John Yates is no stranger to the wellrecognised problems of underprovision of trauma and orthopaedic surgery in the NHS. He has again highlighted under-utilisation of our consultant orthopaedic surgeons due to the many factors that he has described. To these must be added the shortage of available elective beds for orthopaedic surgery because of medical and surgical boarders, and nursing staff shortages in both wards and operating theatres.

I do agree that theatre use is hampered by antiquated practice, including the rigid adherence to 3.5hour operating sessions, which are often incompatible with the current case-mix. In my own department we have shown that increasing consultant numbers can dramatically increase surgical output.A further increase in our consultants, however, would mandate additional theatre resources, beds and nursing staff.

There is huge frustration in the consultant body caused entirely by the lack of resources to enable it to practise surgery effectively. Most surgeons would prefer to operate for a minimum of 12 hours a week - surgeons enjoy operating.

Hugh Phillips Consultant orthopaedic surgeon President British Orthopaedic Association