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The Darzi Debate - Seven Day Surgery

05 March 2024

Lord Darzi's recent statement challenged elective surgery hours in the NHS, suggesting that operating theatres could run more efficiently by adopting a British Airways model of working. His declaration, ‘BA doesn’t ground planes at weekends,’ caused a lively debate on our social media[1] around the feasibility and implications of a seven-day operating week.

Points raised include that Lord Darzi’s call for weekend operations fails to recognise that NHS surgery goes beyond the operation itself. For this model to work, seven-day staffing must be implemented across all aspects of healthcare, including lab work, physiotherapy, and X-rays. The healthcare infrastructure must change to function seamlessly on weekends, with no difference in services and staffing compared to weekdays.

Former president of the Royal College of Surgeons, Neil Mortensen, points out the shortfalls of Lord Darzi’s proposal, which highlights the issues raised on our social media post. “We have highly trained surgeons,” says Mortensen. “We don’t have enough theatre capacity.” We agree that a shift to a seven-day working week is more complex than surgeons scrubbing in on a Saturday morning; it requires significant investment from the Government. CBS Executive Board Member, Peter Sedman, says:

“This is an interesting, and previously explored, idea, which has innumerable barriers. To date, these barriers have been beyond the financial constraints of the NHS. We support every initiative to produce sustainable productivity in the NHS, and to improve and increase the level of operations delivered, but this is more likely to be achieved by increased productivity than by recycled concepts which must later be abandoned due to the cost and complexities of implementation. To address the comparison of surgeons with pilots, we must recognise that individual surgeons cannot work seven days a week, and neither do pilots. Most surgeons are contracted to work 48-hour weeks; we cannot demand they do more, nor would we demand or expect a pilot to do the same.”

There is no rational reason why Lord Darzi has compared the work of a surgeon to the work of a pilot. Could we compare the House of Commons or House of Lords in a similar way, and ask that they sit at weekends to solve the country’s problems?

Furthermore, considering surgeon wellbeing is crucial, and overlooked in this scenario. We doubt any patient would want a burnt-out, stressed surgeon operating on them, regardless of the day of the week. Family time and days off are vital considerations that would need to be addressed prior to the consideration of any new working model.

While the concept of continuous patient care is appealing in theory, Lord Darzi should have further considered the practicalities of implementing seven-day surgery. Likening it to British Airways in itself raises concerns. Yet expanding on that analogy, just as British Airways insists on a full flight crew for safety reasons, the NHS must  guarantee sufficient staffing and resources in order to fundamentally change the working model of elective surgery.

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