Patients less safe than animals, says surgeon

Senior surgeons are demanding new legislation to prevent operations, other than the most minor procedures, being performed by non-medically qualified personnel.

Sir Rodney Sweetman, President of the Royal College of Surgeons, said the health service was "developing into a jungle," and patients had no way of knowing who would be operating on them. They had less protection than animals, he said, who can only be operated on by a veterinary surgeon.

A number of recent high profile cases involving nurses who have carried out surgical procedures, have raised concerns about the profession's expanding role, and generally doctors - and the British Medical Association - have been supportive of this development.

Speaking at the launch of new guidance to protect patients, Professor Sir Norman Browse, chairman of the British Medical Association's Joint Consultants' Committee, said that nurses were the only group of healthcare professionals who had training comparable to that of doctors.

There was no reason why doctors should not delegate minor surgical tasks to them, within the limits of the nurses skill, and with proper supervision, as long as the doctor retained overall responsibility for the patient from diagnosis to discharge.

Doctors are more concerned about other professions, chiropodists for example, carrying out invasive procedures, such as fitting plastic joints, and other less qualified personnel who, it is claimed, have been performing invasive surgery.

"There are people taking up the scalpel with no nationally agreed training or qualifications, " Sir Rodney said. "It is time for regulation by statute, so that people can give informed consent to about who operates on them."

Under current legislation, any person, qualified or not, can operate on another with their consent. This is an anomaly dating from the Medical Act of 1858 and was due to disagreement between doctors, apothecaries and barber-surgeons, all of whom had some commercial interest in carrying out surgery. The UK is the only European country to allow surgery to be carried out by non-medically-trained personnel.

The new guidelines, an effective holding position drawn up by the JCC which represents all the royal medical colleges, say that tasks should only be given to staff who are appropriately trained and supervised to carry out an agreed list of procedures. In all cases the patient must be kept informed. The aim is to provide a framework designed to "set and maintain the necessary standards of education, limits of responsibility and scope of practice to ensure satisfactory service and safety".

Sr Norman said that a surgeon was trained to anticipate and deal with complications. "Surgery is all about the unexpected," he said. About a third of seemingly straight-forward cases of appendicitis prove to be more complicated, involving abdominal and bowel problems.