Report: Protecting surgery through a second wave
Restoring elective services in the context of COVID-19 represents one of the most complex challenges that the NHS has ever faced. Following the suspension of non-urgent elective procedures earlier in the pandemic, planned surgery is now re-starting again in many parts of the country thanks to the extraordinary hard work and dedication of surgeons, their teams and colleagues across the health service. Our survey of 970 surgeons working in hospitals across the UK highlights the challenges that persist.
- Funding for ring-fenced ‘COVID-light’ surgical beds in every region
- Guarantee access to speedy COVID tests for surgical teams, to keep surgery safe
- Use of the independent sector to provide ‘COVID-light’ sites must be maximised, not as an alternative to, but in addition to NHS hospitals
- Ensure the equitable allocation of nursing staff, theatre staff and anaesthetic staff, to support the continuation of surgery through the winter
- Every opportunity must be taken to support surgical trainees to gain experience and training time and complete their training
Summary of findings
1. Restoring elective activity
- In total 93% of surgeons reported that it had been possible to undertake elective procedures in the previous four weeks – 15% said this had only been possible in some specialties.
- In England, two-thirds (65%) of respondents did not think their trust would reach NHS England’s target of restoring 80% of last year’s elective activity levels by the end of September.
- 39% of respondents in England said elective activity was running at less than 50% of the levels seen in 2019, and 48% said that activity levels were between 50% and 80% of last year’s.
- 69% of surgeons highlighted a lack of theatre capacity as a significant barrier to resuming planned procedures, and 53% pointed to a lack of staff. The need for more routine and ward beds was proactively highlighted by a number of surgeons.
- When asked what single measure would help them see more patients, nearly half (48%) of surgeons said that more theatres and facilities were needed to reduce the ‘downtime’ necessary for deep cleaning.
2. COVID-light sites
- 63% of surgeons reported that they were able to access COVID-light sites for their patients – this is very similar to the figure recorded in our previous survey in June (62%).
- Just 9% of surgeons said that COVID-light sites are only available to cancer patients, compared to 24% in June.
3. Testing and PPE
- Half of surgeons (50%) said that they could access COVID-19 test results for surgical patients within 24 hours, an improvement from 41% in June.
- 40% of surgeons said they could get test results for a member of the surgical team within 24 hours. However, over a quarter (27%) indicated that it took at least 48 hours to get results for staff, which could lead to them having to take time off work to self-isolate.
- The majority (59%) of surgeons said that asymptomatic staff are not being tested in their workplace.
- 11% of surgeons did not feel that there was an adequate supply of PPE in their workplace, and 18% expressed concerns that the PPE they had been provided with was not appropriately fit tested.
4. Independent sector
- The majority (58%) of surgeons said that they were able to access NHS capacity in the independent sector, with a quarter (27%) reporting that they were unable to do so.
- 43% of surgeons thought that there were independent sector facilities that are not currently being used for NHS patients, which could help tackle the backlog of elective procedures if appropriate contracts were put in place.
5. Surgical training
- 46% of surgeons said that surgical training has resumed having previously been suspended due to the pandemic, and a further 41% said training had never stopped. Just 8% of surgeons report that surgical training has yet to resume.
- Two-thirds (67%) of surgeons indicated that a lack of elective activity meant that there were fewer opportunities for training.
6. Devolved nations
- Responses from the devolved nations indicate that access to COVID-light sites represents a particular challenge – the proportion of surgeons who said they were unable to access such facilities was high in Wales, Scotland and Northern Ireland.