There is no captive market for the railways

There is no captive market for the railways."He criticised the rush in which privatisation was carried out: "They hurried it through. They should have looked first and followed the motto, 'first do no harm'." He is worried that extra layers of bureaucracy have been created with little benefit to the passenger.Mr Bertram, who lives in Doncaster where he is the chairman of the local NHS Trust, arrived half an hour late for the interview, having been delayed by a broken rail on a crucial part of the East Coast Main Line track, near Welwyn: "I worry about whether these things are increasing. As a result, it takes longer to get things moving again when things go wrong because of the separation of the companies".He feels that railway managers have, in the past, been complacent: "Virtually everyone using the railway has an alternative choice Even commuters can often use cars or buses. He cited how a railway worker on a station with a stuck train would not be able to talk directly to the signalbox worker at the end of the platform because they work for different companies: "The man on the station has to go to head office of the train operating company, which will contact Railtrack and then go back down to the man in the signalbox. British Rail was already introducing better customer service such as free tea and coffee in First Class and improving its performance generally." He said that, so far, "there was a strong argument in saying that privatisation has had a negative impact". However, it has enormous potential for greater numbers of patients than heart transplants."The groundbreaking surgical work features in the BBC1 QED programme on Wednesday..

Rail privatisation has yielded no benefits so far and it is doubtful it ever will, according to the new chairman of the rail passengers' watchdog. In an interview with the Independent, David Bertram, who took over three months ago from Major-General Lennox Napier as chairman of the Central Rail Users' Consultative Committee, said: "Lots of the improvements which are promised would have happened anyway. There are only 400 heart transplant operations in Britain each year, although there are thousands of patients on the waiting list. Professor Angelini hopes that the new technique could offer an alternative.He said: "It is high-risk pioneering surgery and we are in largely uncharted waters. After suffering three heart attacks in 1994, Mr Payne was given six to twelve months to live. His GP referred him to Professor Angelini, who convinced him to opt for the experimental technique.

"I was under no illusion at all about what he was going to do. He was most emphatic that it was high risk and extremely adventurous surgery," Mr Payne said.The operation has largely freed him from severe angina, extreme breathlessness and tiredness. "I am still being treated for some residual pain and cannot work because of stress. But I believe I have a better future now."Downsizing the heart is not a miracle cure, but there is no doubt it does improve quality of life."It takes around two hours from the first stroke of the surgeon's scalpel to the sealing of the wound A heart-lung machine is used while the heart is exposed. The surgeon cuts into the left ventricle, the main muscular chamber of the heart which accounts for two-thirds of the heart's volume.Disease can stretch the walls of the ventricle, increasing its overall volume and making the heart work harder.

The surgeon removes a piece of the ventricle, then stitches and reinforces the cut, reducing the volume of the ventricle by 30 to 40 per cent. In most cases, the mitral valve is replaced by a mechanical alternative.The new operation has advantages over heart transplants in that it is cheaper, quicker and requires less after-care. Three of the patients survived the operation and were able to go home in considerably improved health, although one died months later due to causes unrelated to the surgery.Of the two patients who did not survive, one died of kidney failure and another from a surgical complication.One of the survivors is Garry Payne, 50, an estate agent, of Lichfield in Staffordshire. The technique, in which tissue is cut out of the heart, is called "left- ventricular reduction" and overturns the canon of cardiac surgery that healthy muscle should not be removed. Professor Gianni Angelini, the British Heart Foundation Professor of Cardiac Surgery at Bristol University, has performed five of the operations on patients who were terminally ill. The procedures were the first to be carried out in Britain.Conventional surgery, including heart transplants, was not an option for the patients at the Bristol Royal Infirmary, who were hardly able to walk and had extreme breathing difficulties.