USE it or lose it, that's the message from Andy Northeast, clinical director of surgery at Buckinghamshire Hospitals NHS Trust.

The Government says patients should be able to choose which hospital they are treated in and this week Mr Northeast warned that if people lost faith in their local hospitals, services would be damaged.

He said: "If people went elsewhere we would not be able to employ the people we do employ."

He defended the much-criticised changes to emergency and routine operations at Wycombe and Stoke Mandeville hospitals, saying there was a lot of misinformation and many people did not understand what was going on. Changes are being introduced as a result of policies in the Shaping Health Services (SHS) document.

Wycombe now carries out all planned operations and people from all over the county are taken to Stoke Mandeville for emergency operations. Day surgery goes on at both. The change, in August, led to claims that Wycombe's A&E department had been downgraded and would close, fears about patient safety and demands for Wycombe to return to its pre-SHS status.

In October, consultant anaesthetists said the lives of acutely ill patients were at risk.

Last week, Buckinghamshire Hospitals NHS Trust released data showing that patients were getting quicker operations, spent less time in hospital and no routine operations had been cancelled.

Mr Northeast talked about the tension between different professions in the hospital, saying the anaesthetists' letter, written when the system was still settling down, raised issues which had been addressed.

"What has got lost in all the smoke and whinging is why we did it and what it has achieved," he said.

He says surgeons are now specialists, not general surgeons, carrying out difficult operations and they need to do them all the time not just once a month.

That means a hospital serving at least 500,000 people was needed to provide the caseload. Wycombe and Stoke each serves 250,000 people.

"If you have a bowel tumour, you want the surgeon to be full-time and up-to-date with the latest treatment," said Mr Northeast.

"We built up a large series of radical operations, which would not have been possible with one surgeon in each hospital."

Surgeons are now being trained to carry out advanced techniques - but this fact had not got across to local people, he claimed.

Neither hospital had enough junior staff to run emergency rotas under the European working time directive - surgeons can't work more than 56 hours a week, including being on call.

Hospitals could not just take on more trainee surgeons if there were no jobs for them once qualified.

Also overlooked he said was that consultant surgeons were now based at Stoke for emergencies for one week in 12 so routine ops did not need to be postponed and outpatient clinics not cancelled because of emergencies.

That means, according to Mr Northeast, that emergency patients are operated on quicker and putting all emergencies at Stoke gave a better outcome in complex cases.

The A&E provision at Wycombe remains the same and seriously ill people would still be taken there if they could not cope with the journey to Stoke.

"Everyone would rather have everything on one hospital site, but you have to play with the hand you have been dealt.

"If it was all at one site, it would mean disenfranchising the other," he said.

He added that when something went wrong, people should not assume it had to be the result of Shaping Health Services changes.