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Neurosurgical units working beyond safe capacity

BMJ 2000; 320 doi: (Published 12 February 2000) Cite this as: BMJ 2000;320:399
  1. Muhunthan Thillai
  1. BMJ

    Almost all neurosurgical units in the United Kingdom and the Republic of Ireland are working beyond their safe capacity, according to a report published last week by the Society of British Neurological Surgeons.

    The report claims that there is a growing imbalance between the demand for the service and its supply. The United Kingdom and Ireland currently have 37 neurosurgical units, two fewer than in 1993. Since then the surgical workload has increased by 18%.

    Mr Barry Jackson, president of the Royal College of Surgeons of England, said that there was “a crisis in the provision of services for head injuries, with patients dying unnecessarily or suffering long term consequences due to inadequate funding.” He added that the situation was “urgent.”

    Despite recommendations made by the Society of British Neurological Surgeons in 1993, only half of neurosurgical units have reached minimum staffing levels for consultants, and only one in five units has the recommended minimum number of beds.

    There are currently 166 consultant neurosurgeons in the United Kingdom and Ireland—one surgeon per 378000 population. This compares with a European average of one surgeon per 125000.

    There were 49000 admissions to neurosurgical units last year, 10% of which were trauma cases. Certain areas have shown a rapid growth, with spinal surgery having risen by 62% in the past six years to become the biggest operative group within the specialty.

    The report makes a number of recommendations to “bring standards of safety and quality to acceptable levels for the twenty-first century.” Most importantly it argues that the number of consultants should increase by more than half within the next five years.

    It also calls for a full 24 hour, consultant led service in each unit, with at least five intermediate grade neurosurgical staff, to take into account new training regimes and government policies on reducing juniors' hours.

    There should be 30 neurosurgical beds and four dedicated neurosurgical intensive therapy beds per million popu-ation. There should also beat least two fully equipped operating theatres in eachunit.

    The report also calls for an urgent review of capital funding by the government. The private finance initiative would, it says, significantly reduce the safety and efficacy of neurosurgery in the long term, leading to “devastating clinical, medico-legal and public relations consequences.”

    Safe Neurosurgery 2000 is available from Professor David Thomas, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG (tel 020 7837 3611, ext 3153).

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