Pride of the Clyde ?sx - the debate goes on .sx A pounds180m private 'medical complex' is to go ahead at Clydebank , but the arguments about its effect on surrounding NHS services continue .sx Barbara Millar listens to both sides .sx AFTER AN inordinately long gestation period - nine years according to some observers - plans to build a private pounds180m 'international medical complex' at Clydebank near Glasgow are about to come to fruition .sx Work on the complex , which will include a 260-bed intensive care hospital plus a 150-bed residential annexe for patients and their relatives , will start in September on a 47-acre site in the Clydebank Enterprise Zone .sx According to the project's founding directors , American physicians Dr Ray Levey and Dr Angelo Eraklis of Health Care International ( HCI ) , it will provide 1,800 jobs and a further 2,200 spin-off job opportunities .sx The row over the Clydebank hospital reached a climax four years ago when Labour MPs , the Scottish TUC , local health councils , the Greater Glasgow health board , the Scottish National Blood Transfusion Service , healthcare professionals and even other private hospitals argued vociferously against the plans when they were unveiled .sx Although many believe their original objections are still valid , others have begun to adopt a more conciliatory tone .sx Back in 1987 , the Greater Glasgow health board was concerned that HCI's plan to recruit 80 consultants , 34 registrars and 590 nurses would have a detrimental impact on the NHS .sx " We know there will be fewer nurses around in the 1990s and we will both be competing in the marketplace for them , " said a board spokesperson at the time .sx Now , the same spokesperson insists :sx " We have been given assurances by HCI that they will not pay their staff above the going rate and that they will reimburse the NHS for any staff training .sx " .sx Isabel Duncan , the RCN's chief officer in Scotland , agrees .sx " In the past couple of years new hospitals have opened in Lanarkshire , Ayrshire and Argyll , resulting in a reduced patient population served by Greater Glasgow , " she says .sx " In particular , acute services have been cut back , and now there are more nurses than jobs .sx " .sx But Miss Duncan still fears that , with HCI's plans to specialise in major organ transplantation and cardiac , vascular and thoracic surgical procedures , it will be trying to attract theatre and intensive care nurses with highly specialised skills , already in short supply in the NHS .sx " If they drain these nurses away from the NHS , the service will not be able to staff operating theatres properly and this will have a knock-on effect on waiting lists , " she warns .sx The Scottish National Blood Transfusion Service , another early opponent to HCI's proposals , has also tempered its objections .sx Initially , its then medical director John Cash claimed the new hospital's demands for blood would " destabilise the service " .sx But now its general manager David McIntosh does not believe this to be the case .sx " The HCI project will have a major impact on the supply of red cells to the private sector in Scotland .sx HCI's requirement alone will greatly exceed all the current private hospital demands put together , " he points out .sx " However , given that the private sector only takes off less than one half of one per cent of our volume , and this in blood components - mostly red cells - that are not in short supply , the overall effect on blood transfusion services in Scotland will be minimal .sx " The Scottish blood transfusion service is required by law to supply the private sector , without detriment to the NHS .sx We are confident that we can continue to fulfil this obligation in respect of HCI .sx " .sx HCI liaison officer David Macauley adds that as 80 per cent of the procedures at the hospital will be for elective surgery , much of the blood needed will be pre-donated .sx The hospital's publicity material makes some formidable claims .sx " The state of the art HCI medical centre will attract patients and consultants from all over the world and will incorporate the most advanced features of US teaching hospitals with a patient referral system throughout Europe , the Middle East and North Africa , " it says .sx " We will specialise in complex high-tech surgical procedures supported by an international faculty of eminent physicians and surgeons from North America and Europe .sx We are committed to clinical research and plan to collaborate with Scottish universities , medical schools and research institutes .sx " .sx According to Andrew Gordon , HCI's finance and public affairs director , the first links have already been forged with Glasgow University .sx Yet Mike Brown , the university's information officer , rejects this as " an empty claim " .sx " No agreement of any kind exists between the university and HCI , " he says , adding :sx " I don't believe there will be any stampede down the road from Glasgow to Clydebank .sx " .sx The Independent Health Care Association also believes HCI's plans to attract patients from overseas could run into difficulties because the numbers of such patients are decreasing as their indigenous healthcare systems improve .sx David Macauley remains confident .sx " An analysis of the market suggests we will be able to fill these beds easily .sx " He also points to the financial backing HCI is receiving from many banks including Cr e dit Lyonnais , the Midland and the Royal Bank of Scotland .sx " Banks are some of the most conservative institutions known to man , " he says , " and they have confidence in HCI's plans .sx " .sx But the Scottish TUC is quick to draw attention to the withdrawal of financial backing by a Japanese bank last year .sx Public money was pumped in to save the project from failure at that stage , believes the STUC's assistant national officer Grahame Smith .sx He and others , including the Clydebank and Milngavie NHS Defence Campaign and the Greater Glasgow local health council , are keen to find out just how much taxpayers' money has been put in to keep the scheme afloat .sx " We believe several million pounds have been spent , " says Danny McCafferty of the NHS Defence Campaign .sx " HCI has never had the capital to carry out these plans itself and right up until the last minute it was hunting around for money .sx " .sx HCI's Andrew Gordon acknowledges that the Scottish Office bore the