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. Admittedly there are many patients who have benefited from the development of ISTCs and are now leading pain free lives as a result of surgery carried out much earlier than would have been possible in the early 1990s, when our health service was grossly underfunded. However, the number of patients we are seeing with problems resulting from poor surgery—incorrectly inserted prostheses, technical errors, and infected joint replacements—is too great.

The number of patients we are seeing with problems resulting from poor surgery is too great

Perhaps we should look at the mechanisms through which this whole ISTC exercise has been carried out. Surgeons from overseas have been flown into the United Kingdom to increase the numbers available to provide elective orthopaedic services. They have come from many countries, usually European, and their training and clinical practice at home are quite different from those to which they are exposed in an ISTC.

In Germany, Hungary, and Croatia, for example—countries I know about because I have visited surgical centres in all of them—the junior specialist usually …