BMJ 1994;309:414 (6 August)

Letters

Trust hospitals and vascular services

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 training has been missed. Despite inquiries by the regional adviser there seems to be no mechanism by which separate hospitals can combine to deliver a coordinated modern service. Furthermore, 30-50% of admissions for vascular surgery are either urgent or emergencies, and no singlehanded vascular surgeon can provide a round the clock . . . [Full text of this article]


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