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A&E crisis: ‘It’s stressful and wrong to cancel surgery on the day’ | Norman Williams

It is vital that access to surgery must be provided when it benefits patients most, says the president of the Royal College of Surgeons

Record numbers of NHS elective operations are being cancelled for non-clinical reasons. Any form of surgery is an important event in one’s life. Patients having planned surgery prepare themselves for their operation and make arrangements with family and work, so to cancel them on the day, or just before, is wrong and deeply concerning to me and fellow surgeons.

So what is happening? The population is changing and patients are living longer because of advances in medicine and surgery. This is good news, but an ageing population means more patients with complex health needs, many with conditions that could be effectively treated by surgery. This results in more demand on planned and emergency services.

The first quarter of the year is traditionally busy, with higher numbers of emergency admissions due to the winter weather and the elderly and children tending to make up the lion’s share of patients. This is a situation made worse by targets for A&E admissions, which can result in inappropriate admissions as the target is only met once a patient has been discharged or admitted. Many emergency patients end up occupying hospital beds because there just isn’t sufficient provision to care for them in the community. We need to strengthen facilities in the community so that once patients have left hospital there are sufficient support services available to them.

In surgery we have no option but to cancel lists, because there are either no beds available, or those that are available are in the wrong units within the hospital. The 48 hours after an operation is a critical period. Patients must be able to access the right facilities after their operation – whether it be intensive care or access to specialist nursing – to give them the best chance of recovery following surgery. As a result, we are seeing operating lists and theatres lying idle despite the surgical team being ready to operate.

Cancelling operations is not only highly stressful and frustrating for patients and their families who have to wait longer for their treatment, but in some cases a patient’s condition could deteriorate during an extended wait. It is therefore vital that access to surgery must be provided at a time when patients can benefit most from the results. The past decade has seen real inroads made into reducing long waits for operations and it would be worrying if we now saw those waits lengthening again.

Professor Norman Williams is president of the Royal College of Surgeons

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