Surgical solutions for the next UK government
Our manifesto
Our vision is to see excellent surgical care for everyone. We are urging the next UK government to support the six recommendations outlined in our election manifesto to support and strengthen the surgical workforce and ultimately improve patient care. The UK government has responsibility for health in England, with the devolved administrations overseeing the NHS in the other nations of the UK. RCS England will work with all administrations on our calls to government for the benefit of our members across the UK.
We encourage you to email your MP candidates and ask them to read the manifesto and support our asks for surgeons and surgery.
Our priorities for the next UK government
We call on all political parties to commit to:
1. £6.4 billion annual funding increase to upgrade NHS facilities to reduce NHS waiting lists to pre-pandemic level
NHS patients are experiencing record-long waiting times for treatment, exacerbated by COVID-19 but predating the pandemic. The NHS requires significant investment to expand surgical capacity, update infrastructure, and grow the workforce. Increasing the number of surgical hubs and boosting theatre staff and training opportunities are crucial steps. The UK government's current investment plans lack clarity on postgraduate funding. The next UK government must secure funding for the NHS Long Term Workforce Plan and work to reduce waiting times to pre-pandemic levels.
2. Make the NHS a more attractive place to work by introducing a wellbeing package to support the morale of our workforce
Investment in the wellbeing and morale of the NHS workforce is essential to attract and retain staff and provide quality patient care. Burnout and stress are major issues, with 61% of surgeons citing them as main challenges, and poor working conditions and workplace culture also affecting staff. Over 30% of NHS staff report feeling burnt out. The next UK government must introduce a wellbeing package to improve flexible working options and both physical and cultural workplace environments.
3. Ensure staff feel safe by taking a zero tolerance approach to sexual misconduct in the NHS
RCS England is committed to eradicating sexual misconduct in surgery and healthcare, ensuring no one feels unsafe at work. Fundamental cultural change and accountability are urgently needed within the NHS to prevent sexual assault and harassment. Reporting and investigation processes must be reformed to improve safety and confidence, with external, independent investigations. Surveys show widespread sexual misconduct and we understand that staff may feel unable to report concerns due to fear of repercussions. The next UK government must ensure staff feel safe by taking a zero-tolerance approach to sexual misconduct and reforming reporting and investigation processes within the first six months.
4. Improve the oral health of the UK population
The Faculty of Dental Surgery at the Royal College of Surgeons of England highlights poor oral health in underserved UK areas, especially among children, with tooth decay being the leading cause of hospital admissions for ages 5 to 9. Access to NHS dentistry is limited due to workforce issues, with only 40.7% of adults seeing an NHS dentist in the past two years, a drop from pre-pandemic levels. The outdated NHS General Dental Services Contract makes providing NHS treatment financially impractical. The next UK government must improve oral health by introducing a national supervised tooth brushing program in primary schools, extending free breakfast clubs, and reforming the NHS dental contract by 2025.
5. Protect patients by introducing stronger regulation for cosmetic surgery
Current UK law permits any doctor to perform cosmetic surgery in the private sector, making it hard for patients to distinguish between well-trained surgeons and those who should not be practising. Since 2017, RCS England has run a voluntary certification scheme for cosmetic surgeons meeting specific standards, which patients can verify on their website. RCS England urges the GMC to make this certification a regulated credential to enhance patient safety. Reports highlight UK residents risking their lives for cosmetic surgery abroad, often persuaded by unscrupulous overseas professionals. The next UK government must protect patients by introducing stronger regulations for cosmetic surgery and closing regulatory gaps within the first year.
6. Invest in social care to take pressure off the NHS
Multiple governments have failed to deliver meaningful reform and funding to social care, leading to devastating consequences and a 'healthcare cost lottery' for patients. This issue impacts the NHS, with thousands of patients stuck in hospital beds due to inadequate social care. While there have been short-term initiatives, a long-term approach and increased investment are essential. The next UK government must prioritise social care reform within its first year to alleviate pressure on the NHS and ensure equitable care.
How you can help
Please help us to ensure that your newly elected MP hears about our manifesto by sending them an email and asking for their support. If you have time to add further personalised comments, explaining your views or experience, that will have an even greater impact.
Contact details for your MP can be found on the Parliament website. Find all the candidates standing in your constituency on Who can I vote for?.
