Surgery

When is elective surgery likely to be reinstated in NHS hospitals?

There is no hard and fast answer to this question, as there are still many things to take into consideration. After lockdown at the end of March, it was believed that the COVID 19 virus outbreak would be controlled, but unfortunately, it became a far worse epidemic than the UK ever anticipated.

 

Health trusts and authorities are still reticent to give an exact date, but many are aspiring to recommence prior to the end of May or early June. Understandably, hospitals are paying due care and attention to prioritising patients who have opted for elective surgery, whilst still being mindful of a possible second surge of Coronavirus. The anticipated ‘wait’ for non-essential surgery, could well be a long one, with increasing NHS lists for orthopaedic surgery being one of the main areas hit by these delays.

 

Whilst many frontline staff at Nightingale units have been redeployed, many beds are still being set aside in case of a resurgence of the virus. Likewise, the bed capacity at private hospitals that was claimed by the NHS in case of a pandemic, is now at the centre of debate – private groups are pushing to have their beds back for paying patients, presumably because their revenue has been deeply affected, but more importantly out of concern for those that are in pain or struggling to cope with their condition. Whilst the infection rate has dropped in the last week or so and only 42% of beds earmarked for treatment of those who have the virus are being used, no snap decisions are currently being made. In a nutshell, it simply cannot be rushed along.

 

Sam Foster, Director of Nursing for the OUH Group who have 4 hospitals, said last week ‘Currently, OUH have no electives planned and patients will have to self isolate for 14 days prior to admission. Also, we are not carrying out any private work at this time. We are not sure when this will recommence, but every effort will be made to accommodate and carry out operations as soon as we feasibly can. All patients are our prime concern, and we will endeavour to treat them with our usual care and concern.’

 

Doctors and surgeons are worried that during the backlog, some conditions may deteriorate and what may have been simple surgery, could become more difficult, patients may suffer, and recovery period potentially much longer. Whilst the surgery is elective, that doesn’t stop patients’ conditions worsening. It is anticipated that no less than 8 million patients by August 2020 will be waiting for elective surgery – that is a long waiting list, and double the amount than at the same time last year. This will yet again put considerable pressure on the NHS to treat non-Covid patients as expeditiously and fairly as possible, a huge concern for both GP’s, surgeons and nursing staff.

The timing has to be right

The Royal College of Surgeons have laid out a blueprint as to the essential criteria for the resumption of elective surgery, in order for both staff and patients to feel confident about treatment and risk level.

 

-Consistent and sustained decrease in the number of Coronavirus cases

-Staffing – ensuring adequate pre-op and post operative care is maintained by trained personnel

-More than adequate stock and continuing availability of surgical supplies, including PPE equipment

-Availability of testing services for both staff and patients, even if it is thought that the peak of the virus has passed

-Strong links to external services that can provide back up where needed BEFORE commencing any elective surgery

-Resumption of elective surgery must be carefully monitored, to ensure patients care pathway is in full operation

-Methods of communication, whether virtual or between staff and patients, should be widened

-Planning should include specific patient prioritisation including those on ‘untreated’ waiting lists, and those on halted care pathways. This data should be constantly updated in order for staffing levels to be maintained and to relieve any potential pressure

-At grass roots level – theatre usage and clinicians time should be evaluated to ensure that safety is of paramount concern and administration is at a minimum but acceptable and accurate level

 

Whilst all these guidelines are extremely important and well thought out, can our care facilities cope with the surge of elective surgery admissions from now on? Will budgets allow both NHS and private hospitals to acquire experienced staff where needed? We hope so, but time will tell when everyone has already had a very tough six months, both patients and our care staff UK wide.

 

NHS England are giving the main guidance to hospitals throughout the country. If you are concerned with your treatment and when it will recommence, or whether you have postponed certain medications due to an upcoming operation, patients should consult with their GP. Patients will be informed by letter with the next feasible date for elective procedures, and may be asked to return for a pre-operative assessment.

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