Thursday, 29 September 2011

The Report that makes for Uncomfortable Reading

This report from the Royal College of Surgeons on outcomes after emergency abdominal surgery is both uncomfortable to read and thought provoking.
It highlights the serious deficiencies in experienced manpower and services after hours and at weekends and the thousands of extra deaths these deficiencies cause. On reflection, one should not be surprised that outcomes are so poor. It is interesting and maybe intentional that most of the contributors of this report feature in many of the Ccrisp courses run by the college. Ccrisp is an acronym for Care of the Critically Ill Surgical Patient. This course was started more than 10 years ago by Iain Anderson the Salford surgeon who featured so prominently in the media today. This course is designed to equip young inexperienced doctors with the ability to recognise early signs of deterioration in surgical patients. The problems may be recognised, but are clearly not being dealt with appropriately.
One reason for the diminished medical presence out of hours is the wretched European Working Time Directive. This directive limits the hours worked by doctors. It is disappointing that this report from the  Royal College of Surgeons of all people failed to mention this. In recent months their last president , Mr John Black has highlighted the adverse effect of this directive on surgical training on multiple occasions. It is also disappointing that no one from the Department of Health (not even surgeon/NHS medical director Sir Bruce Keogh, who is very familiar with the whole business of surgical outcomes) has commented on this report-the fact that this is a problem that will not be easily solved may have something to do with it. Reconfiguration alone is unlikely to help.  General and abdominal surgery need to stay in district general hospitals.