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Cancer Patients Wait So Targets Are Met
A consultant has been urged by his hospital to operate on six non-urgent cases before patients with skin cancer in order to meet a Government waiting list target.
Geoffrey Wilson, a plastic surgeon, said yesterday that he was considering resigning from the NHS because of the pressure being put on him by managers at Epsom general hospital, Surrey.
Geoffrey Wilson, plastic surgeon, is unhappy that cancer patients are being asked to wait
If he does not operate on the six patients before the end of February they will have been waiting more than 12 months, exceeding a target that should have been met last year.
Mr Wilson said the surgery was not urgent and included a scar revision and breast augmentation for psychological reasons.
"I have urgent cases on my list, patients with basal cell carcinoma, who should be treated first. I find myself in a difficult ethical position.
"I am not a political animal. Do I make a stand or do I just fit in with their system and act against my clinical judgment? I find it ethically difficult to work in these conditions. If I resign my patients won't be treated."
His predicament exemplifies problems faced by consultants across the NHS who complain that targets are distorting clinical priorities.
The Royal College of Surgeons said Mr Wilson's experience was a familiar story. But health ministers insist that the need to meet targets must not override doctors' clinical judgment.
Mr Wilson said that when the situation was brought to his attention early this week he raised it immediately with his hospital manager. "Her response was that I had put the patients on the list in the first place."
He explained that the patients with basal cell carcinoma were not going to die from their condition. But the tumours grow, are unsightly, can bleed and need dressings.
"The more significant problem is that this is a clinical diagnosis. We have not done biopsies. We cannot be sure of the exact nature of the malignancy.
"If I had a basal cell carcinoma I would want diagnosis and treatment reasonably quickly," he said.
On Monday he operated on three patients with basal cell carcinomas who had been waiting for 11 months. "This is too long," he said.
"I believe in the NHS. I believe that the NHS should be free and that there should be readily available treatment both for emergency and electives cases."
He said he had been working hard to cope with mounting waiting lists.
"Surrey has one of the highest skin cancer rates in the country, probably associated with affluence, with people able to have two or three holidays a year."
An extra operating session for three months, provided at Epsom three years ago, had helped to get waiting lists down, he said.
"I was just starting to crack it. But this was a 'waiting list initiative' and they could not go on funding the extra work permanently."
Hugh Phillips, the vice-president of the Royal College of Surgeons, said: "This is a familiar story.
"This whole issue of meeting targets is one of the biggest causes of tension between managers and consultants. There is no doubt that pressure is being put on doctors to meet targets. It is absolutely there.
"Doctors have to be very careful when they are prioritising. A patient with cancer should take precedence."
Epsom hospital, part of Epsom & St Helier NHS Trust has struggled to gain star status in the hospital rating system. Last year its rating fell from two stars to one.
A spokesman said: "It is quite reasonable for managers to inform him that he has patients who have been waiting a long time. At the end of the day it is his decision."
A Health Department spokesman said clinical priorities must always take precedence over targets. This was a point "emphasised" by John Reid, the Health Secretary.
He said last month: "We have repeatedly emphasised that those patients who are in greatest need will continue to be treated first."