cost - believed to be pounds8m - of clearing asbestos from the site where the hospital will be built .sx But Mr McCafferty says :sx " This asbestos had been buried on the site for over eight years with no suggestion by the Scottish Office that it was a public hazard .sx " .sx Mr McCafferty points out that HCI has also benefited from cash ploughed in by the former Scottish Development Agency , now Scottish Enterprise , and believes the company has been allowed to buy the land it will occupy at a knock-down price .sx Andrew Gordon denies this , saying the company bought the land at the going rate .sx David Macauley adds that any financial help given to HCI through the Scottish Office's regional selective assistance and enterprise zone benefits " is the same as it would have received in any other part of the UK " .sx " People are looking for the bogyman in this but the company has not been offered anything more than what the regulations state , " he says .sx " Scottish Enterprise has not been given discretionary powers to chip in millions of pounds of taxpayers' money simply because they believe this project is a good idea .sx " square .sx Sticking a plaster on the housing disaster .sx The government is bending over backwards to solve the housing crisis .sx But , says Julian Dobson , its new initiatives for people with a mental illness are creating more problems .sx FIND SOME homeless people , and almost immediately it seems there's a government initiative to get them off the streets before a cabinet minister trips over them on his way from the opera .sx To judge from the multiple launches of schemes for homeless people during the past 18 months , the government is now bending over backwards to tackle the crisis whose existence has been denied for so long .sx Confronted the other week with demands for more money to help homeless people with mental illness , junior health minister Stephen Dorrell did not duck the challenge .sx He promised Shelter director Sheila McKechnie a meeting to discuss the problem and held out the hope of more resources if research proved they were needed .sx For the last year the Department of Health has had its own pounds7 .sx 8m homelessness initiative .sx It's not as big as the one launched at the Department of the Environment by former housing minister Michael Spicer , and now expanded by Sir George Young , but it is well aimed .sx Its target is homeless people in central London with mental health problems - an estimated 34 per cent of people sleeping rough .sx Health and housing agencies are excited by the potential for helping people whose needs have been by - passed for years .sx Look Ahead housing association opened the first DoH-funded hostel for mentally ill homeless people in April .sx Association director Vicky Stark says :sx " We have seen amazing things already this year with the homelessness initiative .sx I have been working in homelessness for 10 years and have never seen so much happening .sx " .sx The DoH initiative concentrates on seven London boroughs , covered by eight health authorities :sx Parkside , Riverside , Bloomsbury and Islington , City and Hackney , Tower Hamlets , West Lambeth , Lewisham and North Southwark , and Camberwell .sx Community psychiatric teams , jointly organised by social services and health authorities , operate in north west , east and south east London .sx Experienced housing associations provide hostel places for people contacted by the teams .sx After six months or so residents then move on , freeing hostel places for newcomers .sx The Housing Corporation , the quango which funds housing associations , has promised to make 450 homes available when they fall vacant .sx First indications are that the community psychiatric teams have been remarkably successful in making contact with a particularly challenging client group .sx Sue Lipscombe , project leader with the Joint Homelessness Team in north west London , says her team has made 190 'contacts' in six months , and 53 per cent of those are suffering from schizophrenia .sx Medical Campaign Project mental health worker Sarah Gorton says meetings are now taking place with mental health unit managers to tackle the 'revolving door' syndrome which leaves homeless people to fend for themselves on the streets when discharged from acute psychiatric care - exacerbating their distress and increasing the likelihood of readmission .sx So far , so good .sx But such initiatives tend to discover new needs , generating their own demands for extra resources .sx Among the problems identified already is the inaccessibility of health services to homeless people .sx Liz Sayce , policy director for mental health charity MIND , says the role of the GP as 'gatekeeper' to NHS services can place obstacles in the way of homeless people - particularly when a GP refuses to register them at all .sx The NHS reforms have also brought the problem of how to account for homeless people who have no obvious 'district of residence' .sx Ms Sayce fears there will be an increasing number of boundary disputes over who pays for care .sx Another difficulty is ensuring people leaving acute psychiatric care have somewhere to go .sx Only 11 of the 70 beds planned under the DoH initiative are open .sx One hostel , in Westminster , has been held up because of objections from local residents .sx But where the DoH initiative could really come unstuck is when the planned hostels are full .sx Agencies involved in the scheme , which have banded together to form the Joint Forum on Mental Health and Homelessness , say another pounds87m is needed urgently to prevent it " silting up " .sx The figure is based on calculations by David Pashley of North West Thames regional health authority's community care unit , who argues that DoH estimates of the number of homeless mentally ill people in central London are far too low .sx Mr Pashley says money is needed to house around 1,100 people in central London alone - without taking into account the estimated 15,000 people in similar circumstances throughout the country .sx The joint forum says the DoH has also ignored the need for continuing psychiatric care when people leave emergency hostels .sx The forum says this cannot be achieved simply by re-letting housing association flats .sx " If after six months clients were able to go into unsupported housing association tenancies , I don't think we would be housing the right people , " says Ms Stark .sx