Exclusive: NHS prepares to cancel elective ops in readiness for covid-19 surge

Senior sources told HSJ NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity.

HSJ understands trusts have been told to firm up their plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life saving” procedures such as cancer treatment.

An announcement is expected soon, with patients affected given at least 48 hours notice. It has not been decided how long it might last for, as the duration of any surge in cases and acute demand is unknown. But HSJ has been told it could stretch out for several months, with three or four months discussed, which would potentially mean tens of or even hundreds of thousands of cancelled operations.

The move is part of range of measures system leaders are set to roll out, which also include tightening up admission thresholds, in a bid to free up as much capacity as possible.

The Royal College of Surgeons however cautioned against a blanket elective ban. The influential college said, as in previous winters when a lot of electives have been postponed, “where local resources allow, planned operations should continue”.

The last time there was a major national moratorium on non-emergency electives was in January 2018. It lasted around eight weeks. At the time system leaders estimated around 50,000 operations would be cancelled per month, although the final figure was not that high.

Leading waiting list expert Rob Findlay told HSJ the overall elective waiting list, which at present is around 4.6 million, would likely further deteriorate, but the hardest impact would be felt by the longest waiters.

He said: “It will certainly accelerate the already deteriorating position on 18-week waits, but the effect may be most striking in the rise in 52-week waiters.

“This is because these patients tend to be in the heaviest case mix, like the more serious end of orthopedics, plastic surgery, or neurosurgery, which require in-patient procedures, rather than day cases.

“This means those patients who are already suffering the most extreme long waits are likely to be most impacted by any suspensions.”

Royal College of Surgeons of England president Derek Alderson said: “The situation is rapidly evolving and we receive regular briefings from the chief medical officer.

“However, based on today’s figures, it would be premature for Trusts to introduce blanket bans on planned operations. We learnt from recent winters that where local resources allow, planned operations should continue.

“As we make plans for the worst case scenario, we are committed to making sure that urgent surgery for life-threatening situations can continue to be provided alongside caring for Coronavirus patients.

“Finding the extra capacity needed is no small task, but we are confident surgeons and our colleagues across the health service will pull out all the stops to protect patients, whatever their needs.”

HSJ revealed yesterday that NHSE’s coronavirus incident director told senior figures that hospitals should plan for a massive increase in critical care capacity — potentially up to seven-fold, according to those present. He later insisted he said “several fold”, not “seven fold”.

NHS Providers chief executive Chris Hopson last night said trusts were already preparing to make cancellations.

Mr Hopson told BBC’s Newsnight yesterday: “[We have not cancelled elective work] because we don’t need to at this point, but we are preparing to do so.

“If you stopped doing elective surgery, you could convert theatres, you could convert resuscitation rooms, recovery areas into places where you could provide intensive care.”

He said the system could double intensive care capacity “relatively easily”, but “we are now talking actually about could you increase it four-fold, five-fold, six-fold to be able to cope with the increase [in] level of cases coming in”.

An NHSE spokeswoman said: ”As the chief medical officer has warned, NHS services will come under pressure as the outbreak spreads more widely and so it is only right we are preparing a number of practical solutions to respond.

“Last week, guidance was sent out across the NHS to help local services to prepare so patients can get the care they need which remains the priority for hardworking staff and advice will continue to be updated.”

The Department for Health and Social Care did not want to comment.

UPDATED: On 13 March this piece was updated to include statement from the Royal College of Surgeons