Page last updated at 01:33 GMT, Friday, 16 May 2008 02:33 UK

Local child surgery 'threatened'

Surgeons
Children's surgery is being concentrated in specialist centres

Surgeons who can carry out routine child operations at local hospitals may be in short supply in the future, experts have warned.

A survey found a third of NHS hospitals offer no paediatric surgery at all, as cases are sent to specialist centres.

Surgeons' leaders say this means fewer young doctors will gain the skills to operate on children - meaning long journeys even for simple operations.

The Department of Health said hospital services should be set by local needs.

This is a looming problem and one we need to settle now if we are to avoid serious shortcomings in the care of future generations of children
Jonathan Pye
Association of Surgeons of Great Britain and Ireland

In the past few decades, more complex paediatric surgery has tended to be concentrated in fewer and fewer regional specialist hospitals, as clear evidence has emerged that this is the best way to improve outcomes.

However, the survey claims there has been a more recent "drift" of more simple procedures such as hernia repair and appendix removal away from the district general hospital.

Often, where these are performed at a local hospital, they are carried out by a general surgeon, who operates mainly on adults, but also has the skills to perform routine operations on children.

Basic care

Jonathan Pye, Honorary Secretary of the Association of Surgeons of Great Britain and Ireland, said that, as these surgeons retired, no-one would be ready to take their place.

"This is a looming problem and one we need to settle now if we are to avoid serious shortcomings in the care of future generations of children.

"There is a great swathe of basic care, that, with the right support, could be delivered locally.

"The answer requires a concerted effort from the medical profession and NHS management - renewed training, trusts advertising local general paediatric surgery posts and regional networks to ensure best practice is spread."

There must be sufficient demand locally to maintain the skills of surgeons and anaesthetists in paediatric surgery
Department of Health spokesman

The survey, to be debated at Friday's International Surgical Congress in Bournemouth, says that many NHS trusts are worried about their future ability to provide this kind of surgery, and suggests that specialist centres, in their present form, would be unable to cope with the work currently carried out locally.

Richard Stewart, from the British Association of Paediatric Surgeons, said that one solution was for surgeons from the specialist centres to carry out operations at local hospitals - pointing to examples where this had happened in some areas.

"But this has occurred without planning and we strongly recommend the involvement of strategic health authorities working with local trusts, surgeons, anaesthetists and parents to plan the future provision of this service."

Surgical increases

A spokesman for the NHS Confederation, which represents trusts, said: ""Services need to be designed for local populations based on local circumstances.

"This might look different in rural areas compared to big cities for example. In the future, services will be increasingly based on standards and pathways.

"Local people and clinicians should determine these services with commissioners and hospitals."

He said that paediatric surgery was a specialty identified for more training in the future.

A spokesman for the Department of Health said that the number of paediatric surgeons had increased by 41% since 1997.

He added: "The National Service Framework for children emphasises that care should be delivered as close to home as possible.

"However, there must be sufficient demand locally to maintain the skills of surgeons and anaesthetists in paediatric surgery.

"It is therefore, for local NHS organisations to assess local needs and to ensure the right workforce is in place to meet these needs."




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