By James Meek, London Review of Books, September 22, 2011

[...] Martyn Porter, a senior surgeon and the hospital’s clinical chairman, waited in his office to be called to the operating theatre. He fixed me with an intense, tired, humorous gaze. ‘The problem with politicians is they can’t be honest,’ he said. ‘If they said, “We’re going to privatise the NHS,” they’d be kicked out the next day.’ [....}

‘The case we’re doing this morning, we’re going to make a loss of about £5000. The private sector wouldn’t do it,’ he said. ‘How do we deal with that? Some procedures the ebitda is about 8 per cent. If you make an ebitda of 12 per cent you’re making a real profit.’ You expect medical jargon from surgeons, but I was surprised to hear the word ‘ebitda’ from Porter. It’s an accountancy term meaning ‘earnings before interest, taxation, depreciation and amortisation’.

‘Last year we did about 1400 hip replacements,’ he said. ‘The worrying thing for us is we lost a million pounds doing that. What we worked out is that our length of stay’ – the time patients spend in hospital after an operation – ‘was six days. If we can get it down to five days we break even and if it’s four, we make a million pound profit.’

I felt as if I’d somehow jumped forwards in time. Lansley has not yet, supposedly, shaken up the NHS. He’d barely been in power a year when I talked to Porter. But here was a leading surgeon in an NHS hospital, about to perform a challenging operation on an NHS patient, telling me exactly how much money the hospital was going to lose by operating on her, and chatting easily about profit and loss, as if he’d been living in Lansleyworld for years. Had the NHS been privatised one day while I was sleeping? [....]