Future of vascular servicesBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7127.305 (Published 24 January 1998) Cite this as: BMJ 1998;316:305
Concessions on all sides are needed
- Adrian Marston, Past presidenta
- a Vascular Surgical Society of Great Britain and Ireland, London SW7 4TT
- b Royal Infirmary, Edinburgh EH3 9YW
- c North Manchester General Hospital, Crumpsall, Manchester M8 5RB
- d Southampton General Hospital, Southampton SO16 6YD
- e Ipswich Hospital, Ipswich IP4 5PD
- f St Mary's Hospital, London W2 1NY
Editor—Wolfe has made an important personal contribution to the organisation of British vascular services, and his sensible and timely review will command general support.1 Though I agree with everything he says, I would like to take the discussion a stage further.
A modern vascular service is not exclusively surgical. (In the unit where I served at the Middlesex Hospital for many years, most of the work was done by surgeons, but my radiological colleague, Dr Maurice Raphael, in fact carried out more interventions than did any one of us.) An effective vascular service comprises three elements: the surgery, the radiology, and the quantitative preoperative and postoperative assessment in the blood flow laboratory. Although surgeons and radiologists can be found to work in small hospitals, it would be profligate to equip every district with a flow laboratory and many thousands of pounds worth of imaging machinery, which in any case has a limited useful life and is certain to be supplanted before long by something better. The problem is how to equate the legitimate demand of a community of 50 000 people to have their own vascular service with that of surgeons who, if they are to provide that service, must have up to date equipment to work with and radiologists who are able to use it.
Certainly, the “hub and spoke” arrangement suggested by Wolfe is the only way forward. But this requires concessions on all sides. The small trust may indeed appoint a vascular surgeon but should not expect a total vascular service that will do all of the things Wolfe requires of the surgeon. We cannot tolerate the creation of dozens of small substandard departments, and the advanced radiology and laboratory work must be concentrated in regional units. By the calculations of Wolfe and others, the United …