The Cumberland Infirmary
Newtown Rd, Carlisle CA2 7HY
Anaesthetic Department, First Floor (entrance to Theatres opposite Aspen Ward).
Direct Telephone: 01228 814 196
Email address: Lisa.Hughes@ncuh.nhs.uk
Cumbria is the most North west county in England with a population of just under half a million people. We are lucky enough to have the Lake district national park here so during your time off there will be opportunities to enjoy our beautiful scenery; biking, walking, climbing/mountaineering, fishing, camping etc and lots more. There are a number of outdoor enthusiasts within the department so if interested bring your bike! (The less energetic are represented as well). www.visitcumbria.com
The Cumberland Infirmary is a busy district general hospital. We have a very wide range of clinical specialties here and relatively few trainees in comparison to bigger teaching hospitals allowing plenty of opportunity for all levels of trainee to gain experience in major surgery with little competition and in a supportive environment.
The hospital is part of the North Cumbria university hospitals trust and provides emergency services for the whole of Cumbria. Our range of surgical specialties include;
There are major cases every week. The full spectrum of head and neck cancer resection is carried out including neck dissection and free flap surgery. Trainees in anaesthesia can also expect to gain experience in laryngectomy, mastoidectomy and endoscopic nasal surgery. Laser resection of oral and glottic tumours is carried out using venturi techniques. Fibreoptic, Bonfils and video laryngoscopic equipment is available. There is a heavy workload of diagnostic scope work, which in addition to theatre experience provides an opportunity for surgeon and anaesthetist to plan workup for major surgery. Attendance at the weekly head and neck cancer MDT is encouraged. Fibreoptic airway skills may be practiced in the department and also refined in outpatients via nasendoscopy (ENT clinic) or bronchoscopy (in respiratory day case endoscopy).
Colorectal/upper GI surgery
The trust undertakes the second largest volume of emergency bowel surgery of the hospitals within the Northern Deanery according to NELA data. All emergency bowel surgery is centralised to the Cumberland Infirmary site. The trust has an established upper GI and colorectal service which undertakes annually on average: 150 major colorectal cases, 90 upper GI procedures, Endoscopic procedures- i.e. 40 OGD for UGI bleeds, 400 Lap. Chole.- acute/elective.
Elective and emergency vascular services are provided at the Cumberland Infirmary, Carlisle (CIC). This is called the Solway Vascular Network. Through this network emergency vascular services for the region are delivered at CIC and supported by four consultant vascular surgeons
On average 55-60 elective AAA repairs (30 of which are EVARS) and 20 emergency AAA repairs are undertaken yearly.
An average of 80 carotid endarterectomies are undertaken each year at the Carlisle site, and 200 open/hybrid infrainguinal arterial reconstructions. The CIC vascular department also undertakes approximately 400 varicose vein operations per annum and provides a dialysis vascular access service.
Trainees attached to a vascular module would expect to obtain experience across the range of vascular services provided at CIC. They should expect to acquire the skills necessary to undertake a peripheral vascular reconstruction with local supervision and gain exposure to open abdominal aortic surgery. They are expected to participate in the pre-assessment of patients, engage with audit activity and undertake a project which would lead to a quality improvement outcome/publication. There would also be the opportunity to attend vascular MDT meetings and interventional radiology minimally invasive vascular procedures.
Obstetrics and Gynaecology
The obstetric service at CIC is consultant obstetrician led and undertakes approximately 1800 deliveries per annum. High risk patients and those requiring operative intervention are transferred to CIC from the WCH and the midwifery unit in Penrith.
The delivery suite has a dedicated obstetric theatre and 10 delivery rooms. There is the 24 hour availability of a dedicated obstetric theatre team and anaesthetist.
The emergency caesarean section rate for 2015 was 15.6% (263), elective rate 12.5% (202) and instrumental delivery rate 9.2 % (156). There is an elective section list every day. An epidural service has been successfully introduced in the autumn of 2015.
There are weekly specialist antenatal obstetric clinics for the high risk pregnancies run by our consultants.
