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Where best for Surgery

Hedley J Easter   (24 March 2006)

Where best for Surgery 24 March 2006
Hedley J Easter, Consultant Orthopaedic Surgeon Wishaw General Hospital, ML 2 0DP Send response to journal: Re: Where best for Surgery	That Health Service Planning over a decade or so has moved towards incorporation of Obstetric Units into General Hospitals was considered a quality issue to allow maternity patients the back up of a main hospital in the event of complications. Many of this Government’s ‘modernisation’ issues are relocating other types of patients from this safe environment. Why can major surgical procedures, with known morbidities and mortalities, greater than childbirth, and on riskier patients than women of child bearing age, be carried out in establishments lacking such facilities as high dependency and intensive care and the myriad of other expertise and facilities which a General Hospital can provide? Previously only Private patients, knowingly or otherwise, opted for this type of environment. Might the unidentifiable policy makers and centrally-placed Party Worker special advisors, driving this Government’s agenda not appreciate this paradox? As older patients on a poly-pharmacy of medicaments wish the benefits of surgical procedures so the need for a safe environment increases not diminishes. One can only hope that Patients’ Choice discussions with individuals include ease of access to whatever were considered necessary General Hospital facilities for Obstetric patients. Failing this, Patients’ Choice is really the Government’s choice to send individuals to any of four establishments other than their first (and possibly only favoured) choice. Under Conservative policy guidance, the development of income generating Private facilities in NHS General Hospitals encompassed more individuals in this safe environment. Current outsourcing cannot but reverse this. Income generation within a hospital achieves a local Robin Hood style flow of funds for the benefit of all. Indeed some local units faced with closure as all-NHS establishments, during the current mania for centralisation of NHS facilities, might well be viable as mixed healthcare providers. I am sure the essence of the Robin Hood philosophy does not require all monies to flow to Westminster in the hope that some of it might come back. Undoubtedly some establishments will be able to strip down marginal costs per procedure by the longstanding habits of the private sector in defining their limited liability to manage short term and long term complications of such procedures. Equally they will have to make no provision for the salaries of the peripherally-placed Party Workers who inhabit, at ground-level, our individual hospitals, distorting Clinical priorities to seem to achieve targets. HJ Easter Consultant Orthopaedic Surgeon Competing interests: None declared