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Tuesday, 22 October, 2002, 12:21 GMT 13:21 UK
Surgeon 'ordered to stop working'
Martin Bircher
Martin Bircher says patients will suffer
One of the few surgeons skilled in vital surgery for crash victims has been told to stop his work - so that bosses can drive down waiting lists instead.

Martin Bircher, an orthopaedic surgeon from St George's Hospital in south west London, says some patients could end up with permanent disabilities because of the clampdown.

His skill is painstaking reconstruction of badly-smashed pelvises - often the result of motor accidents.

This is a highly specialised field, and patients from throughout the country are referred to him as soon as possible after their crash.


I have been told that patients can go elsewhere - the problem is that there isn't an elsewhere

Martin Bircher, St George's Hospital
However, last month, managers at St George's proposed that his Pelvic Trauma Unit - the only one in London - should stop taking cases from outside the immediate area for two months.

He was told that priority had to be given to local patients, even routine waiting list work.

Hospitals throughout the country are under pressure to reduce waiting times for routine surgery to meet government targets.

Permanent disability

Mr Bircher said he had already heard of cases in which surgeons from district general hospitals had tried to carry out the same work - with terrible results.

He told the BBC: "There have been two cases in the last two weeks in which people were treated at local hospitals - with disastrous outcomes.

"If these patients are not assessed and treated rapidly, the disability is going to be significant and their lives affected dramatically.

"Orders are that we must get our waiting lists down, so we must stop treating these patients."


This is a stark example of the perverse pressures which waiting list targets can create

Dr Peter Hawker, BMA
There are other units that cater for such severely damaged pelvises - in Oxford and Bristol - but Mr Bircher believes that only a few of his patients will be found a bed there.

"I have been told that patients can go elsewhere - the problem is that there isn't an elsewhere."

The hospital, in a letter seen by the BBC, told Mr Bircher that "interhospital transfers" of the kind that filled his unit were bottom of the list of priorities for beds.

It said that the patient's own primary care trust was often unwilling to pick up the bill for treatment at St George's.

It said that it was "no longer acceptable" for operations involving local patients to be cancelled to make way for an urgent pelvic trauma case.

Service constraints

The government has also set firm targets in order to reduce the number of such last-minute cancellations.

St George's chief executive, Ian Hamilton, said that the problem of providing enough pelvic trauma capacity was a national one.


Specialist services like this should be properly planned so that specialist surgeons can deal with specialist cases, while less complicated waiting list patients are dealt with conventionally

Department of Health
He said: "St George's is one of a number of centres in south east England, including Bristol and Oxford, able to provide specialised pelvic reconstruction services.

"The surgical team at St George's endeavours to admit all referrals for pelvic reconstruction dependent on the availability of beds, intensive treatment facilities and theatre on any given day.

"Priority has to be given for the immediate emergency cases in the local catchment population and to accept more distant referrals only when there is capacity, acknowledging that these more distant patients are already under the care of a surgical team."

A spokesman for the Department of Health said the order patients are seen should depend on their clinical priority and that should be decided by doctors.

"We would be concerned at any allegation that this process has not happened properly.

"However, the situation should not have been allowed to arise in the first place.

"Specialist services like this should be properly planned on a regional or national basis, so that specialist surgeons can deal with specialist cases, while less complicated waiting list patients are dealt with conventionally."

Political reaction

Shadow health secretary Dr Liam Fox attacked the "cynical" manipulation of statistics saying it was clear that maximum waiting times were being prioritised.

He said: "It is very sad because it means we have a system where it is the statistics not the patients that are at the centre of the system.

"It is absolutely disgusting that people with serious conditions are being forced to wait for operations, whilst minor conditions are dealt with in an attempt to meet government targets."

Dr Evan Harris, for the Liberal Democrats, said waiting time targets were a "blunt instrument".

"Where there are maximum waiting time targets there will be an inevitable distortion of clinical priorities.

"There has to be an end to political interference with clinical decisions."

Dr Peter Hawker, chairman of the British Medical Association's consultant's committee, said: "This is a stark example of the perverse pressures which waiting list targets can create."

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The BBC's Niall Dickson
"The hospital says the specialist work cannot go on"

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See also:

10 Jul 02 | The Service
25 Jun 02 | Scotland
16 May 02 | Health
22 Oct 02 | Health
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