There is an obstetric review ongoing at the moment and we expect a decision as to whether obstetrics services from Whitehaven may move up to the Cumberland Infirmary site. We anticipate that such a move will increase our delivery rate to around 3000 year.
Gynaecological services operate on a day case and in patient basis. A full range of operative procedures are undertaken up to and including the management of stage 1 endometrial carcinomas. This includes total abdominal hysterectomy, vaginal hysterectomy, pelvic floor repair, hysteroscopy, endometrial ablation and laparoscopic interventions. A weekly MDT link occurs with the regional tertiary centre at the Queen Elizabeth Hospital, Gateshead.
The Urology Department of North Cumbria comprises 5 consultants.
A wide range of endoscopic surgical procedures are performed including percutaneous nephrolithotomy and complex stone treatments with the use of flexible ureterorenoscope and laser. A range of oncological interventions are offered including nephrectomy (approximately 30 laparoscopic and 5 open per annum) and laser HOLEP prostatectomy.
Trainees will be exposed to day case, in patient and emergency urological cases.
The breast service treats approximately 300 breast cancer patients a year. Apart from free flap procedures the full range of breast reconstructive procedures such as LD reconstructions, subpectoral reconstructions and therapeutic mammoplasties is offered to patients.
Electively, we have plenty of primary joint replacements also hip and knee revisions etc, upper limb surgery. We also provide regional anaesthesia for these patients and so there are learning opportunity . We have a busy 7 day trauma theatre with in the region of 2000 cases last year. According to the national hip fracture data base we have the 2nd highest number of fractured neck of femur cases in the region.
Our paediatric workload is considerable. We anaesthetise children down to 1 year old and/or 10kg in this hospital. We are within the Northern paediatric network (NEPAN) working closely with our colleagues in Newcastle. Electively, we have dedicated lists in general surgery,dental/maxillofacial surgery, ophthalmology, ENT, orthopaedics. There are also regularly paediatric cases on our trauma lists and emergency lists.
Intensive care unit
We have a 9 bedded unit with plans to expand to 13 beds. Beds are used flexibly between HDU and ICU allowing an annual turnover of 840 patients making our unit one of the most efficient in the UK. 40% of our admissions are surgical and over half of those are emergencies. Medical admissions include unselected general medical emergencies plus patients with renal disease (on site nephrology department and dialysis unit) and cardiology emergencies (team of 7 cardiologists providing 24/7 PCI). Trainees will experience management of organ support including haemofiltration and mechanical cardiovascular support (aortic balloon pump). Consultants within the team can provide training in Critical Care Ultrasound, Echocardiography and Tracheostomy (approx. 100 done per year). The ICU has approval for all levels of ICU training.
Accident & Emergency
We are a trauma unit within the Northern trauma network. Our Major trauma centre is the RVI in Newcastle. Due to our geography we deal with 1 to 2 major traumas a week in our A&E department. For this reason, there is plenty of opportunity to learn and be involved in inter hospital transfers.
Our Anaesthetic department consists of 15 consultants and 12 intensivists. We are a friendly and supportive department who take a keen interest in our trainees. We understand that there is a reasonable commute to get here and so we aim to get to know each trainee and provide them with as many learning opportunities as we can so that you can make the most out of being here. We run a 7 week Rota template here with 3 weeks of daytime shifts only (no night shift!). This gives an excellent opportunity for gaining experience in one of your chosen 3 month modules. We have an on call room for our trainees when on night shift.
Our teaching programme consists of weekly tutorials run by our consultants on various clinical topics. We have exam based teaching days and simulation based training regularly too. Our trainees are very welcome to join our monthly Morbidity and mortality days giving plenty of opportunity to present and be involved with audit and improvement initiatives. As we are expanding as a trust there is a lot of change and so exciting opportunities to be involved in such as governance/management etc. We have a good recent record of trainee publications at national and international scientific meetings and if this is something our trainees are interested in we can direct them to ongoing projects.