Warning of orthopaedic surgeon shortage as cancelled operations during pandemic leaves trainees 'poorly prepared'

The pandemic has severely impacted on training opportunities for orthopaedic surgeons in Northern Ireland
Seanín Graham

A MASSIVE drop in training opportunities for orthopaedic surgeons during the pandemic could have dire consequences as graduates feel "poorly prepared" to perform operations, a doctor has warned.

Graham Finlayson, a trainee surgeon in the Belfast trust, revealed that just five per cent of planned orthopaedic procedures had taken place over the past three months compared with pre-Covid levels.

This has left he and his colleagues without the vital "exposure" to surgery they require, he said.

Waiting list for hip and knee replacements in Northern Ireland have consistently been the highest in the NHS, with many patients facing delays of more than four years even before the pandemic hit.

Mr Finlayson confirmed in an online event hosted by the Royal College of Surgeons in Ireland (RCSI) that he is among a group of trainees who have written to Health Minister Robin Swann about the crisis.

"This is a major issue and will come to a head in the next six months," he said.

He explained that redeployment of staff - in particular theatre nurses as part of Covid surge planning - had led to the "decimation" of elective or planned operations.

Musgrave Park Hospital, which for decades has been regarded as a centre of excellence for orthopaedic surgeries and treats patients from across the north, has only 14 of 100 specialist orthopaedic theatre and recovery staff remaining.

Mr Finlayson, who is a member of the British Orthopaedic Trainees Association (BOTA), said there was an "immediate dip" where trainees were redeployed to ICU during the first wave.

However, this was exacerbated by the "huge nursing deployment" from Musgrave Park, with many of these staff subsequently quitting their jobs to work in either the private sector, retiring or go on sick leave.

He added these highly skilled nurses were not redeployed "through choice" and that retention levels were "appalling".

"Elective surgery is decimated. Fifteen of the 31 orthopaedic trainees are in their last 18 months and it is a huge challenge for them to have the indicative number that's required to exit the training programme," Mr Finlayson told the RCSI event.

"At present, elective orthopaedic activity in the Belfast trust over the past three months has averaged five per cent of pre-Covid levels. Even that doesn't refelct the whole picture.

"...Trainees at my stage, and I include myself in this, feel poorly prepared for elective practice as consultants as we have not had the necessary exposure.

"..The worst case scenario is if this doesn't improve, the training scheme is not sustainable. You can't train orthopaedic surgeons if you can't provide them with orthopaedic opportunities.

"..If the orthopaedic training programme fails, the trauma network in Northern Ireland - which relies on a trainees for service provision and in particular for out-of-hours consultants - will collapse.

He insisted: "This is not hyperbole".

The major downturn in surgical training is not unique to the north however, with warnings last week about that Covid has resulted in the cancellation of one million operations in Britain - and lead to a surgeon shortage.

However, figures compiled by data analyst Peter Donaghy show waiting list patients in the north are 11 times more likely to face delays of more than year compared with those in England.

Last nigtht the Department of Health said it has received the letter from the trainee surgeons and "will be responding in due course".

Meanwhile, it has emerged that 21 hip replacements were carried out by a private healthcare company at the South West Acute Hospital in Enniskillen last week as part of a department initiative to slash waiting lists. 

No opportunities were given however to NHS trainee surgeons. The DoH declined to say how much the contract with the private firm is worth.

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