Surgical Hubs – Practical Solutions or Political Buzzwords?

31 October 2021

In July, the CBS blog focused on the myriad issues and knock-on effects surrounding the surgical backlog for patients, those in the surgical team and involved in providing peri- and postoperative care.

We are also mindful that the backlog further creates repercussions for other medics and individuals working in healthcare, as patients needing surgeries and facing delays are likely to need additional supports and monitoring. We are grateful to our colleagues for their support and understanding as we face these challenges, and manage the consequences of the surgical backlog, together.

At the beginning of September, NHS Providers and the NHS Confederation released a joint report, A Reckoning: The Continuing Cost of COVID-19, based on survey data from over 50% of the provider sector. In it, they stated that the pandemic had increased the cost of running frontline NHS services by ~£4-5bn annually, in addition to other key financial factors, for example, the need to fund capital investment and recover care backlogs. The report stated that these additional costs would remain for the duration of a three-year period that was expected to be covered by the Government’s Comprehensive Spending Review.

Further to this, the report stated an estimated £10bn of additional funding would be needed over the ensuing 12 months, to cover costs generated by the response to the pandemic, and to help manage the treatment backlog in England. The report calculated the continuing costs of COVID-19 as follows:

Between £4 and £5bn to cover extra costs driven by COVID;

Between £3.5 and £4.5bn to tackle treatment backlogs, spread over 3 years; and,

The shortfall in funding for NHS trusts, which have been unable to make the 1.1% efficiency savings set out in the existing 5-year NHS plan.

The report further highlighted that these funds would need to be additional to previous Government pledges to build 40 new hospitals and reform the social care system, as well as central funding for COVID vaccinations and the test and trace service.

Additionally, the report highlighted rising costs associated with supporting the wellbeing of staff 18 months into the pandemic, when many are facing burnout, working despite exhaustion and experiencing ever-more detriment to their wellbeing. These factors also play a significant role in NHS trusts being able to retain staff, and the report stated that in order to mitigate these effects and help to improve staff retention, 2/5 respondents saw these supportive measures needing to be in place beyond 2024/2025.

Two days before the formal release of the Autumn Budget and Spending Review, the Government pledged £5.9bn to the NHS in England to help clear the backlog of people waiting for tests and scans, and to purchase new equipment and improve IT issues.

Whilst the additional resources have been welcomed after years of austerity and cuts, there are valid criticisms: many have pointed out that diagnostics are only useful if there are qualified medical professionals available to analyse and act on the data – and indeed, that getting patients’ diagnostics relies on timely referrals from primary and secondary care.

Likewise, surgical hubs are not in and of themselves a panacea to the problems posed by the surgical backlog and staff shortages, which currently stand at over 90,000 vacancies in NHS England. According to the Royal College of Anaesthetists, the UK is currently 1,400 anaesthetists short with 1 in 10 positions vacant, and it is estimated that it could take up to 2 years for enough doctors to complete training to build up the workforce numbers in operating theatres. Without HDU, ICU and medical staff providing peri- and postoperative care, surgical hubs on their own are unlikely to present long-lasting change, and some have stated that this may be spreading resources more thinly, and require the innovation and adoption of new models – putting additional pressures on overworked frontline medics.

Others have raised questions and concerns at the idea of private ‘angel investors’ funding these hubs, and a lack of discussion over how these budgets will factor in transportation support for patients and overnight accommodation for relatives. Whilst the option to travel further away to be seen faster may appeal to many patients and their families, it also presents barriers to access for those with limited incomes or mobility.

In May, the Royal College of Surgeons of England called for a ‘New Deal on Surgery,’ proposing the adoption of the surgical hub model to be implemented across England for appropriate specialties, to help reduce elective waiting times and ensure patients could be treated safely during the COVID-19 pandemic as well as to prepare for possible future pandemics - but this proposition stressed the importance of a long-term plan.

According to RCS President Professor Neil Mortenson,

“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.”

In the coming days and weeks, we expect more concrete information to be disseminated, but in the meantime, it must be said that there is a sentiment being expressed by many in the UK surgical workforce: that building new theatres offers only a partial, short-term solution. Without a clear plan on how to address staffing and how these surgical hubs will run practically, the question on many minds is whether the Government has simply presented a false sense of reassurance and a stopgap approach.

As always, we invite you to share your views and comments to our social media platforms @UKsurgeons; and encourage you to spread the word about CBS to encourage awareness and membership to your colleagues.

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