Warning over 'poor surgery' at private treatment centres

Personal view: Independent sector treatment centres: how the NHS is left to pick up the pieces; BMJ Volume 332, p 614

NHS surgeons are being left to "pick up the pieces" after poor surgery at private treatment centres, warns a senior doctor in this week's BMJ.

"The number of patients we are seeing with problems resulting from poor surgery is too great," argues Angus Wallace, Professor of Orthopaedic Surgery at the University of Nottingham.

There is no doubt that the expansion of orthopaedic services, provided by the Department of Health through private hospitals and independent sector treatment centres (ISTCs), has been a much needed development, but it has occurred at a price, he writes.

What has happened in ISTCs is that junior specialists have been imported from overseas and asked to provide total surgical care without help and supervision from a more senior colleague, a situation that is alien to many of them - hence the reason why the failures find their way to the NHS hospitals.

He suggests that this situation has arisen because of a political philosophy called "additionality." When ISTCs were set up, there was concern that their development might result in NHS hospitals losing some of their own surgical staff. To ensure that this could not happen a six-month rule was imposed - an NHS surgeon could not work in an ISTC until he or she had stopped working for the NHS for six months.

While this ensured that the NHS hospitals were protected from losing their own staff, it also meant that the ISTCs did not have access to many, or any, senior surgeons who could act as senior consultants and help their colleagues when they ran into trouble.

"Now we are seeing the consequences of this philosophy - poor operations, inadequate supervision of surgeons, and a poor mechanism for remedying any problems that occur," writes Wallace.

There are also concerns about how clinical governance and appraisal procedures are being addressed in ISTCs, creating a suspicion by NHS staff that corners have been cut in achieving the goals of high productivity and throughput.

But perhaps the issue that should be of most concern is that of training the country's up and coming surgeons, adds the author. The "straightforward" cases, now dealt with by the ISTCs, had been the cases on which young NHS surgeons learnt their craft. This time honoured and soundly proven method of training has now, sadly, been denied. Consequently the competence of our next generation of surgeons is in jeopardy.

"We, as NHS staff, need to help, and many of us wish to, but we are frustrated by the artificially created divide between the ISTC and the NHS hospital," he says. "The government has created a two-level health service that is creating many problems. I believe that we should now integrate the ISTCs with the NHS instead of running them as a private healthcare system paid for by the state."

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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