Further detail on our manifesto priorities
1. Commit to £6.4 billion annual funding increase to upgrade NHS facilities to reduce NHS waiting lists to pre-pandemic level
The number of NHS patients waiting for treatment is at record levels across the UK. Waiting times for surgical procedures have spiralled following the outbreak of COVID-19 but they were already increasing well before the pandemic.
It is clear to everyone that the NHS needs reform. However, the scale of the challenge and rising demand from an ageing population means this cannot be achieved without additional investment. Significant funding of surgical services, including replacing ageing infrastructure and outdated IT systems, introducing reforms such as surgical hubs, and expanding the surgical and dental workforce, is essential to reform the NHS and expand the capacity needed to tackle the waiting list backlogs.
More than half (56%) of respondents to RCS England’s 2023 UK Surgical Workforce Census Report cited limited access to theatre, with surgeons not having enough operating time, as one of the main challenges facing surgery. Two-thirds (67%) of consultants stated that they "always" or "frequently" work more than their contracted hours, expanding surgical capacity and making our staff and facilities more productive. Funding could also expand the availability of surgical hubs with protected elective beds across the country (as promoted by RCS England) having a key impact on bringing down surgical waiting times.
The NHS Confederation has also identified the need for increased investment in capital to support greater productivity, and has estimated the NHS requires £6.4 billion annual capital funding. We support this call. Their report states that the UK has invested less in health capital over several decades when compared with comparable nations. The result is a less productive service hampered by, among many other things, Victorian estates, too few diagnostic machines and outdated IT systems that cannot communicate between hospitals. The NHS Confederation report says capital is the number one issue NHS leaders tell them is holding back their progress.
Workforce investment
Alongside the urgent need to upgrade NHS infrastructure, we also need to invest in workforce capacity to reduce NHS waits, improve quality of care, and support workforce sustainability. Despite the surgical workforce regularly working beyond their contracted hours, we haven't seen any significant reduction in the size of the waiting list. Our census revealed 67% of consultants always or frequently work beyond their contracted hours and 42% of all respondents to the survey did not take their annual leave entitlements in the previous year.
Even when there are enough operating theatres, there may not be a full team available to do the operation - a surgeon, anaesthetist, nursing and theatre staff. This can be due to additional external pressures such as retention and recruitment of NHS staff, or there simply are not enough beds.
If the NHS is to meet future service requirements and demand for flexible working, the surgeon workforce will need to increase year-on-year. We also need an increase in training numbers across surgical specialties, with priority for training opportunities given to those in designated training programmes. There must be contracted and protected time for educational and clinical supervisors to support training. In addition, there must also be a significant increase in theatre staff numbers, especially theatre nurses and anaesthetists.
While the current UK government has promised more than £2.4 billion to fund the 27% expansion in training places by 2028/29 via the NHS Long Term Workforce Plan (LTWP) there is uncertainty about longer-term funding. The LTWP sets additional undergraduate medical places but it does not give any detail on the required increase in postgraduate training places. The next UK government should address uncertainty and back the funding required for delivering the necessary number of postgraduate surgical and medical training places as soon as they take office, making sure NHS England works with the medical royal colleges to agree numbers.
Summary
The next UK government must invest in surgeons, surgery and hospital infrastructure to ensure NHS waiting lists return to at least pre-pandemic levels by the end of the next Parliament. To do this they should:
- Commit to a £6.4 billion annual capital funding increase for the NHS at next year’s three-year Spending Review, as called for by the NHS Confederation. This funding should support increases in surgical capacity.
- Work with NHS England to rapidly analyse the success of the surgical hubs programme to determine where else in the country hubs may benefit patients, and commit to investing in these as part of additional capital funding.
- Set out a complete funding plan to increase postgraduate medical and surgical places, as set out in the NHS Long Term Workforce Plan, including an increase in the surgical and dental workforce year on year.
- Instruct NHS England to work in partnership with medical royal colleges to agree postgraduate training numbers to support medical and surgical and dental workforce sustainability.
2. Make the NHS a more attractive place to work by introducing a wellbeing package to support the morale of our workforce
Just as the next UK government needs to invest in the capacity of the NHS, we also need greater investment in the wellbeing and morale of the NHS workforce. Without a healthy, happy and fulfilled NHS workforce, the NHS will struggle to attract and retain staff, and provide the care that patients rightly expect.
