Roderick Duncan FRSCEdOrth Chair SCCCSS

1. General Surgery in Childhood across ScotlandService delivery and sustainability remains an unresolved problem Roderick Duncan FRSCEdOrth Chair SCCCSS SCCCSS September 13

2. Which is the orthopaedic surgeon? SCCCSS September 13

3. Scottish Colleges Committee for Children’s Surgical Services • RCSEd and RCPSG • Representatives from • General paediatric surgery • Surgical Specialties • Anaesthesia and PICU • RCPCH • RCN • Scottish Government • NSD SCCCSS September 13

4. General Surgery in Children • 50% performed in District General Hospitals • Elective or planned • Emergency care • Aim for safe, local and sustainable care where possible • Managed clinical networks SCCCSS September 13

5. The problem • Lack of surgeons in DGHs able to do children’s surgery SCCCSS September 13

6. Why has this occured? • Retirement of senior surgeons • Successors appointed without training in paediatric surgery SCCCSS September 13

7. How has this happened? • Organisational reasons • Priorities elsewhere • Matching numbers of trainees to vacancies doesn’t happen • Professional reasons • “unrewarding” • “high emergency load” • “isolated” • “fear of adverse outcomes” SCCCSS September 13

8. What are the consequences? • Transfer to centres • Inconvenience, delay, anxiety, patient safety • Increased number of transfers • Impact on centres • Pressure on local paediatric services • Reduction in trainee numbers SCCCSS September 13

9. Has this been recognised before? • British Society of Paediatric Surgeons • Association of Surgeons of Great Britain and Ireland • Royal College of Paediatrics and Child Health • surgical Royal Colleges • CYPHSG • Specialty Training Board • SCCCSS • National Clinical Leads from England, Scotland and Wales SCCCSS September 13

10. The Youngson report • Commissioned by CYPHSG • Consulted • Conducted site visits • Reviewed activity • Conducted a review of local facilities • International comparisons • Performed a literature review • 10 recommendations • Condition specific guidelines SCCCSS September 13

11. What has happened since? • Appointment of extra surgeons – mainly regional centres • Outreach lists have increased – effect possibly detrimental • Urologists treat torsions – split site, time-dependent treatment • “Children in remote and rural areas get better (local) care than those in ……….!!” SCCCSS September 13

12. What are the solutions? • Change the training of general surgeons • Aberdeen example • Is not going to happen in the rest of Scotland • Continue to offer post CCT training • Appoint DGH general surgeons with children specifically in the job description • Professional responsibilities • CPD supported SCCCSS September 13

13. SCCCSS suggests….(1) • Re-examination of the conclusions of the Youngson report • Audit of standards of surgical care in DGHs as published by RCPCH/SCCCSS • An approach to the training bodies in both Paediatric Surgery and General Surgery to insist that all applicants for the CCT should be able to assess and manage independently the acute abdomen in children and manage and treat suspected torsion of the testis. SCCCSS September 13

14. SCCCSS suggests…. (2) • That through the CYPHSG, the Scottish Government insist that Health Boards include the provision of an emergency surgical service to children in the job description of general surgical consultant posts advertised for district general hospitals. • That through the CYPHSG, the Scottish Government get a declaration from the Health Boards of what general surgical childhood is delivered and planned for each Health Board Region. SCCCSS September 13