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Planned operations: the wheels must keep spinning

05 Feb 2016

Mr Peter Prinsley

I’m an ENT Surgeon in the East of England. I see and treat patients with ear, nose, throat, head and neck conditions. I, along with my colleagues around the country have experienced first-hand the demand that is on our NHS and the impact this has had on the care that we can deliver to patients.  We are now seeing unprecedented cancellation of planned procedures across the country - much to the distress of patients and surgeons.  The cancellation of planned operations is driving up waiting lists and leaving us and theatre teams faced with having to tell patients that we are not able to operate today. This should not be the case when it is not due to clinical reasons.

Why is this happening? We haven’t got any beds to admit our planned surgical patients. Medical wards are too full as we are forced to move patients who have been admitted for emergency medical care onto the surgical wards when the medical wards are at capacity. We hear that A&E is overwhelmed with patients who should be seeing the GP or calling 111 but these are not the patients who are filling our beds. Our beds are filled with patients who are sick and need to be admitted, such as patients with pneumonia.  Hospitals of course need to ensure that all medical emergencies can still be dealt with, leaving planned procedures left out on the wing.

Where there’s a problem there’s an acronym -DTOC. Delayed transfer of care. Most days there are 100 DTOC patients  in our 500 bed hospital who could be discharged. It is estimated that up to 40% of wards are filled with patients who are now well enough to be discharged but the necessary arrangements for doing so are not in place. It’s not the patient’s fault. I’m sure they don’t want to stay in hospital longer than they need to. Our hospital just has intestinal obstruction.

Where are the rows of beds with crisp linen waiting for patients to fill them that I remember from my days as a student in the 1970s?  Instead we have rows of patients waiting to fill beds. The beds don’t cool down between occupants and our store rooms are converted for patients. Our hospitals are simply too small.

When an operation is cancelled we can be deployed to other activities such as running outpatient clinics but ultimately you wouldn’t expect a car factory to keep running if it can’t make cars in the same way that patients shouldn’t expect hospitals to run without planned operations.

Let’s change something. We need bigger hospitals, better systems of discharge, discrete and separate planned surgical departments and more day surgery. On top of this, we need an increased recruitment drive for community nurses to help ensure that patients have the necessary support when they are discharged. At the moment the arrangements for discharging patients into the community are insufficiently resourced. As surgeons we want the best outcomes for our patients. Primary, secondary and community care need to work better together so that the medical wheel can keep spinning and we are not forced to deliver the news to patients that another operation has had to be cancelled.

Mr. Peter Prinsley is a Consultant ENT surgeon working in the East of England. He is also a Director of Professional Affairs for the Royal College of Surgeons of England.

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