How can the NHS safely clear the surgical backlog?

It is reported that around 5 million people are now waiting for routine operations and procedures in England. Nearly 388,000 people have been waiting more than a year for non-urgent surgery compared with just 1,600 before the pandemic began. Among them are nearly 100,000 patients waiting for major operations such as hip and knee replacements, whose operations were cancelled during the early stages of the coronavirus pandemic. Many of these people will have been struggling with work and daily activities because of severe pain and limited mobility for at least 1-2 years now.

The Royal College of Surgeons has called for 42 Specialist surgical hubs to be established in England to tackle the huge backlog of what are deemed to be ‘non-urgent’ procedures. The body said such hubs should be developed and ring fenced so as to protect surgical patients from Covid patients. They have asked for an additional £1 billion per year for the next 5 years to clear the backlog in a controlled and safe manner and clearly they and their members will know what it best for patients and I would say that their demands should be agreed to.

The question remains as to how the backlog can be cleared whilst maintaining high standards. Hip and knee surgery remains extremely safe and incredibly beneficially for the vast majority of NHS patients and the government must avoid pressurising the NHS to cut corners on this.

Several years ago a waiting initiative was attempted for Welsh orthopaedic patients who were offered surgery over the border in Weston Super Mare. A team of Scandinavian surgeons were brought into the UK to reduce NHS waiting times for such Welsh orthopaedic operations.

At the time, Welsh hand consultant David Shewring sent letters to his patients claiming that overseas doctors employed by Weston Area Health Trust (WAHT) may not have been skilled enough to carry out operations. He was criticised by various groups at the time for making such comments.

However, his views were vindicated when it later emerged that more than one third of patients operated on by Scandinavian surgeons in Weston General Hospital had an unsatisfactory result. An audit of 224 patients undergoing knee surgery between 2004 and 2006 and published in the Daily Telegraph newspaper, found that one in three suffered a poor outcome and one in five cases were so bad that another operation was needed.

This was clearly a counter productive exercise and costly in terms of the impact on the patients’ lives and in terms of litigation. This type of organisational failure must be avoided in the coming months. NHS surgeons must be funded properly so that the backlog can be safely cleared as quickly as possible.

The hidden socio economic impact of delayed surgery has been overlooked for some time now and a real effort must now be made to tackle this in the manner proposed by the RCS.