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Friday, December 12, 2008

Hidden agendas

When Welsh consultant neurosurgeons signed a letter to the Chief Medical Officer for Wales arguing for a single neurosurgical centre I was prepared to listen. The Health Minister's preference is for a single service on two sites so as to retain a service in Swansea. However, there is a danger that this will not be sustainable in the long term and may wither on the vine.

In particular there needs to be a critical mass of operations to maintain clinical safety and the service will need the capacity to deliver a fully staffed 24 hours, seven days a week emergency service on both sites. In my view there is a strong argument to have a single service centred on Morriston Hospital. This would maintain the viability of the trauma centre there whilst ensuring that everybody in South Wales will be within striking distance of a neurological service, either at Swansea or Bristol.

However, after listening the one of the Consultants on Radio Wales this morning it turns out that their agenda is not so much a single service but a single service based in Cardiff. It is another bid by Cardiff based physicians to build up their empire in the capital, backed up with nonsense arguments about threats to paediatric neurosurgery and the Cardiff Children's Hospital if they do not prevail.

If they want another fight then they have got it. The people of South West Wales will not stand for the further dilution of vital services so as to big-up Cardiff physicians.
So you are prepared to listen to neurosurgeons unless they say something that you disagree with? It is absolute crass idiocy this stuff playing political games with people's health in this way.
Well actually the Steers report has a different view and would facilitate a neurosurgery unit in Swansea. The issue here is that these neurosurgeons have their own agenda.

There are factors at work here not amenable to political pressure. The Royal College will need to approve training posts in neuro surgery and there will need to be enough staff to meet working time directive requirements. This is all a matter of critical mass and its just a fact that the efficiency of critical mass is badly degraded by fragmentation over more than one site.

The arguments about neuro paeds are all to do with anaesthesia and intensive care support, as there are key elements shared between adult and childrens services.

You really need to be careful here in that you have command of all the facts before you get into a ruck on the radio with a professional. People in the NHS felt you come off a poor second best yesterday.

Incidentally, the 40 minutes between Swansea and Cardiff is frankly of little consequence in this type of service. You must of course realise this or you wouldn't be arguing that Cardiff residents should travel the 50 minutes to Bristol should the service be located in Swansea..........
You will note that I have acknowledged most of these points in my second paragraph which is why I have argued that the ideal situation is for a single site in Swansea. As you say if the 40 minutes to one hour that it takes to travel between Swansea and Cardiff is of little consequence then there should be a workable solution to do with shared services. Incidentially, it is not the travelling distance between Cardiff and Swansea that is the problem but the extra hour that it will take to travel from Aberystwyth and Pembroke if the service is based in Cardiff. The fact is that the Steers Report allowed that it would be possible to base this service in Swansea if required and consultants I have spoken to believe that the links between paediatric and adult neurosurgery are not critical.

Personally, I thought the Cardiff Consultant lost credibility when he started to argue that a networked service would lead to the closure of the Cardiff Children's Hospital. That is nonsense but worse than that it reveals the manoeurvres that have been going on behind the scenes to build up empires in Cardiff at the expense of the rest of Wales.
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