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Lack of Specialist Surgeons putting patients at risk

Created - 31.12.2017


Lack of specialist surgeons ‘putting patients at risk’

A radiologist
Interventional radiologists use state-of-the-art imaging devices to pinpoint where in the body medical problems have occurred. Photograph: Anne-Christine Poujoulat/AFP/Getty Images

Patients are dying because of an acute shortage of specialist doctors to perform life-saving surgery on women after childbirth, victims of car crashes and other emergency cases.

An NHS-wide lack of interventional radiologists means that some patients are having to undergo major, life-changing operations – ending up disabled after a stroke or losing a limb as a result of diabetes – simply because they cannot get the minimally invasive help they need, senior doctors have revealed.

They have spoken out to highlight the human cost of the health service’s shortage of specialist radiologists after the government admitted that one in four hospitals cannot provide such care to patients every day of the week because they cannot recruit enough of them.

Interventional radiologists are doctors who are also known as “image-guided surgeons” and use state-of-the-art imaging devices to pinpoint where in the body medical problems have occurred. They then perform minimally invasive surgery to stop acute bleeding, remove life-threatening blockages such as blood clots and also treat cancers and the potentially fatal infection sepsis. Advances in medicine mean they now perform almost one million procedures a year, NHS figures show.

“There is no doubt that around the country people are dying or coming to serious harm due to the lack of interventional radiology provision in their area, although we can’t explicitly quantify how many people die or suffer because they do not get seen by an interventional radiologist,” Dr Nicola Strickland, president of the Royal College of Radiologists (RCR), told the Observer.

“We know of cases where patients suffering severe bleeding from their kidneys and post-operative bleeding have died because they were unable to reach an interventional radiologist in time.” One patient had an obstruction in their bile duct and had it drained but then developed an aneurysm, a life-threatening weakness in the wall of an artery. But the hospital could not get hold of an interventional radiologist in time and the patient died, said Strickland.

The shortage – a dramatic illustration of the NHS’s staffing crisis – means that some women who suffer a haemorrhage as a result of giving birth are having to undergo a hysterectomy to stop them bleeding to death. “It’s tragic for a young woman who wants more children to lose her womb unnecessarily due to lack of interventional radiology,” said Strickland.

In other cases, patients end up needing to have a colostomy bag fitted after having part of their colon removed, again because the NHS could not provide specialist help. And in others the shortage means that people who have had a stroke end up permanently disabled. “It’s outrageously unfair that if you have had the misfortune to have a thrombotic stroke in a part of the country where there are no neuro-specialist interventional radiologists, or no out-of-hours stroke thrombectomy services, you could end up in a wheelchair with half your body paralysed and possibly not being able to speak,” added Strickland.

“This postcode lottery, where the NHS is unable to offer the 24/7 care by these IR specialists that everyone agrees is crucial to ensure good patient care, means that some patients come to avoidable harm because their urgent health needs are not addressed. This really serious shortage of these specialists across the NHS is having a damagingly negative effect on patient care.”

Her intervention follows health minister Philip Dunne’s recent disclosure, in a parliamentary written answer, that 39 out of 148 hospital trusts in England – 26% – are so short of interventional radiologists that they cannot offer the service to patients across all seven days of the week.

Hospitals have about 44% fewer interventional radiologists than they need. Five years after a government-commissioned review said the NHS in England needed about 735 of the specialists to provide a 24/7 on-call service everywhere, there are just 414 of them, according to RCR figures.

In a recent case, a cyclist who had severe bleeding in his thigh after being hit by a car avoided having to have a leg amputated because an interventional radiologist was able to perform a procedure called coil embolisation.

Dr Trevor Cleveland, an interventional radiologist at the Sheffield Vascular Institute and president of the British Society of Interventional Radiology, said the shortage means that some patients end up being transferred as a medical emergency to another hospital, sometimes as far as 100 miles away, so they can receive specialist help.

However, “inter-hospital transfer of seriously ill patients can be risky and complex”, and many NHS trusts do not have any arrangements in place to ensure a patient who needs interventional radiology is moved quickly to another hospital, he said.

The Department of Health declined to comment on the claims of patients dying and suffering avoidable harm, and insisted that hospitals were obliged to ensure that all units were safely staffed.

A spokesperson said: “There are 29% more clinical radiologists than in 2010, and Health Education England is running an additional 35 clinical radiology training programmes each year from 2017 to 2021.

“We expect trust boards to take responsibility for safe staffing in their hospitals, and support doctors to decide the best course of action for their patients.”


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