By Marjory Inglis, health reporter, and Steve Bargeton, political editor

NHS TAYSIDE plastic surgeon Alex Munnoch prompted a political storm yesterday after his letter to a patient claimed he was under pressure to remove patients from his waiting list to meet government targets.

The letter was brandished in the Scottish Parliament by Liberal Democrat leader Nicol Stephen in a bid to embarrass Scottish Health Minister Nicola Sturgeon, who had praised health boards across the country the previous day for meeting waiting times targets.

Mr Munnoch later apologised “unreservedly” and NHS Tayside said the small number of people waiting for a highly specialist pioneering treatment would get their treatment in Tayside.

But it was made clear no further referrals would be accepted for the treatment.

Mr Munnoch is the only consultant in Scotland offering liposuction to patients with the condition lymphodema, which causes heavy, swollen limbs and can be very disabling.

He started offering the treatment at Ninewells Hospital around three years ago and is understood to have undertaken liposuction for medical reasons in only a handful of patients.

It emerged yesterday that patients were being referred from all over Scotland to Tayside for the treatment that is still being evaluated.

The health authority’s chief operating officer Gerry Marr last night pledged to make the arrangements for those patients Mr Munnoch had already promised to treat, but said NHS Tayside was “not in a position to accept any new referrals.”

NHS Tayside plans to discuss the possibility of national funding for the service in future.

Mr Munnoch has been guest speaker at conferences both nationally and internationally where fellow specialists gather.

Last year at the International Society of Lymphology Conference in China, specialists heard that Mr Munnoch’s liposuction centre had been open for 30 months and he had assessed over 20 patients for treatment.

At the time eight patients had been through surgery.

Last night a colleague said that the new treatment offered “very promising results” but other health boards were “not prepared to pay for it.”

The colleague said the treatment was developed by a Scandinavian surgeon. Mr Munnoch had “done a number of cases” and presented on the subject at international professional meetings, where his work had been “very well received.”

“He is certainly the expert in Scotland and possibly around the UK,” said the colleague.

Last night NHS Tayside issued a statement pointing out that Mr Marr had now looked into circumstances surrounding the issue and had given a commitment that the patients Mr Munnoch had agreed to see from Tayside and other health board areas would be treated in Tayside.

Mr Marr said, “Irrespective of the circumstances of this situation, I recognise the distress that may have been caused to the small number of patients involved and I apologise for this.

“I will personally be making whatever arrangements are necessary for those patients to have this treatment here in Tayside.

“Mr Munnoch is the only surgeon in the UK who undertakes this highly specialised procedure and, although I will be making arrangements for those patients who Mr Munnoch has already promised treatment to, we are not in a position to accept any new referrals.”

The statement added that following discussions yesterday with Professor Stewart Forsyth, medical director of NHS Tayside’s single delivery unit, Mr Munnoch had apologised for any confusion he had caused to patients requiring liposuction for lymphodema.

He had also apologised unreservedly for any suggestion patients were being removed from his list to meet waiting times targets.

Mr Munnoch said, “I would like to make it clear that I have been under no pressure from managers in Tayside to alter waiting lists inappropriately.

“I have also been advised that our medical director will be in discussions with the National Services Division to look at the possibility of funding this service on a national basis in the future.”

Earlier Mr Munnoch’s letter was brandished by Scottish Lib Dem leader Nicol Stephen at First Minister’s Questions as he demanded action over a “shocking and scandalous situation.”

Alex Salmond promised an immediate investigation, carried out yesterday afternoon by his health secretary Nicola Sturgeon.

She described removing patients form waiting lists as “unacceptable” and wrote to all health boards that hidden waiting lists “will not be tolerated by this government.”

Mr Stephen revealed to MSPs the detail of the letter sent to the woman who was waiting to have liposuction.

The letter signed by Mr Munnoch said, “I am afraid I am writing to inform you of some bad news. I have been instructed by hospital management to remove your name from my waiting list.

“The prime reason for this decision relates to the 18-week target for patient treatment which is now in enforcement.

“I currently have a significant number of patients in breach of this and the simple solution by management is to reduce my waiting lists by removing patients’ names.”

It later transpired the letter had been sent on December 21, before the abolition of so-called hidden waiting lists on January 1.

Ms Sturgeon has written to the patient apologising, and to reassure her that the action taken was unacceptable and would be reversed.

“I have thoroughly investigated this case. The patient’s removal from the waiting list was unrelated to waiting time targets and cannot be justified. NHS Tayside have accepted this. I have written to the patient concerned this afternoon to apologise for what has happened, and to say her removal from the waiting list was unacceptable.

“I have also advised her that I have taken immediate action to ensure that she will get the treatment she requires within the waiting time guarantee period, and that the treatment will be carried out within the NHS and funded by her home NHS Board.”

Scottish Tory leader Annabel Goldie said, “This is what happens when NHS priorities are based on political targets rather than the clinical need of patients—pressure is exerted to pull out all the stops in a bid to meet the targets. The last Labour-Lib Dem Executive and the SNP minority government are all guilty of allowing this practice to continue.”