treat people without symptoms aggressively you can demonstrate that the disease gets better. He would like to do that kind of research on larger numbers of people and with a far greater degree of accuracy than before."
With Scotland's woeful record on tackling heart disease, it should certainly take a powerful argument to hold back any research which may improve the situation.
There are always going to be concerns raised about any private involvement in the health service.
It is right there should be a debate about any wholesale move to replace public funding with money from private sources before it could be allowed to happen.
But it is hard to find fault with the Royal Bank's gift. Where are the losers when NHS patients can still expect to receive a prompt service? And when it will allow more groundbreaking research to take place?
It is tempting to suggest that in this situation at least a more apt accusation would involve the old adage about looking gift horses in the mouth.
The full article contains 958 words and appears in Edinburgh Evening News newspaper.
