Emergency surgical care in Scotland.

The introduction of waiting list initiatives and targets has resulted in the concentration of resources in politically important medical disciplines. This has inevitably meant that other medical disciplines, many of which involve emergency or unplanned admissions, have diminished resources. We believe that both the scale of this problem and the number of emergency or unplanned admissions to Scottish hospitals are underestimated. An analysis of the surgical mortality in Scotland between April 2004 and March 2005 was undertaken and the prevalence of emergency and unplanned admissions in the different surgical disciplines in different areas of Scotland was calculated. It is apparent that about 40% of all surgical admissions in Scotland are emergency or unplanned admissions with about 70% being in general or orthopaedic surgery. About half of all admissions in neurosurgery, paediatric surgery, general surgery, orthopaedic surgery and cardiothoracic surgery are emergency or unplanned admissions. The numbers of emergency and unplanned admissions are much greater than is appreciated by many surgeons, managers and politicians. Recent changes in working hours, staffing levels and training have proved detrimental to the provision of good care for these patients. This situation is likely to worsen as the population ages and there are more emergency admissions. We believe that increasing centralisation is required in the major surgical disciplines if future problems are to be avoided.