EDITOR, - We write to express concern over the detrimental effect that trust hospitals are having on strategic planning for vascular services. Many recent consultant appointments have been of singlehanded vascular surgeons in district hospitals as they adopt trust status. The proportion of singlehanded surgeons fell from 43% to 7% between 1988 and 1992 but will inevitably rise as a result of these appointments.

This problem has recently been highlighted in South West Thames region, where retiring single-handed vascular surgeons have been automatically replaced at separate but adjacent hospitals and the opportunity for rationalisation and improvement in services and …