Sir, You rightly applaud (leading article, January 8) the reduction in numbers awaiting surgery by virtue of the independent surgical treatment centres (ISTC). However, you do not address the effects on the Cinderella specialities of the NHS and the training of the next generation of doctors.

ISTCs hive off the easy, low-risk operations, leaving the NHS hospitals to cope with the emergency admissions, the high-risk and cancer operations (letters, January 4, etc).

In April, national tariffs (the “average” cost of an operation) will apply: the cost of a hip replacement in a fit 55-year-old is substantially less than the same operation performed on a frail 80-year-old following a fall.

The “profit” made by low-risk elective surgery in NHS hospitals assists in financing the care of the elderly and chronic sick. Who will care for these and emergency admissions when the local NHS hospital goes under? My conservative estimate is that the training of young doctors and theatre staff reduces throughput by 30 per cent; Department of Health provision for training in ISTCs is inadequate.

The ISTCs are a short-term “solution”. The medium to long-term consequences, if recognised, have been ignored.

Yours faithfully,
T. C. B. DEHN,
(Programme Director, Oxford Deanery General Surgical Training Scheme, 1996-2001),
Church Farmhouse,
Stratfield Mortimer,
West Berkshire RG7 3NU.
January 9.

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