Training Cuts will Risk More Great Ormond Street-Type Scandals

02 March 2026

CBS in the press (Clinical Services Journal and Healthcare Today)...

The CBS the UK’s only trade union to be recognised under UK law to protect the welfare of surgeons and the surgical team is warning that an NHS England decision to withdraw funding for specialist surgical training will have ‘inevitable consequences’ and make a recurrence of the recent Great Ormond Street Hospital scandal which affected just under 100 children more likely than ever.

Training Interface Group (TIG) Fellowships, the only nationally qualityassured, GMC regulated supraspecialist fellowships have effectively been axed by NHS England. They have been removed as training opportunities for surgeons leading the Confederation of British Surgery (CBS - www.cbsgb.co.uk) to raise the alarm that the cuts are dangerous and will threaten patient safety.

Specialty Surgical Trainee Raiyyan Aftab is a CBS board member as well as President of the Association of Surgeons in Training (ASiT – www.asit.org). He warns, “The decision to make the cuts by the Postgraduate Medicine and Dental Education Oversight group in NHS England (NHSE) effectively dismantles a regulated pipeline into complex subspecialist surgery at the same time as highprofile failures in paediatric orthopaedics are exposing the dangers of poorly governed, siloed complex practice. The withdrawal of funding will have inevitable consequences for future patient safety.”

Prior to defunding, TIG Fellowships were curriculumbased in complex sub-specialist surgical practice which require additional training such as cleft lip and palate, hand surgery, head & neck oncology, spinal, oncoplastic breast surgery and major trauma. Their aim, as described by the Joint Committee on Surgical Training (JCST) is to ensure “excellence in a selected group of talented trainees” over a minimum of 12 months reaching defined competencies for formal certificates of completion.

Raiyyan continues, “In practice the cuts mean, the loss of the single, regulated, UKwide pathway for specialist competence in these fields, to be replaced by a patchwork of adhoc, locally employed posts of variable oversight and quality.

“Removing TIG’s creates a patient safety issue in that without quality assurance, patients and commissioners cannot reliably know, what training a surgeon has actually received in supraspecialist procedures or whether their unit has met any nationally agreed threshold for casemix, supervision, and governance.”

The recent internal investigation at Great Ormond Street Hospital (GOSH) into paediatric limblengthening and reconstruction found that 94 of 789 children treated by one surgeon between 2017 and 2022 were harmed, more than one in eight patients.

35–36 children suffered severe harm, with documented issues including: Operations without clear clinical rationale, incorrect bone cuts and implant placement, premature removal of fixation devices, and poor management of complications. A toxic working culture, inadequate challenge, were also serious concerns raised by a Royal College of Surgeons review about how complex cases were overseen.

Raiyyan explains: “This is precisely the kind of complex, highrisk subspecialist work that depends on robust training, multidisciplinary teambased decisionmaking, and strong external governance standards. At a moment when national reviews are calling for stronger oversight and standardisation in complex paediatric surgery, dismantling a proven, qualityassured national training pathway for comparable supraspecialist fields is counterintuitive from both a safety and regulatory perspective.”

There is plenty of evidence on siloed and poorly coordinated care, for example, a UK perioperative care review describes how multidisciplinary working can improve outcomes but also warns that “less wellorganised” multidisciplinary models are associated with worse survival than conventional care, highlighting how fragmented, poorly structured practice can be.(1)

Other examples of recent standard lapses included cleft palate surgery which historically was a fragmented service being delivered in some places as an ad hoc service. Poor outcomes reported which led to a central government push to centralise services as well as setting clear measurable and quality assured standards for training.(2) Also the Bristol Paediatric Heart Surgery scandal where highly complex paediatric cardiac surgery was performed in a small number of centres with big outcome differences; Bristol’s problems were amplified by insularity, poor external benchmarking and lack of robust national standards and training oversight.

Raiyyan adds: “The lesson is clear: Subspecialisation improves outcomes when it is formally trained, integrated and governed. Removing regulated training pathways risks drifting towards isolated, siloed practice with variable standards – exactly the pattern exposed at GOSH and other examples highlighted above. We do not want history to repeat itself.”

The Plastic Surgery Trainees Association (PLASTA – www.plasta.org) have added their voice to the concerns. President Richard Clough says;
“Patients with complex conditions often need specialised care from surgeons with cross-specialty expertise. TIG (Trainee Interface Group) fellowships provide this structured training. Their removal raises real concerns for future training quality and patient care.”

Consultant plastic surgeon Mark Henley, President of CBS, concludes: “Whilst CBS understands that certain changes are necessary for NHS England, the decision effectively withdrawn funding for specialist surgical training is inexplicable especially at this time when patient safety and trust has been eroded by maverick behaviour and poor oversight.”

(1)https://cpoc.org.uk/sites/cpoc/files/documents/2020-09/Multidisciplinary%20working%20in%20perioperative%20care%20-20rapid%20review.pdf
(2) https://www.bristolhealthpartners.org.uk/news/centralised-care-needs-to-be-improved-to-ensure-children-with-cleft-lip-and-palate-have-best-outcomes/

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