Alan MacDermid, Medical Correspondent

A case of mistaken identity adds to tension at Glasgow Royal

Infirmary.

THE man accused of running a ''regime of fear'' at Glasgow Royal

Infirmary is 34, with a boyish countenance that might almost qualify him

for a job in the casualty department.

Nigel Clifford joined the Royal as unit general manager after 11 years

with British Telecom, latterly in charge of developing their mobile

services.

He was kept on the move yesterday as the flak came in from one

direction after another -- the accusation that staff are being gagged,

and the revelation that two fourth-year pupils on work placement were

mistaken for medical students last week and invited to help stitch up

accident patients.

Staff who feel that they -- and their patients -- are being stitched

up as the Royal gets into trim for trust status in April will still be

there after yesterday's embarrassment has faded.

Mr Clifford, aided by his top aides, tried to set their minds at ease

in the course of a lengthy interview yesterday, but there is no escaping

the fact that the Royal, like other hospitals in the city, faces a

squeeze as they compete with each other for business from a health board

with a shrinking budget.

''An atmosphere of fear is not the kind of thing I want to exist

here,'' he said. ''Certainly there is trepidation about what trust

status is going to mean. When I came in here I asked what staff morale

was like and got a mixed response, so we ran a census. We asked about

everything from communications to car-parking.

''I found that people felt far more positively about their jobs than

you would find in an internal industrial environment. They thought their

job was worthwhile. But there are concerns about what trust status will

mean.

''Since then we have run a series of presentations by heads of

departments. A lot was unknown about what a trust would be like. We have

done a lot of communicating.''

He added:'' We have addressed a lot of concerns. People will remain

concerned but it would be the same if we remained a directly-managed

hospital.

''I hope the atmosphere is such that people can raise issues. I have

written to Mike Watson [MP for Glasgow Central] to say I am very

concerned and would like to meet him to hear his reasons for making

these complaints. We do not wish to gag people.''

His emphasis, however, was on official channels -- the nursing and

medical hierarchies, and the clinical directorate structure.

''I also meet union representatives on a quarterly basis; and once or

twice a week I take a walk round and drop in on various areas to give

people the opportunity raise what they want. I want everyone to feel as

if they can talk to their line manager if they have a problem.''

These concerns centre on the changes that are taking place in the way

the 850-bed Royal treats patients -- fewer beds, faster turnover, more

patients treated at home -- and the effect this will have on jobs, wages

and conditions.

Details about the infirmary's bed-closure plans have leaked out

piecemeal until now. The new configuration means that three wards -- 29,

35, and 36 -- are closing, a total of 62 beds.

As a result general surgery will be located in the new block,

alongside the hospital's 16 operating theatres, ending the regular

trolley trip -- for surgery patients at least -- through the long

connecting corridor. Net reduction, 16 beds; paediatric cases -- largely

ENT -- will be handled by the Royal Hospital for Sick Children (18

beds); oral surgery (six beds) will be transferred to Canniesburn.

Other specialties to be cut are gynaecology (seven beds), medical

investigation (nine), vascular medicine (four), and urology (two).

Professor Ross Lorimer, the Royal's medical executive, insists: ''It

gives us space to redevelop in the fullness of time. The reduction in

surgical beds is compensated for by the increase in day surgery. It is

not that there will be less done; more and more is being done on a day

basis.''

The patients, he says, are happy to sit at home if they are re-assured

that there is continuing care -- in the form of visits from liaison

nurses and other back-up staff -- and that if they need to come in, they

can.

The move to trust status in other hospitals has already been marked by

skirmishes with the unions over attempts to change wages and conditions,

with threats of legal action. There is no assurance that life at the

Royal will be any different in the long-run.

Meantime, however, Nigel Clifford said: ''The 3900 whole-time

equivalent staff we have at the moment will move into the trust on the

same terms and conditions they have at the moment. Any change will have

to be negotiated.

''For those who come in after April, we will have the opportunity to

offer something different, but we have not got any plans in that

respect.

''The health board will be seeking to place business with the most

cost-effective trusts. Each of the trusts is going to be taking a view.

We have to have a cost profile which is competitive. The GP fund-holders

are going to have to be very sharp on this too.''