they said, "We're going to privatise the NHS," they'd be kicked out the next day.' The Conservative Party's 2010 manifesto promised: 'We are stopping the top-down reconfigurations of NHS services, imposed from Whitehall.' Two months later, the new health secretary, the Conservative Andrew Lansley, announced his plans for a top-down reconfiguration of England's NHS services, imposed from Whitehall. The patient whom Porter was about to operate on was a 60-year-old woman from the Wirral with a complex prosthesis in one leg, running from her knee to her hip. She'd had a fracture and Porter had had a special device made at a workshop in another part of the NHS, the Royal National Orthopaedic Hospital in Stanmore in Middlesex. The idea was for the device to slide over the femoral spur of the knee joint, essentially replacing her whole leg down to the ankle. '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