NHS staff feel under pressure, undervalued, and overworked. 61% of respondents to the RCS England’s 2023 UK Surgical Workforce Census Report cited burnout and stress as the main challenge in surgery, with NHS culture, systems and processes contributing to this. Half (49%) of respondents cited working conditions as the additional barrier. Similarly, the NHS Staff Survey 2023 national results found more than 30% of respondents feel burnt out because of their work.
The physical environment in which someone works also has an important impact on wellbeing; underlining the need for more capital funding to improve NHS estates.1 Pressure must be put on NHS employers to ensure they are providing adequate welfare facilities for staff, including 24-hour access to nutritious food and drink; places to rest, study and eat meals; changing facilities and lockers; and facilities for parents returning to work.
Bullying and harassment is also a problem with 24% of respondents to our survey saying cultural environments in the workplace (including bullying and harassment) continue to affect individuals and the delivery of surgical services. The General Medical Council’s National Training Survey 2023 found over a quarter (28%) of respondents reported hearing insults, stereotyping and jokes on the grounds of someone's protected characteristics.
Generational changes in lifestyle expectations, working environments and the welcome increase of women in the medical workforce have seen more and more surgeons and other healthcare professionals choosing to work flexibly. Despite this, concerns remain regarding awareness and access of Less Than Full Time (LTFT) training and working opportunities for surgeons.
The next UK government must make the NHS an attractive place to work by introducing a wellbeing package to support the morale of our workforce. To do this it should:
- Within the first year of office, work with NHS England to set out plans to improve the physical working environment for NHS staff. This should be funded through increased capital investment and include adequate access to welfare facilities for staff.
- Ensure NHS staff get continued access to the NHS Practitioner Health service, which provides mental health support, beyond the service's current extension to March 2025.
- Require NHS England to ensure policies on sexual misconduct and bullying and harassment are: in place at each NHS trust; that each NHS trust is proactively enforcing these policies through effective delivery and support of staff; and that each NHS trust records the number of incidents.
- Require NHS England to ensure policies on flexible and LTFT working are: in place at each NHS trust; that each NHS trust is proactively enforcing these policies through effective delivery and support of staff; and that each NHS trust records the number of requests alongside the number of staff who are working flexibly and LTFT.
3. Ensure staff feel safe by taking a zero-tolerance approach to sexual misconduct in the NHS
RCS England is committed to a zero-tolerance approach to sexual misconduct; we are actively working to eradicate this behaviour in surgery and healthcare. No one should feel unsafe at work. Fundamental cultural change and accountability is urgently needed within the NHS to prevent everyone working within the NHS experiencing sexual assault and harassment at work. Moreover, work is needed to guarantee a supportive and accountable system that will appropriately address the issues reported.
There must be urgent reform of reporting and investigation processes of sexual misconduct in healthcare, to improve safety and confidence in raising concerns and to ensure investigations are external, independent and fit for purpose.
Breaking the Silence – Addressing Misconduct in Healthcare found that two-thirds of women (63.3%) had been the target of sexual harassment from colleagues, along with almost a quarter of men (23.7%). In addition, the majority of participants in the research (89.5% of women, 81% of men) reported witnessing some form of sexual misconduct within the previous 5 years.
Participants also reported instances of rape at work, as well as in other work-related contexts including teaching spaces, conferences, and after-work events with colleagues. Nearly a third of women (29.9%) surveyed had been sexually assaulted by a colleague.
The latest NHS Staff Survey showed that almost 9% of all NHS staff and 18% of medical and dental staff in training have been the target of unwanted sexual behaviour in the NHS from patients, service users, their relatives or other members of the public. The data also showed that nearly 4% of NHS staff have been the target of unwanted sexual behaviour from staff/colleagues in the NHS.
Although these surveys have demonstrated widespread issues, we also know staff can feel unable to report concerns, especially if they feel there might be repercussions for them, and they can be confused about which bodies they report different types of concerns to.
The next UK government must ensure staff feel safe by taking a zero tolerance approach to sexual misconduct in the NHS. To do this it should:
- Support to recommendations from the report Breaking the Silence – Addressing Misconduct in Healthcare, the Working Party on Sexual Misconduct in Surgery.
- In their first six months, the next UK government should begin work with healthcare regulators, NHS England, the police and the criminal justice system, to reform reporting and investigation processes of sexual misconduct in healthcare. The aim of this work is to improve safety, as well as confidence in raising concerns and the effectiveness of reporting mechanisms.
