EDITORIAL

I am pleased to introduce to you the third edition this year. The rate of submission of articles remains healthy, which has resulted in backlog between publication online and in the paper edition of the journal. Articles, once published on-line can be cited using their URL in any necessary way – either for papers or for personal “curriculum vitae” purposes – naturally I am aware of both these imperatives!

The content addresses some scientific issues and I am happy to include the abstracts from the recent meeting of the British Neurovascular Group. There are also a number of articles addressing issues of organization and safety. I hope the international readership finds some degree of interest in the issues raised in our domestic environment, which perhaps do have some generic aspects to them.

Two issues are covered – one is relatively new but relatively little debated – the dreaded MDT! Or to give it its unabbreviated title – “Multidisciplinary team meeting”. Neurosurgery has for a long time indulged in multidisciplinary working – there being many historical examples going back to the origin of neurological surgery itself and reflected in this description of the service and the full title of the British Society (of Neurological Surgeons). Those of us that have worked in functional neurosurgery have long been used to collaborations with other neuroscience disciplines although in the modern era it is perhaps the sub-speciality of neuro-oncology that has most promoted the MDT. Such development of co-working has been perhaps – depending on your viewpoint – hijacked by the politically correct “MDT” – the multidisciplinary team meeting without which no action can be taken. Without any really good evidence of clinical efficacy or cost effectiveness, MDTs have sprung up in large numbers in all institutions. In labour costs they are extremely expensive, and many of the key decisions devolve to one or two key individuals with the necessary expertise and qualifications – for example the judgement as to whether a case is operable obviously requires the expertise of a trained and experienced neurosurgeon – remembering that in the brave new world training and experience have to be separated. I do not intend to rehearse all the various arguments here regarding the value or otherwise of the MDT, but I do welcome this debate. Two of the articles here look at aspects of the MDT in oncology, including its basic safety.^1,2

The second issue is that of coding – and it is you might say a repeat offender, having appeared before in the journal in a variety of guises. Although you might think that sorting out coding should be a straightforward matter for “brain surgeons”, clearly this is not the case. What is perhaps worrying is that the difficulties extend beyond areas that can be predicted to be complex, into much more simple areas involving basic definitions, and basic, accurate data collection. Perhaps the issue is one of resource, and maybe the approach to be taken is not to throw money at the problem, rather to throw “expertise” at the problem – certainly as it pertains to rigorous data collection. Perhaps the problem is that money without expertise has been thrown at the problem – certainly the issue of data collection! Closely allied to this is outcome data collection. Without outcome data collection it is hard to see how any planning can be done for commissioning purposes, or that the public – via the agency of the GMC – could have any confidence that revalidation is anything other than an expensive paper exercise.

Moving onto commissioning is quite topical – the new health bill has been passed, and the changes are now intruding into our world whether we like it or not. This will be a challenge – to date it is not clear whether all work will be centrally commissioned; of that which is centrally commissioned there is overlap of the scope of some of the clinical reference groups; tariffs still do not reflect the real costs and have anomalies with respect to specialist involvement and regional factors. To add to this, the interests of each separate provider – the various NHS trusts, foundation and otherwise - are heavily influenced by the demands of financial viability, and their self-interests. We live in interesting times!!!