High Risk | rogergale

Gale's View - High Risk & Emergency Surgery

February 24th 2014

No Member of Parliament could support a situation that places his or her constituents` lives at risk. The East Kent Hospital Trust`s Medical Director has indicated that, with the loss of two surgeons already and facing the resignation of a third in May it will no longer be possibly to safely provide 24-hour seven-day-a-week cover for high risk and emergency surgery on the separate Ashford and Thanet A&E hospital sites. Neither of us, as Thanet`s MPs, can quarrel with that medical judgement which is backed by the authority of the Royal College of Surgeons. Whether we like it or not – and neither of us do – we believe that it is inevitable that as an interim measure, and at least until enough of the nine promised new surgeons are recruited, the services will have to be located on the single Kent and Canterbury facility.

How this situation has been allowed to develop is a matter for further discussion and there are clearly serious questions that the Medical Director, Dr. Paul Stevens, will need to answer upon his return from leave. We are told by the Chief Executive of the Trust, Stuart Bain, that the service has been on a knife-edge for some time and that although the problem has been identified it has not been possible, given the timescales and the fact that the Royal College has to approve the terms and conditions of all surgical posts advertised, to recruit the desperately needed new staff. We shall need to see further evidence of the attempts that have been made to recruit staff and of the discussions that have taken place between the Trust and the Royal College. However, the indication, given a week ago, that a third surgeon had elected to give notice and to leave in May to pursue his career overseas was the tipping point that led to a decision, taken in haste, by the Board of Directors on Friday 14th of February and communicated to MPs and to other consultant surgeons on Monday 17th February, to consolidate services on Canterbury as the only geographically suitable location with the space and facilities to almost immediately accommodate the work.

In the short term, this move comes at a price. There will have to be investment in an additional operating theatre at the K&C as well as a re-configuration of wards. On an annual basis it also means that some 300 patients who would formerly have been treated close to home in Thanet, together with a further three hundred from Ashford, will have to be transported to Canterbury with all of the inherent inconvenience for visiting friends and families that that will entail. If, however, it is a choice between losing a life in Margate and saving a life in Canterbury then, for Members of Parliament, it is a no-brainer. In the interests of those that we are elected to represent we have to agree to the life-saving option.

Looking to the future, we note that the Trust has described the proposed transfer as “an interim measure”. To most people that means “temporary” but it is clear that the word has been chosen carefully, if not disingenuously, to mask the possibility of permanence. If that proves to be the case then of course the whole issue will have to be the subject of full, transparent and public consultation.

It seems likely that part of the difficulty has been caused by the policy, adopted by the Royal College of Surgeons, of promoting sub-specialisation of skills. This has meant, on the credit side, that a surgeon specialising in, say, breast surgery is likely to be superbly expert in that particular field of work. It is also the case, however, that that same surgeon, asked to participate in an overnight on-call rota, may find himself faced with the demands to operate upon parts of the body (gastro-intestinal work has been used as an example) that he has not had to deal with for some years and utilising rusty skills acquired and last used as a student or Houseman. Add to that the fact that the practitioner will then hand over the patient admitted in an emergency to another medic and you begin to see emerging a potentially toxic mixture of lack of skill exacerbated by a lack of continuity of care and that is neither safe nor acceptable. The Royal College of Surgeons must, we believe, take some responsibility for compelling the best to become the enemy of the good and for enhancing the cause of specialisation that the expense of a diminishing the pool of genuinely general surgeons. It seems to us that the Royal College may have been guilty of promoting its own professional interests and career paths at a cost to patient care and that this has resulted in a national shortage of generalists.

In the fullness of time there will, clearly, have to be a thorough appraisal of what medical services are provided, nationally and locally, very precisely where and by whom. The “usual suspects” will inevitably try to turn this into a political football but in the public interest it is vital that the debate is calm, rational and thorough. People`s lives are too important to play politics with.

In the short term, however, a side-effect of the interim transfer of services will be, ironically, to actually increase the surgical capacity in Margate and Ashford as the on-call rota for a single site will demand the presence of only one surgeon rather than the current two. We have also, following a meeting with the Chairman and the Chief Executive of the Trust, received an absolute assurance that the measure that has had to be taken will not impact upon the Accident and Emergency facilities available at either the QEQM or the William Harvey hospitals, or indeed on the other services that, far from being diminished are in the process of being developed. As your Members of Parliament Laura Sandys and Roger Gale remain determined not only to protect but to enhance the medical services, at every level, that are available to the growing populations of Thanet, Herne Bay and Sandwich.