Surgeons call for ring-fenced beds to avoid ‘tsunami of cancellations’ during second COVID wave

Leading surgeons today (Tuesday) called for hospital beds to be ring-fenced for planned operations, to avoid a ‘tsunami of cancellations’ during the second wave of COVID-19.

• Read the summary of findings and download the full report

The demand comes as the Royal College of Surgeons of England publish new data showing that the NHS has been unable to meet its target of returning surgery to 80% capacity by the end of September.  The service set an objective in July to return to 90% capacity by the end of October, but RCS England’s findings show efforts to meet the target falling behind.

In a survey of nearly 1,000 surgeons, the College finds that:

• Only 14% of surgeons can treat the same number of patients in a session as pre-COVID.Most report that where they might have treated four patients in a session, the number would now be only two or three.
• Nearly half (48%) said they need access to more theatres and facilities to avoid surgical “down time” during deep cleaning, with many citing the need for more ring-fenced surgical beds.
• Four in ten (39%) respondents in England said that elective activity levels were running at less than 50% of those achieved last year, and nearly half (48%) reported that elective activity levels were between 50% and 80% of those seen in 2019.
• Two thirds (65%) of respondents in England did not think it was realistic for their Trust to meet the 80% target. Just a quarter (26%) thought it could be achieved.
• Treatment rates are particularly low in trauma and orthopaedics – where operations to repair or replace hips, knees and other joints take place – with three in five (58%) T&O surgeons saying activity has fallen below 50% of the norm.

Planned surgery for everything from knee operations to replacement heart valves was put on hold in March, to free up NHS capacity for COVID patients.  The NHS asked hospitals to start surgery again beginning in mid-June but professionals cite multiple barriers, including a lack of access to fast-testing for patients, a lack of staff, and a lack of critical care beds.

• 22% are unable to access “COVID-light” hubs, which keep surgical patients safe and separate from COVID patients.Access is a particular problem in Wales, Northern Ireland and the North East.
• 59% say their Trust or Health Board is not routinely testing asymptomatic staff, to keep COVID off surgical wards

For the first time, more than two million people in England have been waiting longer than 18 weeks, with 83,000 waiting more than a year.  New NHS figures due to be released this week (Thursday) are expected to show the problem growing further still.

In a report published today, Protecting surgery through a second wave, RCS England calls for guaranteed access to fast COVID tests for surgical staff, to keep the virus off surgical wards.  In addition they say more ring-fenced “COVID-light” beds are needed, with more nursing staff assigned to surgery, and greater use of the independent sector to expand capacity. 

43% of the surgeons surveyed said there was spare capacity in the independent sector which could be used to treat NHS patients more quickly, if appropriate contracts were put in place.

Commenting, Professor Neil Mortensen, President of the Royal College of Surgeons of England said:

“Patients waiting for operations cannot be left behind indefinitely by the COVID crisis.  Many are in serious pain, with their conditions deteriorating while they are on the list. 

“As the virus becomes more prevalent again, there is a real risk of a tsunami of cancelled operations unless surgical beds are funded and protected.  That means building up theatre capacity and designating beds exclusively for those who need an operation.  These facilities must be kept “COVID-light” with a rigorous regime of testing for patients and staff.

“In addition to protecting surgical wards in the NHS, we need to see more capacity bought in from the independent sector, to help get through the backlog.  This is a national crisis requiring a truly national effort across all hospitals – private and NHS alike.

“Surgery is a team effort, requiring nursing staff and anaesthetists, who likewise must be allocated to getting through the backlog, rather than being diverted elsewhere. 

“Huge strides are being made to get surgery going despite major productivity constraints, but it is essential our recommendations are heeded to avoid a major setback.”

Practising surgeons from around the country gave the following testimonies in the RCS England survey:

“Lack of ring fenced surgical beds is the main limiting factor on restoring 90% elective surgical capacity. The bed base was reduced to maintain social distancing between medical patients and this has had a significant impact on restoring elective surgical capacity.”

Consultant, Urology, East of England

“Resilient COVID-protected sites are needed to provide at least 90% of last year's activity through the winter or a second spike. If not the waiting list will become unmanageable.”

Consultant, General Surgery, London

“The complete cessation of normal NHS activity in the first wave must not be repeated – there has to be ring-fencing of non-COVID activity in future waves.”

Consultant, Cardiothoracic Surgery, West Midlands

“While every effort to increase the provision of surgical services is being made it is important to recognise this will only be possible with a parallel increase in staff from the entire Multidisciplinary Team. Increased theatre capacity will not be sufficient without additional theatre support staff, recovery space and nurses, ward staff and hospital capacity.”

Clinical Practitioner, General Surgery, South East

ENDS

Notes to editors

1. On 29 April, Sir Simon Stevens wrote to all NHS Trusts saying that over the following six weeks they should “ensure that urgent and time-critical surgery and non-surgical procedures can be provided at pre-Covid19 levels of capacity.”
2. In July, Sir Simon Stevens wrote to all NHS Trusts saying “Having carefully tested the feasible degree of ambition with a number of trusts and systems in recent weeks, trusts and systems are now expected to re-establish (and where necessary redesign) services to deliver through their own local NHS (non-independent sector) capacity…, in September at least 80% of their last year’s activity for both overnight electives and for outpatient/daycase procedures, rising to 90% in October.”
3. Survey fieldwork ran from 10 September 2020 to 21 September 2020. The survey received responses from 970 surgeons and surgical trainees.
4. The full report, Protecting surgery through a second wave, recommendations and results from the survey is attached, under embargo until 00.01 Tuesday 6th October 2020
5. The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance surgical standards and improve patient care.
6. For more information, please contact the RCS Press Office: telephone: 0207 869 6047/6052; or email: pressoffice@rcseng.ac.uk.  For out-of-hours media enquiries, please telephone: 0207 869 6056.