THE Department of Health has published an information leaflet explaining key decisions it has made for the future of breast care services in the Island.
The question and answer style document explains why the department has taken the decision to appoint a general surgeon with a speciality in breast care instead of a specialist breast cancer consultant.
Health Minister David Anderson MHK said: "Health, both good and ill, is a matter that affects us all, yet it is often shrouded in clinical jargon and confusing and complex terminology.
"That's why I think that it remains as important as ever that the Department of Health continues to do all it can to explain in clear terms, matters relating to the Island's health service. This includes the topical issue of the future of surgical breast care in the Isle of Man. It is for this reason that I have requested that this leaflet to be drawn up."
isleofman.com can bring you the content of the leaflet in full:
Why was a locum consultant surgeon appointed instead of a full time, permanent consultant surgeon?
The retirement of the previous post holder in 2008 came at a time when we were already considering the future of breast care in the Isle of Man.
Understanding the importance of continuing to deliver high quality on-Island breast care, we appointed a locum consultant surgeon to continue this vital work.
Meanwhile, a full review of on-Island breast care was carried out and an appropriate future plan developed.
What was the outcome of the review and what does the future hold for breast care in the Isle of Man?
Following the introduction of a breast screening call and recall service, there is now an agreed broad three stage plan for developing and enhancing breast care in the Isle of Man.
Stage 1 - Fund and appoint a permanent dedicated consultant surgeon to lead breast services
Stage 2 - Introduce a sentinel node biopsy service
Stage 3 - Introduce an appropriate breast reconstruction service
Why can't we just keep the current locum consultant surgeon?
The appointment of a locum is by its very nature a temporary arrangement, with minimal obligations for both parties. Whilst this practice is quite right and proper as a short-term arrangement to provide cover, it does lead to insecurity in service provision.
For example if a locum decided to take a fulltime post elsewhere, minimal notice is required. This would cause serious disruption to patient care and services and a breakdown in the continuity of care enjoyed by the patient.
It is therefore in the best of interest of both patients and Noble's Hospital to make a permanent appointment and secure the service for the long term. This brings with it a substantive member of staff, with the commitment of leading the development of the services into the long term.
Can the current locum consultant surgeon apply for the permanent post?
Yes.
I've heard the term consultant general surgeon used in relation to this issue, are they less qualified than specialist surgeons?
No. Despite its name general surgery is a speciality in its own right, one of nine specialist areas of surgery. Both breast surgery and cancer surgery (oncology) are actually sub-specialities of general surgery.
In the UK general surgeons account for the largest speciality of surgeon at around 31 percent.
This means that all breast surgeons actually begin their specialist careers as general surgeons and can then go on to sub-specialise in breast care or another area (such as oncology, vascular, or gastrointestinal surgery).
Will the new consultant surgeon be sub-specialist in breast surgery?
Yes. The new consultant surgeon will be advertised with the job title of 'consultant surgeon with a special interest in breast care'. It is the latter part of this that means they will be a specialist in breast surgery.
How does a specialist general surgeon become a sub-specialist in breast surgery?
During higher surgical training which lasts six years, doctors usually decide on a sub-specialty and pursue this in the final two years of their training.
Why doesn't the current locum consultant breast surgeon have the same job title as the newly proposed post?
At the time of appointing our present locum consultant surgeon, we sought someone to cover only the breast care service. This meant that if this consultant left there would be minimal impact on the other surgical services.
This temporary cover was to give us the opportunity to review current services and ascertain exactly what we needed for the future of breast care, whilst continuing to provide an on-Island breast care service.
Will the Isle of Man have a dedicated breast surgeon?
Yes. Despite the differences in job titles both the current locum consultant surgeon and the new consultant surgeon with a special interest in breast care, will both be consultant specialist general surgeons who have sub-specialised in breast surgery.
The level and standard of care and surgical capability of the new postholder is set at the exact same level. So despite the nuances of job titles the new post-holder will very much be the Isle of Man's breast surgeon.
I've heard that as well as breast surgery, the new consultant surgeon will perform other types of surgery. Does this mean the Island's breast surgery service will be diminished or downgraded?
No, not at all. In fact we plan to enhance the current service. We plan to introduce an additional dedicated theatre session per week, taking this to two theatre sessions from the current one session. We also plan to increase the capacity within the outpatient clinics.
Will the new consultant surgeon primarily deal with breast care?
Yes. Breast care will be the primary role of the new consultant surgeon. Other surgical work will only take place as part of emergency out of hours cover or if there is capacity within the surgeon's workload for other types of surgery. The priority for this consultant surgeon's post is breast care.
Why does the new consultant surgeon need to provide emergency out of hours cover?
The Isle of Man currently has three surgeons on-call for emergencies at the weekend and at night, in addition to their day to day surgical duties. That means just three surgeons provide emergency surgical cover 24 hours a day, 365 days of the year - a considerable commitment between a small number of people.
Given the population size of the Isle of Man this is considered onerous by the Royal College of Surgeons. The current one in three cover does not represent best practice and is no longer deemed acceptable. We have been asked to address this matter urgently.
The new consultant surgeon could be called upon if you needed your appendix out at 3am in the morning. But it is envisaged that their scheduled day to day work will see them focussing on breast surgery as their substantive role, making them a dedicated specialist breast surgeon.
They will need to maintain their surgical skills in order to safely provide the out of hours cover but there is the capacity and means of doing this without taking anything away from our breast care provision.
The issue over job titles is confusing the matter - can't you just call the new post holder a 'consultant breast surgeon'?
Job titles and role specifications are scrutinised and approved by the Royal College of Surgeons. The job title of 'consultant surgeon with a special interest in breast care' is deemed the appropriate title in this instance by the Royal College of Surgeons and is in line with other hospitals in the UK delivering services similar to ours.
The important thing to remember is that despite these technicalities, which we must adhere to, the new surgeon will first and foremost be the Island's breast surgeon.
Is it true that the Isle of Man Council of Cancer Charities, Breakthrough Breast Cancer Isle of Man and Isle of Man Breast Care support the Department of Health's proposals?
Yes. We have fully consulted with these bodies and explained our stance and reasoning and they support the Department of Health's plans.
A member of the Council of Cancer Charities will also be a key member of the recruitment panel when we interview for the new post holder. This will allow full scrutiny of the appointment from the patient's perspective.
When do you expect recruitment to take place?
We hope to be able to begin the recruitment process in the next few weeks. As soon as the Royal College of Surgeons has given their approval, the post will be advertised.
The Royal College of Surgeons has a representative on the interview panel, so we have to involve them in the shortlisting process. We have to give the Royal College eight weeks notice of the interview date.
When the interviews have been held, the successful candidate may have to give three months notice if they are employed elsewhere. It would be realistic to expect that the new consultant surgeon may be in post by November 2011.
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