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Surgeons call for a ‘New Deal for Surgery’ to reduce the ‘colossal’ elective backlog 

28 May 2021

The Royal College of Surgeons of England has today called on the government to agree a ‘New Deal for Surgery’, commit an additional £1bn for surgery every year for the next five years and create ‘surgical hubs’ across the country to reduce the ‘colossal elective surgery backlog’.  

The College is urging every Integrated Care System (ICS) in England to identify at least one 'surgical hub' where planned surgery can continue safely if the country is hit again by COVID-19, a new variant or a severe seasonal flu/winter pressures.     

New opinion polling, undertaken by Savanta ComRes on behalf of the College, shows broad public support for the College’s proposals:  

Three quarters (78%) of UK adults agree that the government should continue to give the NHS £1 billion extra funding each year for the next 6 years to tackle long hospital waiting times.  

Approaching six in ten (58%) UK adults say that if they needed an operation, it would be important for them to be treated in a ‘surgical hub’ hospital – defined as a hospital which is not treating COVID-19 patients.  

Seven in ten (73%) UK adults say that if they needed an operation, they would be willing to travel to a surgical hub if it was not their nearest local hospital. 

The College’s New Deal report makes 12 recommendations to government, including both long and short-term measures designed to improve the future sustainability of surgical services.  The report details the devastating impact the COVID-19 pandemic has had on surgical services in England.  All elective (planned) surgery was cancelled in the first wave and many surgical teams were redeployed to help the NHS treat COVID-19 patients.  Latest figures show the largest ever recorded NHS waiting list in England of 4.95 million people, including over 400,000 (436, 127) waiting over a year.  

However, 2020 was not the first time that elective surgery has ground to a halt.  In the winter of 2018 all elective surgery was suspended for a month, when a spike in flu cases led to bed shortages. The suspension created a backlog of patients waiting for surgery. The NHS in England has not met the statutory 18-week waiting time target for planned hospital treatment for over five years. The pandemic has worsened the situation further, and now surgeons are calling for a long-term solution.   

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

“We need government support for a ‘New Deal for Surgery’ to reduce the colossal backlog in elective surgery and to help the NHS weather future pandemics.  Surgery must be available on the NHS all year-round, not stop and start. If a dangerous new variant of COVID-19 takes hold, or another bad flu arrives in the autumn, we cannot allow surgery to grind to a halt again or waiting lists will become insurmountable.”  

The ‘New Deal for Surgery’ report calls on the government to support adoption of the ‘surgical hub’ model across England for appropriate specialties, to help reduce elective waiting times and ensure surgical patients can be treated safely. During the pandemic, hospital trusts and surgeons provided ‘mutual aid’ at times of extreme pressure to ensure urgent surgery continued. Trusts also put agreements in place to designate certain hospitals as ‘surgical hubs’. These hubs have helped to expand capacity for specified types of elective procedures by bringing skills and resources together under one roof in COVID-secure environments.     

Professor Mortensen said: “The ‘surgical hub’ model is the best way we can keep treating people who need operations, regardless of future pandemics.  But it requires being open to doing things differently. Throughout the pandemic, staff have gone wherever they are most needed, working flexibly and collaboratively to put patients’ interests first. Our patients have adapted too, with many outpatient consultations happening virtually, by telephone or video. Now we need politicians to be open to change too. They must accept that the services available at their nearest hospital may not be the same as before. Their voters are willing to travel to a surgical hub for an operation, even if it is not the nearest local hospital. Today we are explaining why it’s key the government and MPs embrace change and commit to longer term investment in surgery.” 

The New Deal report also calls on the Government to adopt longer-term aims of increasing the number of hospital beds and doctors to reach the OECD average. This would involve expanding the number of hospital beds in England from 2.5 to 4.7 per 1,000 population. -and the number of hospital doctors (including surgeons) from 2.8 to 3.5 per 1,000 population.  

Professor Mortensen added: “The Chancellor of the Exchequer, Rishi Sunak, promised the NHS ‘whatever it needed’ to fight COVID-19. Looking ahead, sustained investment will be needed every year for the next 5 years at least, to bring waiting lists down. We need a ‘New Deal for Surgery’, to fund extra capacity in our hospitals and train the nurses, doctors and surgeons of the future.” 


Notes to editors

  1. Methodology: Savanta ComRes interviewed 2,203 UK adults online from 7th to 9th May 2021. Data were weighted to be demographically representative of UK adults. Savanta ComRes is a member of the British Polling Council and abides by its rules. 

  2. Media interviews with hospitals which have successfully re-started elective surgery through ‘mutual aid’ arrangements and establishing surgical hubs are available upon request.  

  3. Full, historical NHS England Consultant-led Referral to Treatment Waiting Times can be found here:  

  4. The Royal College of Surgeons of England is a professional membership organisation and registered charity, which exists to advance patient care. We support over 25,000 members in the UK and internationally by improving their skills and knowledge, facilitating research and developing policy and guidance.  

  5. For more information, please contact the Press Office: Tel. 0207 869 6052/6047; email: For out-of-hours media enquiries, please telephone: 0207 869 6056.  

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