Over the next five weeks we have a special op-ed series from our co-founder, Dr Andrew Stein. He writes about the five big changes the NHS needs to make not just to survive, but to soar. They are written in order of importance, but all five issues are interlinked, and need to be addressed together in order to meaningfully improve NHS systems.
1. Emergency and elective care
There are currently over six million people in the UK waiting for an operation or procedure, and we hear of A&E corridors full of patients waiting for beds all the time in the media.
In a large hospital, about 20 surgical and 10 orthopaedic emergency operations take place a day. But there will also be around 50 planned operations, with a large proportion of those being orthopaedic procedures such as hip replacements. Many of these end up being cancelled due to scheduling conflicts and emergencies.
At the moment, we’re mixing medical and surgical emergencies (like someone with pneumonia or appendicitis) with planned, elective surgeries (like having kidney stones removed). Hospitals must always prioritise the most vulnerable patients in order to save lives, so these emergency patients are admitted and elective surgery is cancelled.
Without separating these two types of operations, we can’t tackle NHS waiting lists.
Solution: split emergency and elective care
During the COVID-19 pandemic, we learnt that private hospital buildings could be used to carry out NHS elective surgery near acute hospitals. This model could be implemented in new or refurbished hospitals, so that elective surgery is carried out in a different building. Private operators can efficiently run these surgical treatment centres, or ‘hubs’ as they’re sometimes called.
Hospitals should be designed to have two different NHS buildings side by side – one acute hospital, and a surgical treatment centre. In the meantime, private hospitals in the UK (and abroad) could provide significant beds, while the buildings in current acute hospital sites can be separated to facilitate this change. Patient care would still be free at the point of access as in the NHS currently, but be delivered by private operators. This is a politically delicate area, however it should be noted that many NHS services are already delivered by private companies on a contract basis, for example many dentists and opticians.
The proposed public and private hubs would not be required to compromise beds for emergencies, resulting in fewer cancelled operations and working through the waiting list backlog.
An example of a high-volume elective surgery centre is the South West London Elective Orthopaedic Hospital, or SWLEOC for short. It is linked to Epsom Hospital (an acute general hospital), but performs only elective orthopaedic operations. Efficiency is increased and more patients undergo procedures due to time and cost saving features. One of these features is that surgeons will generally perform only one type of operation per day, and operating theatres can be set up in the same way from patient to patient.
In the future, the only operations happening at acute hospitals should be emergencies, and high risk elective ones where an ICU bed is predicted to be required post-operation.
Part 2 on its way.
As always, best wishes from myHSN!
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