Surgeon fears put pressure on A&E
PATIENTS received a clear and ominous warning last Tuesday that – if Hinchingbrooke Hospital were to lose significant numbers of consultant surgeons – they could kiss goodbye to a serious A&E department. Emergency surgery is a key issue in retaining A&E a
PATIENTS received a clear and ominous warning last Tuesday that - if Hinchingbrooke Hospital were to lose significant numbers of consultant surgeons - they could kiss goodbye to a serious A&E department.
Emergency surgery is a key issue in retaining A&E at its present, highly-effective level. But the number of surgeons available for the on-call rota to cover serious - and by definition unpredictable - emergencies is crucial.
At present surgeons, including consultants, put aside routine work every six weeks to provide round-the-clock cover for the unexpected, explained Jo Reed, the hospital's clinical director for general surgery, told a public meeting - the first of four last week and this looking at the future of Hinchingbrooke.
If that suurgery rota were changed, even to one week in five, she predicted, it would become increasingly difficult to recruit and retain the best surgeons. Surgery at the hospital would soon lose critical mass, emergency capability would be lost and major surgery would move to Addenbrooke's and Peterborough.
"Doing less is difficult in general surgery because of the need to sustain the on-call rota," Miss Reed told the meeting.
"We already work closely with neighbouring hospitals. We could do more of that. We could move breast surgery to Addenbrooke's and colo-rectal surgery to Peterborough. We could send emergency admissions to Peterborough, but we need to know how that would affect patients and the ambulance service. These are some of the options we have been looking at."
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Miss Reed made it unequivocally clear that her favoured option was to find a way to keep emergency surgery in Huntingdon.
"Emergency surgery cannot easily be transferred to the community. Nor can elective surgery. And we have to continue to teach the doctors who are going to be looking after us when we retire.
"A&E and the medical assessment unit cannot function without senior surgical input," she warned. "The whole system is very closely interlinked. Many different parts of the hospital may be involved in treating just one single patient."
An alternative would be to move the surgeons to Peterborough, where the operations would be carried out, with diagnosis and follow-up at Hinchingbrooke - and repeated ambulance trips up and down the A1(M).
"The theory, as I understand it, is that the primary care trust is going to send us 40 per cent fewer patients, so we should be able to manage," she said with pointed irony.
Earlier, Chris Town, acting chief executive of the new Cambridgeshire PCT, had said 40 per cent more Huntingdonshire patients used hospital services than the national average. Many of those episodes could be dealt with less expensively in the community - health centres, doctors' surgeries and patients' homes.
Michael Lynch, who was chairman of Hunts PCT from its creation in 2001 until his resignation at the end of July, disputed the 40 per cent figure. The numbers the Hunts body had been using suggested it was nearer 10 per cent above average, he said.
Mr Town insisted his figures were accurate and promised to post them together with their methodology on the Cambridgeshire PCT website this morning.
The new body had saved 25 per cent of administrative costs since the amalgamation of the four previous trusts in the county, he told a sparsely-attended meeting.
Just 40 people turned out for the meeting at St Barnabas Church Hall in Huntingdon, half of them NHS employees. There were journalists and 18 people identifying themselves as "members of the public". But they included retired consultants, the leader of Huntingdonshire District Council, Councillor Ian Bates - for many years a nurse at Addenbrooke's - Mr Lynch and a number of past and present members of patient consultation bodies.
The hospital's interim chief executive, Jane Herbert, conceded afterwards turnout for such an important discussion had been disappointing.
Perhaps the problem was night was the title - "general surgery" does scant justice to the vital labyrinth of services the words cover. But that's what it's called.