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Analysis shows more surgical hubs needed to meet waiting list recovery targets

11 Jul 2022

In a new joint report with The Strategy Unit, The Case for Surgical Hubs, the Royal College of Surgeons of England makes seven recommendations to government to support surgical hubs and help tackle the record NHS waiting list.

New analysis of NHS data shows the full impact of COVID on planned surgery over the last two years. During COVID, surgical activity levels reduced at more than four times the rate we see in a typical winter [1].

Before the pandemic, the NHS typically reduced planned surgery in winter to respond to emergency pressures, with the intention to ‘catch up’ over the year. But with ‘winter pressures’ now seen year-round, there is no opportunity for the NHS to catch up with the growing waiting list. The ‘winter trade-off’ model is no longer appropriate. 

In the first twelve months of the pandemic, levels of orthopaedic surgery were 59% lower than would normally be the case.

Substantial reductions were also seen in the three other largest surgical specialties:

  • General surgery reduced by 41%
  • Ear, nose, and throat activity was down 58%
  • Urology surgical activity reduced by 40%

To get through the record waiting list of 6.48 million, the NHS will have to achieve higher levels of activity than in the pre-COVID years.  The target is to achieve 30% more by 2024/25, but ongoing emergency pressures are hindering these efforts.

Last year the Royal College of Surgeons of England recommended every region create ‘surgical hubs’, where winter pressures are less likely to disrupt planned surgery. The government’s Elective Recovery Plan agreed with this approach, and in the autumn, announced £1.5bn of new funding to increase elective capacity and establish surgical hubs.

‘The Case for Surgical Hubs’ recommends the government also looks at where surgical hubs feature in the New Hospital Programme, and works with ICS’ to identify under-served parts of the country. 

Our research has identified three different types of surgical hub:

1. Stand-alone hub - a site away from the hospital, undertaking less complex surgery

2. Hub within a hospital or integrated hub - ring-fenced area within a hospital

3. Specialist surgical hub - stand-alone hospital providing specialist surgery

The report includes case studies of surgical hubs already up and running, that have succeeded in reducing or eliminating long waits for surgery. We recommend formal designation of hubs, to support their evaluation. We note it is vital that surgical hubs have truly protected, ring-fenced resource, if they are to have a chance to prove their worth.


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

“Policy makers asked for clarity on what surgical hubs should look like. Today we answer their questions by explaining the three models of surgical hubs our research has identified.  As ever, we found that surgical teams have innovated, and established new ways of doing things. Surgical hubs have helped services to recover and have eliminated or reduced the longest waits of over two years. 


“Recovering services in the wake of COVID was a hard task. One surgeon described it as ‘wading through treacle’. But with funding and support, surgeons are getting things moving now.  We urge government to work with ICS’ to address regional gaps in surgical provision, and to use the New Hospital Programme and elective recovery funding to establish hubs in areas that need them.”


Peter Spilsbury, Director of The Strategy Unit, added:

“Levels of elective surgery reduced substantially during the pandemic.  The NHS is working hard to recover lost ground, but waiting lists have reached record levels and are set to increase further.  The way the NHS organises its services may need to change if we are to get back on track. 

“In the past, elective surgery was often scaled back in the winter so that hospitals had capacity to deal with emergency patients.  We need to consider whether this model is still appropriate.  Surgical hubs are an important innovation that may help the NHS to deliver care to more people, all year round.  But as with all innovations, it is important they are carefully evaluated.  Surgical hubs should be given a chance to prove their worth.”


[1] As illustrated in Chart 3, p6 in ‘The Case for Surgical Hubs’.  Data tables available on request.

Notes to editors

  1. The Strategy Unit is a team of NHS staff that provides specialist support to health and care organisations and systems.  The support takes the form of data science and computer modelling, qualitative research, evidence review, evaluation, problem structuring and strategy development.  The Strategy Unit is hosted by NHS Midlands and Lancashire Commissioning Support Unit.

  2. The Royal College of Surgeons of England (RCS England) is a professional membership organisation and registered charity. The College provides world-class education, assessment and development to more than 28,000 surgeons, dental professionals and members of the wider surgical and dental care teams, at all stages of their career. The College sets professional standards, facilitates research and champions the best outcomes for patients – with a vision to see excellent surgical care for everyone.

  3. For more information, please contact the Press Office:

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