Patient died after surgeon was 'forced to carry out three operations in a day' at under-fire hospital Mr Walker suggested that he was placed under pressure for prioritising emergency care rather than diverting resources to meet Whitehall targets for non-emergency operations. But three letters leaked by independent Lincolnshire councillors, published on a local news website, reveal that there were additional concerns about the amount of work having to be performed by surgeons to meet the targets. One strongly-worded letter - which has been redacted to conceal the identities of the addressee and writer - was fired off by a consultant "in the immediate aftermath" of the "tragic death" of a patient who had been operated on two days before. The letter, published on the Lincolnite website and dating from February 2010, said: "The patient's operation occurred on a day upon which, unusually, three radical procedures were undertaken by the same surgeon on a single extended list. Habitually, one or two procedures would be performed within this session and the additional case was required due to target pressures. It added that there was "enormous pressure" exerted by targets resulting in "ad hoc arrangements" for surgery at short notice, after working hours or at weekends, as well as on patients with whom surgeons have had "no prior contact." This is not only prejudicial to ongoing patient care, but presents enormous and unsustainable pressure on the operating surgeons. This cannot be tolerated in all but exceptional circumstances. It demanded the recruitment of additional surgeons and said that doctors would no longer be willing to carry out extra operations to "chase the targets" in the future. A letter from a second consultant surgeon, also dated February 2010, described the doctor's concern over being put under pressure to perform a complex ten-hour operation shortly before he was due to go on holiday which would leave him unable to give post-operative care. It had been pushed back because no intensive care bed was available. The surgeon said that while endeavouring to meet targets, the "absolute paramount importance" was patient safety and to fail to put this first would be to risk being struck off. I do not think there would be any defence either in court or in front of the GMC if I put the Trust's target in this instance above the patient's welfare. A letter in March 2010 from a clinical director to Paul Richardson, chairman of the trust, said: "I feel I must make you aware on my concerns about the balance between patient safety and target and inform you that in my view the current bullish and sometimes ruthless pressure from above on the management team in my Directorate is unfair and unacceptable. Such a culture that has evolved over the last few months has caused a subtle but significant shift in the balance between achieving targets and the quality and safety of our service to patients. A ULHT spokesman said: "Patient safety remains the top priority for United Lincolnshire Hospitals NHS Trust and this means that our focus is to provide safe, high quality care at the same time as meeting our patients" expectations. We have made significant improvements in all areas of patient safety in the last two years and this is demonstrated by recent inspections carried out by the Care Quality Commission which are expected to show only minor concerns compared to 14 major, moderate and minor concerns raised in 2011.