Mass cancellations of NHS operations inevitable this winter, say doctors

Mass cancellations of routine operations in England are inevitable this autumn and winter despite an NHS edict that hospitals must not again disrupt normal care, doctors’ leaders have said.

Organisations representing frontline doctors, including the British Medical Association (BMA), also criticised NHS England for ordering hospitals to provide “near-normal” levels of non-Covid care in the second wave of the pandemic, and demanded that fines for failing to meet targets be scrapped.

Their intervention came as Nottingham University hospitals became the fourth trust in England to postpone non-urgent surgery after an influx of Covid-19 patients.

On Friday sources said hospitals in Rotherham, Doncaster and Barnsley were also cancelling “small numbers” of both elective operations and non-urgent outpatient appointments. “Things are very, very difficult at the moment, very challenging,” said one official in the South Yorkshire NHS. “It feels like a juggling act every day.

“The problem is both the growing numbers of patients coming into hospital with Covid and the numbers of staff we have off sick due to Covid, either because they are ill themselves or because someone in their household has symptoms, so they are isolating,” the official said.

NHS national leaders have decreed that normal care should continue amid growing evidence that widespread suspension of screening services, diagnostic testing and treatment in the spring left hundreds of thousands of patients unable to access care for cancer, heart disease and other serious illnesses. Knee and hip replacements, cataract surgery and other operations were cancelled.

As a result, some experts have estimated that tens of thousands of people could die prematurely of cancer alone. In June, the NHS waiting list was projected to hit 10m by the end of the year.

Three years ago, without a pandemic but faced with a winter health crisis including an intense strain of flu and bad weather, non-urgent surgery was postponed across the country.

Over the past week, coronavirus has led to the hospitalisation of nearly 1,000 people a day on average across the UK. The number of Covid patients treated in hospital in Liverpool surpassed the peak of the first wave.

The BMA, which represents about 70% of Britain’s 240,000 doctors, says hospitals have too few beds and staff to maintain surgery and diagnostic testing for non-Covid illness while the second wave is unfolding.

“While trusts did their best to reintroduce elective care after this first wave, many have now been forced to return to limited services to keep their heads above water as we work through the second, even more demanding peak of cases,” said Dr Rob Harwood, the chair of the BMA’s hospital consultants committee.

“As we approach winter, it’s likely that many trusts will have no choice but to continue to restrict their elective care services, which is incredibly worrying for both staff and patients, as backlogs increase and health conditions potentially worsen.”

He added: “We always knew that Covid was going to disrupt the health service, but years of underfunding meant we started on the back foot at the beginning of the pandemic and in some places it’s been impossible to keep to NHS’s plan of resuming elective care as figures picked up again. There simply aren’t enough staff or resources.”

Addressing NHS plans to fine hospitals if they do not undertake this month at least 90% of the planned operations they performed in October last year, Harwood added: “It’s clear that with Covid cases rising rapidly across the country this approach is not realistic and must be scrapped. Hospitals should not be penalised for having to make difficult decisions about cancelling elective procedures where they urgently need to divert resources to ensure Covid patients get the care they need.”

Dr Nick Scriven, the immediate past president of the Society for Acute Medicine, said: “I think this [trusts cancelling operations] is going to be inevitable across large areas of the health service as the pandemic and winter coincide. We know bed numbers are low compared with other countries and with the necessary infection control processes the ‘functioning’ of what we have is slowed down across the board.

“In a ‘normal’ winter, the NHS plans for less elective work, especially around Christmas and new year, and this is nothing like normal. If you add in the increasing difficulty of keeping ‘green’ areas [of hospitals] clear of Covid, having enough staff to cover the front door as well as elective areas and the ICU capacity issues, it will be extremely difficult to keep elective surgery running at anything above a low urgent/emergency procedures-only model.”

Scriven added: “I feel it is unrealistic to expect trusts across the country to meet the set elective targets in the current climate, especially in those areas already hit hardest in the north-west of England, where even today we see hospitals with more Covid patients than in the spring. I do hope the financial consequences of not hitting elective targets this autumn and winter are removed.”

The impact of Covid-19 on one of Northern Ireland’s largest hospitals led to warnings that trauma surgery may have to be rationed. Ronan McKeown, a Craigavon Area hospital consultant who treats patients with injuries from road collisions and domestic accidents, told the BBC: “As the capacity of the hospital diminishes that will influence what we can do and the services we may be able to offer the public.”

Tracy Taylor, the chief executive of the Nottingham trust, said it had made the difficult decision to postpone some non-urgent surgery and appointments until 2 November following a dramatic increase in the number of patients with Covid-19.

The trust has this week had more than 200 inpatients being treated for coronavirus. “This surge is now at levels similar to April and is combining with our normal winter emergency pressures. This is not a decision we have taken lightly, but we need to ensure we have the beds and staff available to care for those in urgent need during this surge of Covid-19,” Taylor added.

Bradford teaching hospitals trust on Tuesday suspended some non-urgent surgery and outpatient appointments with consultants for two weeks to help it cope with an influx of Covid patients that took its total of such cases to 100.

Prof Mel Pickup, the trust’s chief executive, said: “The surge is now at levels similar to the peak of the first wave in May. It [delaying surgery] is not a decision we have taken lightly, but we must create as much bed capacity and free up clinical staff within our hospitals to help us manage this surge in Covid-19 patients.”

The trust is sending some patients needing surgery and investigations to private hospitals in Yorkshire to help ensure at least some of them get treated.

NHS England was approached for comment.