Paediatric surgery in a general hospital The view of the general surgeon

Elective operations HerniasHernias OrchidopexyOrchidopexy CircumcisionsCircumcision Cutaneous lesionsCutaneous Insertion of V-P shunts

Emergency operations Spina bifida AppendixAppendix HerniaHernia Intussussception Scrotal operationsScrotal operations Pyloric stenosisPyloric stenosis

Consultant staff Raigmore Belford Caithness Anaes1433 Surgeon843

Hernia/Groin operations YearRaigmore Belford Caithness /556(28)5(3)4(2) Number <=5 44(22)/1(1)/4(2)

Circumcision YearRaigmore Belford Caithness /540(20)05 Number <=5 13/0/3

Orchidopexy YearRaigmore BelfordCaithness /586(43)4(2)5(3) Number <=5 49

Appendicitis Raigmore BelfordCaithness 2003/5 109(55)8(4)16(8) Number <=5 1 at Raigmore

Pyloric Stenosis YearRaigmoreBelford

Two recent cases 4 week old (gestational age 43 weeks) Weight 3.0Kgs Pyloric stenosis 9 week old (gestational age 43 weeks) Weight 3.6 kgs Incarcarated inguinal hernia

Total number of operations 2003/5 All ages<=5 Raigmore414(207)219(105) Belford63(32)10(5) Caithness50(25)12(6) Excludes ENT/Opth/ortho/dentists

Classical problem(1) Low number of admissions Low number of operations Increasing numbers of surgeons and anaesthetists Increasing public expectations re outcome

Classical problems(2) Will travel for elective procedures Expect emergency care locally Guidelines re “children friendly areas” increasing Political pressure

Requirements for paediatric surgical care (1) Designated ward (beds) Designated lists Paediatrician active involvement Theatre reception child friendly OP clinic child friendly A&E child friendly area

Requirements for paediatric surgical care (2) Paediatric trained nurses Paediatric trained surgeons Paediatric trained anaesthetists

Types of Hospital Teaching hospitals DGH Remote & Rural hospitals

Teaching hospitals Aberdeen, Edinburgh and Glasgow They have all the above Can therefore provide a comprehensive paediatric surgical service

Requirements for paediatric surgical care (1) Designated ward (beds) Designated lists Paediatrician active involvement Theatre reception child friendly OP clinic child friendly A&E child friendly area

Requirements for paediatric surgical care (2) Paediatric trained nurses Paediatric trained surgeons Paediatric trained anaesthetists

Dundee Visiting service from Edinburgh 2 days per week. Clinics and op lists Joint appointment 2 local surgeons do 1 in 4 o/c for 3 &<3 Edinburgh cover the other nights. GS look after 4 and >4 Active involvement of paediatricians.

District General Hospital Can and should provide all of the above requirements. No neonates Elective service by nominated GS/Anaesthetists Emergency service - ?all GS/Anaesthetists ? separate rota Visiting service ?clinics ?op lists

Requirements for paediatric surgical care (1) Designated ward (beds) Designated lists Paediatrician active involvement Theatre reception child friendly OP clinic child friendly A&E child friendly area

Requirements for paediatric surgical care (2) Paediatric trained nurses Paediatric trained surgeons Paediatric trained anaesthetists

Raigmore hospital 8 GS 2 do elective work 8 do emergency work 1 fully trained paediatric surgeon Elective theatre/clinic work in Inverness 1 week O/C in Aberdeen

Remote and rural hospitals They have very few of the above Could provide a visiting service for elective cases What about the emergencies? Should they transfer all emergency paediatric cases? Island versus mainline hospitals

Requirements for paediatric surgical care (1) Designated ward (beds) Designated lists Paediatrician active involvement Theatre reception child friendly OP clinic child friendly A&E child friendly area

Requirements for paediatric surgical care (2) Paediatric trained nurses Paediatric trained surgeons Paediatric trained anaesthetists

The future More visiting services to DGH and R&R Elective work by those who undergo training as trainees Emergency work by these surgeons when O/C. When not O/C ?transfer ?”babysit”?phone around. GS o/c treat 5 and >5 ? Dual appointments by 2 hospitals close to each other. Active paediatrician involvement.

Surgical training N&N/E scheme do 6/12 in first year or two This will continue with MMC ? Where else will training be available Needed to provide future DGH surgeons Proleptic appointment or top up training