4. Improve the oral health of the UK population
The Faculty of Dental Surgery at the Royal College of Surgeons of England recognises that the oral health of some underserved parts of the UK, and particularly that of children, is poor. Tooth decay remains the leading cause of hospital admission for children aged 5 to 9 years. This fact is even more disturbing when we consider that tooth decay is largely preventable and therefore avoidable through reduced sugar consumption, regular tooth brushing and visits to the dentist.
Access to NHS dentistry, due to workforce issues, remains a problem. In June 2023, only 40.7% of adults had seen an NHS dentist in the previous two years, significantly lower than before the pandemic. The NHS General Dental Services Contract has remained largely unchanged since its inception in 2006. It makes NHS dental work financially impractical, and thereby the provision of NHS treatment unappealing and unsustainable. Furthermore, the lack of contractual obligations for NHS dentists to continue treating patients beyond completing ongoing treatment courses exacerbates issues.
The next UK government must improve the oral health of the UK population. To do this it should:
- Within the first 100 days of office, introduce a national supervised tooth brushing programme and distribute dental kits in primary schools. These kits should include toothbrushes, toothpaste, and educational materials that highlight good oral hygiene practices and the importance of dental health.
- Within the first two years of office, extend free breakfast clubs to every primary school to ensure universal access to nutritious meals for every child. Children from disadvantaged backgrounds are more likely to consume products high in fat, sugar and salt (HFSS).
- Enact comprehensive reforms to the NHS General Dental Services Contract by the end of 2025.
- Extend the current Soft Drinks Industry Levy (SDIL) to include all sweetened juice and milk-based products. The revenue from these levies could be reinvested in improving children's oral health.
5. Protect patients by introducing stronger regulation for cosmetic surgery
Current UK law allows any doctor – surgeon or otherwise – to perform cosmetic surgery in the private sector. There are many excellent surgeons working in the cosmetic surgery industry, but it is difficult for patients to identify these highly trained surgeons from those who should not be practising.
Since 2017, working with other surgical royal colleges, RCS England has run a voluntary certification scheme for cosmetic surgeons who meet certain standards of knowledge, training and professional behaviour. A key requirement for certification is being on the General Medical Council’s (GMC) specialist register. There is a resource on the RCS England website where patients considering cosmetic surgery can check if their surgeon has been certified.
RCS England is calling on the GMC to make the certification scheme a formal regulated credential to ensure that patients are safe in an industry that has been largely unregulated to date.
In addition, it is well documented in the media that UK residents are risking their lives travelling abroad for cosmetic surgery. While we cannot restrict patients from travelling abroad for surgery, there are deeply concerning reports of unscrupulous overseas medical professionals persuading UK residents to seek risky surgical procedures abroad during sales events held at UK hotels.
The next UK government must protect patients by introducing stronger regulation for cosmetic surgery. To do this it should:
- Set out an action plan for protecting patients from unregulated cosmetic surgery in the UK within the first year in government.
- Introduce legislation that closes the regulatory gaps around cosmetic surgery in the UK, including the loopholes which allow overseas-based medical professionals to come to the UK and improperly coerce UK patients to undergo cosmetic surgery abroad.
6. Invest in social care to take pressure off the NHS
Multiple governments have promised and then failed to deliver meaningful reform and funding to social care. The human cost of this inaction is devastating. A ‘healthcare cost lottery’ has emerged: patients diagnosed with cancer can expect the NHS to cover their care for free, but patients with Alzheimer’s disease might need to sell their home.
This is not just a “social care” problem but an NHS one. As The Times’ Health Commission set out, thousands of patients are stuck in hospital beds because there is no social care provision for them, and patients without the social care support they need are more likely to end up in A&E, further increasing pressure on the NHS.
While policymakers have responded to increases in delayed discharges through a series of piecemeal initiatives and funding increases, a longer-term approach is essential. Cross-sector calls for increased investment must be a top priority for the next UK government. The Health Foundation has calculated to meet future social care demand without any improvement in availability there would need to be an investment of £0.6bn by 2024/25 and £8.3bn by 2032/33 (3.4% a year real-terms increase). This is before taking into account the costs of improved access to care and to cover the full cost of care.
The next UK government must invest in social care to take pressure off the NHS. To do this it should commit to set out plans for reforming social care within its first year in office with delivery achieved by the end of the next Parliament.
1 BMA ‘Building the Future – Brick by Brick: The Case for Urgent Investment in Safe, Modern, and Sustainable Healthcare Estates’ December 2022
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