NHS Improvement’s recent report reveals the startling figure that an additional 280,000 non-emergency surgical procedures could be undertaken within the NHS in England, as a result of improved organisation of services.
The study reveals its headline figures are as a result of ‘avoidable’ lost time, equivalent to around 2 hours per day per theatre list. So what are the underlying causes to such wastage? How achievable is this uplift in activity? And, more importantly, what is the solution?
My overwhelming instinct is to raise caution. The public reaction to such headlines will immediately raise alarm and concern – and rightly so. However, as somebody who has played stakeholder on several aspects of this debate – as a patient, an NHS employee, a tax payer and as a healthcare improvement advisor – we need to more deeply understand the causes as well as the impacts in order to ensure a balanced and informed view.
This number is alarming and the subject highly emotive – 280,000 procedures. That’s 280,000 unwell or injured individuals, potentially suffering pain, discomfort or mobility challenges. Nobody would disagree with the importance of these people receiving the treatment they need as soon as possible. So why aren’t these procedures taking place?
NHS theatre scheduling can be a complex and challenging process. The wide coordination of operating theatre, Consultant Surgeon, and Anaesthetist is not straightforward. Especially so when factoring in the elective and emergency demand for theatre slots as well as the myriad of responsibilities within a clinician’s role: outpatient clinics, ward rounds, discharging patients, liaising with relatives and carers, and educational, supervisory and regulatory roles. Combine that with the need for a highly trained supporting theatre team and specialist surgical equipment, the scheduling becomes that bit more challenging.
Perhaps the single biggest operational challenge being faced by the NHS in England is that of increasing levels of hospital bed demand, leading to high bed occupancy levels, delayed transfers of care (DTOCs) and surgical cancellations. The premise being: if there is not a bed available for you once you leave theatre, the procedure will not go ahead. On safety alone, this makes good sense.
As every patient, condition and procedure are different (“we are not building widgets or cars here” is what I often hear) procedure length is not set in stone. Inevitably a margin of error should should be built into the schedule. So, some lists will overrun, and some will simply finish early. A relatively unavoidable loss of theatre time.
One must also account for the time taken to anaesthetise and prepare a patient prior to surgery, as well as the post-procedure anaesthesia and recovery. As such, a 30 minute procedure can reasonably consume an hour of theatre time. My point is not all ‘unused’ theatre time can be meaningfully utilised.
The scale of ‘avoidable’ lost time is highly significant in both its causes and impacts. The complexity of service demands, clinical rotas and staff shortages, combined with unpredictable patient condition deterioration, non-attendances and lack of bed availability lead me to believe that all 280,000 procedures quoted by NHS Improvement may be difficult – if not impossible – to realistically achieve.
However there are still big gains yet to be made here. The success that Unipart has shared with its healthcare clients shows that significant opportunity remains within theatre scheduling. Our tried and tested methods have been successfully deployed within many of our NHS clients. By deeply understanding existing processes (and difficulties) we engage with clinical and operational teams to devise a clear, simple and visualised theatre scheduling processes. Overlaying this with improved day-case services, benchmarking analyses and advice, along with embedding and implementing a truly sustainable, demonstrable and proven method of working, we can (and do) support NHS hospitals to make significant improvements to their theatre efficiencies. Not only does this improve the working lives for staff and clinicians, but offers a much more responsive patient service, while also saving agency/overtime staffing costs, reducing waiting lists and increasing elective surgical revenues.
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