Annex A > Chapter 6 - Funding and Resources > Resources > Cardiac surgery and cardiological services at the BRI

Cardiac surgery and cardiological services at the BRI

128 Dr Johnson (Chairman of the Division of Anaesthesia), wrote to Mr Wisheart, Mr Keen and Mr Dhasmana, in June 1988:

`I am afraid that the Summer months are going to be a little problematic regarding experienced staffing of the Cardiac Unit. The most difficult months will be July and August when we will not have Steve Bolsin and there will be considerable consultant leave being taken. Donald [Dr Donald Short, consultant anaesthetist UBH/T] will provide you with full details, but I would ask you to be patient with us and go carefully on workload until September, when I hope that our anaesthetic service will match your every requirement (or almost so).' [180]

129 Dr Russell Rees, consultant cardiologist (adults), set out his views about the resources available for cardiological services in a letter to Mrs Margaret Maisey dated 3 June 1991:

`Thank you for asking me to list the main problems with cardiology following our meeting with the Chairman.

`We are faced with difficulties which have gradually built up over the years as district and regional demands for cardiological services have rapidly increased outstripping local resources and regional funding. The problems are inter-related and are listed below.'

As regards beds, he stated: `There is a severe shortage [of beds]... '. As regards staffing, he wrote: `At present we are just about coping, but serious problems will appear if we successfully contract for more work and our bed state improves ... This lack of junior support for our senior registrars was severely criticised by the review body of the Royal College of Physicians at their last review, when withdrawal of recognition was threatened if things were not improved.'As regards emergency services, he wrote: `As a result of delays, this aspect of our work is rapidly increasing. Many patients wait much longer than desirable in peripheral hospitals before transfer. Their management when they arrive disrupts planned work both by ourselves and surgeons. There are always appreciable delays before these patients can be transferred from our [cardiology] beds to the cardiac surgical unit, and seriously ill patients can wait three to four weeks. If we were to increase our throughput substantially, it would have serious implications for the surgical unit.' [181]

130 Surveys of cardiological staffing levels conducted on behalf of the British Cardiac Society (BCS) and others, indicated the national situation at various times. In 1988:

`... there were less than six cardiologists per million population. The United Kingdom, with Ireland, has fewer cardiologists than all other European countries with reliable figures. The ratio for Europe as a whole is approximately 45 per million population; the recommended figure for the United States of America is 60 per million. The distribution of cardiologists in England and Wales is still very uneven. Seven million people - nearly 15% of the population - have no immediate access to special expertise in cardiology...

`The total number of cardiologists within the regions shows wide disparities that do not appropriately reflect the differences in population. For example the South Western region has one cardiologist for every 246, 500, whereas North West Thames has one cardiologist for every 140, 500.' [182]

131 In 1992, the position as regards paediatric cardiologists was stated to be as follows:

`The present staffing levels for paediatric cardiology in the United Kingdom are perilously low, and not comparable to those in most developed countries. Their training depends on eight senior registrar posts with two others agreed but not yet implemented.' [183]

132 In Bristol, there were problems in recruiting a paediatric cardiologist during the 1980s. Dr Martin was eventually appointed on a proleptic basis. [184]

133 The paediatric cardiology service in Bristol was provided by consultants only; there were no junior staff training to be paediatric cardiologists, who would have been capable of relieving their consultant colleagues of some of their workload.

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Footnotes

[180] UBHT 0162 0084; letter from Dr Johnson dated 13 June 1988

[181] UBHT 0038 0280 - 0281 ; letter from Dr Rees to Mrs Maisey dated 3 June 1991

[182] BCS 0001 0018 - 0020 ; Chamberlain D, Bailey L, Sowton E, Ballantyne D, MacBoyle D, Oliver M. `Staffing in Cardiology in the United Kingdom 1988 Fifth Biennial Survey'. From the Sussex Centre for Medical Research, University of Sussex, Brighton, in collaboration with the Cardiology Committee, Royal College of Physicians of London and the British Cardiac Society

[183] BCS 0001 0096; Chamberlain D, Parker J, Balcon R, Webb-Peploe M, Cobbe S, Boyle D, Tynan M, Hunter S, Reval K. `Eighth Survey of Staffing in Cardiology in the United Kingdom 1992'

[184] Appointment of a consultant on a proleptic basis is where the appointment is made in anticipation of further training taking place in the consultant grade