A&E crisis: surge in cancelled operations

Doctors raise alarm as surgery is hit, after figures show cancellations have reached a 10-year high

More planned operations were cancelled in the first few months of this year than for any similar period in almost a decade, it has been revealed, as senior surgeons warn that the crisis in accident and emergency is cascading through the NHS.

More than 220 operations a day were cancelled with less than 24 hours’ notice during the first three months of 2013, official figures show. A similar scale of cancellations of elective surgery has not been seen since 2004-5. NHS England figures further reveal that the proportion of those patients not treated within 28 days of being turned away from operating tables has crept up to 5.6% – a four-year high.

The number of urgent operations cancelled every month has also doubled under the coalition, from 172 in August 2010 to 401 in April this year.

The Royal College of Surgeons (RCS) warns that the crisis in accident and emergency wards is creating chaos across the overstretched health service, with surgeons “up and down the country” registering fears for their patients.

One surgeon took to Twitter to voice his frustration. Mark Cheetham, a colo- rectal and general surgeon at Shrewsbury and Telford hospital, where cancellations have increased by 127% in the last three years, wrote: “The hospital is full with patients admitted as emergencies. Planned surgery is cancelled. It is very frustrating. I haven’t done a day list for three months now.”

A&E departments have struggled to cope with an influx of an additional 4 million people a year compared with just a few years ago, with trusts across the country failing to meet performance targets to see patients within four hours.

Surgeons say that, as a result, hospital beds are being monopolised by patients attending emergency departments, creating a dangerous logjam in the system.

In the past year, 63,517 elective operations were cancelled on the day of the surgery or on the patient’s admission to hospital.

Writing in the Observer, Professor Norman Williams, president of the RCS, says that operating theatres are being left idle because there are not enough beds available for post-operative care. He writes: “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.”

Scarlett McNally, a consultant orthopaedic surgeon, and council member of the RCS, said: “Many surgeons up and down the country are talking about it and worried about it.

“The problem is that if you don’t have a bed to put someone into after an operation then it has to be cancelled. The problem is that all beds, in all the acute hospitals, are full pretty much. The system is now overstretched. I know managers and admissions officers running around desperately trying to find beds anywhere.”

Clare Marx, consultant orthopaedic surgeon, and lead spokesman on patient safety at the RCS, said that change was needed to address the deteriorating situation, which was multiplying the risks to patient safety.

Figures obtained by Labour MP Gareth Thomas also suggests the growth of a postcode lottery, with a 32% increase in the number of planned operations being cancelled in hospitals in the north-west in the past three years. The West Midlands has seen a 20% increase in last-minute cancellations, compared with a national rise of 9% over the same period.

Health secretary Jeremy Hunt has accused Labour of causing the crisis by allowing GPs to opt out of offering out-of-hours care in 2005.

However, Labour claims that a failure by the coalition to provide social care for the elderly and frail is pushing them into A&E. Andy Burnham, the shadow health secretary, announced on Saturday that Labour would spend £1.2bn not allocated by the Department of Health last year, focusing on emergency aid to the country’s ailing system of social care.

“For older people this could make a huge difference by enabling them to stay in their own homes for longer and providing the support they need to return home after hospital,” he said.

“For example, it could allow for an extra 70 million hours of home care across England over the next two years, or provide home care for an extra 65,000 older people each year.”

A spokesman for the Department of Health said: “We need to put these figures in the context of the millions of operations performed by our NHS each year. Our NHS is performing well, with more operations carried out last year than ever before, and only 0.9% of all NHS operations being cancelled.

“However, we expect hospitals and local NHS managers to keep the number of cancelled operations to an absolute minimum. Where this is unavoidable, patients should receive treatment as soon as possible.

“Our focus on better community care for the frail elderly, and creating a more joined-up health and social care system, will help to reduce unplanned hospital admissions and ensure that patients are discharged in a more timely way, which will free up beds for other patients.”

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