Bed shortages causing dangerous surgery delays, report finds

A report into cranial neurosurgery showed bed shortages had seen only eight of England’s 24 providers hitting the elective waiting time target, with another third with a performance of less than 60 per cent.

The latest report from the Getting It Right First Time programme found surgical teams were frustrated by the high number of delays and subsequent cancellations in the speciality.

Issues included admissions before the day of surgery and significant delays in discharging patients, often because district general hospitals would not accept transfers once a patient had been treated.

This can mean patients who need urgent treatment miss the two-day target.

The report said 10 per cent of patients with a subarachnoid haemorrhage waited longer than this, with increased risk of death or brain damage.

The report said coroners had issued a number of prevention of future deaths reports on the subject.

HSJ reported last February that NHS England chief executive Simon Stevens had been warned about two deaths caused by a lack of intensive care unit beds, one case in the East Midlands, the other in the south east.

A third of providers took at least two days in more than 10 per cent of cases, the report said.

Cranial neurosurgery is provided from 24 different centres in England, 22 which are co-located with trauma centres. They undertake roughly 75,000 procedures a year, 54 per cent of which are elective.

The GIRFT team found that six trusts saw 10 per cent or more cancellations from their elective list.

Outcomes data showed there was no difference between patients discharged quickly after a procedure and those who stayed in a bed for a significant period afterwards.

The report made recommendations on managing bed base and referrals and said one provider treated only five per cent of elective patients on the day they were admitted – compared to two trusts that managed 90 per cent on the day. The 10,000 pre-operative bed days across England cost almost £4m a year.

Consultant neurosurgeon Nick Phillips, who led the review, said the recommended changes: “Might only make a small difference to the number of patients a cranial neurosurgery team can treat.

“Together, however, freeing up just one extra bed, per trust, per day, would allow thousands more patients to receive the care of cranial neurosurgeons each year without any increase in resource.”

The report also said trusts could save 15 per cent from their £50m combined spend on medical devices used in the specialism.

It said for some products there were “50 different brands used across trusts and no clear understanding of which represent the best value for money. In other product groups such as neuro stents and stimulators there is limited competition with markets dominated by two or three major international suppliers.”

Mr Phillips added that brain cancer survival rates had doubled over the past 40 years.

Other recommendations included increasing day-cases, ”greater use of non-consultant and non face-to-face outpatient appointments” and providing treatment for ”extremely rare conditions, such as rare tumours (for example, chordoma)” at regional centres.”

Trusts have been issued their own individualised recommendations which NHS Improvement expects to be implemented by this time next year.