Demands from NHS England to reduce bed capacity has not prepared hospital systems for predictable winter pressures, writes Angus Wallace

An NHS Improvement letter, dated 9 December, and sent on behalf of chief executive Jim Mackey, has recommended that most elective operating lists in NHS hospitals in England planned from 19 December to 16 January should be rescheduled and these operations should be postponed to ensure that beds are available for winter pressures.

This recommendation will result in:-

  • a huge disappointment for the many NHS patients who have been allocated an operation date for their long-awaited operation
  • conversion of most of our NHS hospitals into even more inefficient NHS hospitals by withdrawing one of the NHS’s most valuable “production lines”
  • an underutilization of expensive NHS plant – the operating theatres
  • an under-employment of operating theatre nurses, surgeons, anaesthetists and others whose skills are not necessarily those which would benefit elderly frail patients with pneumonia, cardiac failure and multiple co-morbidities.
  • a significant increase in the Referral to Treatment Time (RTT) of all NHS surgical patients in England
  • a further three week backlog of surgery which we must battle with over the first six months of 2017

Operating theatre costs

Our operating theatres are the most expensive “plant” within our hospitals and if we are to run an efficient NHS, there is no logic behind closing them down for almost four weeks.

The advice to cancel elective surgery is therefore going to increase further the current financial deficits experienced by most NHS hospitals.

In fact, the worst period for winter pressures is probably the four weeks from 16 January 2017 onwards, so will we be asked to close down elective surgery for a further four weeks in the future?

Our operating theatres are costly to run when they are fully utilized - ”running costs for an operating theatre average approximately £1,200 per hour. Therefore, the greatest efficiency gains in most acute trusts can be achieved through improved session utilisation”.

It has been estimated that the actual cost of running an empty operating theatre is £500 per hour to cover the plant maintenance, staff allocation to the empty theatres and pre-preparation for future operating lists.

The advice to cancel elective surgery is therefore going to increase further the current financial deficits experienced by most NHS hospitals.

Winter pressures

This crisis has occurred because of “winter pressures”. These winter pressures should not come as a surprise, they are totally predictable and indeed they occur every year.

Unfortunately, our hospital systems have not been developed to absorb these pressures, partly because of the pressure from NHS England to reduce bed capacity in most hospitals in the country to save money.

Our operating theatres are the most expensive “plant” within our hospitals and if we are to run an efficient NHS, there is no logic behind closing them down for almost four weeks

Some hospitals, like the Royal Derby Hospital, have planned in advance for winter pressures and have created a virtual bed system which allows them to decant patients from their hospital beds in a more efficient way thus avoiding cancelling elective operating capacity.

Ironically even in Northumbria (previously run by Jim Mackey) where they have created a stand- alone Acute Specialist Emergency Care Hospital with parallel, but physically separate elective units in other hospitals, elective surgical operations have also been reduced.

Stress tests

NHS Improvement should now consider the development and introduction of ’winter pressure stress tests’ in the same way as the Bank of England has introduced its bank stress tests which have been so successful in identifying banking problem this year.

These winter pressure stress tests would assess in advance the changes that need made to ensure elective operations are not cancelled during the winter months.

Our NHS cannot afford to close down elective operating for four weeks. Methods must be developed to accommodate these winter pressures and it is ironical that the letter that was circulated came from NHS Improvement which is actually promoting a deterioration in NHS services.

Angus Wallace is a consultant trauma and orthopaedic surgeon at Nottingham University Hospitals Trust