FUTURE SURGE RY
Prof. Skinner added that we must look at ‘super hospitals’ and how we can make room, when there is no obvious separate space. In terms of the workforce, he emphasised that “no surgeon is an island”. There is a need to incentivise theatre nurses to ensure their retainment, as well as targeting recruitment. “The working environment in the NHS is being compromised, at the moment…Morale is low and people are working very hard. It requires leadership but we can all help to improve this. The pension issue also needs to be addressed. We cannot have a penal pension system that is discouraging work and encouraging early retirement of senior surgeons. The law needs to change…The whole of the NHS must work to facilitate this,” Prof. Skinner continued. He further highlighted issues around training. During the pandemic, a lot of elective surgery stopped, as well as trauma surgery [as less people were being injured due to less activity], which significantly impacted opportunities for surgical training. Junior doctors are going to need extra time, therefore.
“Surgical training needs to recover to ensure the next generation are ready as soon as possible,” Prof. Skinner commented. Prof. Mortensen said that the Government needs to hear solutions. Surgical hubs quickly gained support at the top because they were “relatively easy to grasp” and to put in place. Other suggestions put forward by the panel included offering time off – for example, offering staff sabbaticals of two months after five years of service. Staff could use the time to learn new skills and it would be a “pay rise by stealth” that could incentivise staff retention.
Stella Vig commented that “what got us through COVID was leadership”, but retention is also “down to us” – by respecting and valuing colleagues. We need to look after our teams and also to start lists on time, so that operating theatre colleagues can get home on time to their families. Dawn Stott raised concerns that there is not enough staff to support safe surgery and emphasised the importance of “showing kindness” as part of efforts to ensure retention of staff. She added that theatre practitioners are retiring early, leaving the NHS and then returning as agency staff and sometimes “being paid twice as much”. “Something needs to change,” she
asserted. “But the personal touch is really important to retaining staff in theatres.” The panellists acknowledged that clinical leadership will be vital – but everyone has some responsibility and power to deliver improvement. They acknowledged that there is “only so much that politicians will understand” and that we are in “challenging fiscal times”, so there needs to be some
JANUARY 2023
realism around extra funds. In summary, the challenge will be to come up with solutions, innovation, and to look after each other. There are opportunities to optimise theatre start times, which will require the whole theatre team to be on board, as well as opportunities to treat more patients as day cases.
A key message from the session was that social care often prevents patients from being discharged from hospital; while this may be beyond the control of surgeons, the wide variation in rates of day case surgery across the country is within the power of surgical teams. Optimising pathways to support day case surgery will help increase efficiency and throughput, as well as having benefits for patients.
Launch of new white paper The discussion of the elective care backlog continued in a later session dedicated to “working together to meet the challenge.” This included the launch of the ‘Recovering Elective Care’ white paper, released by medical solutions provider Mölnlycke – which was developed following a roundtable with healthcare professionals (HCPs) and experts in elective care.
The white paper provides an overview of the scale of the challenge, highlighting best practice across the healthcare system and issuing recommendations to help healthcare leaders to address the crisis. It also provides considerations for future research, suggesting how healthcare, Government and industry stakeholders could work together to embed improvements in the NHS. Commenting on the launch of the report, deputy director at the Centre for Perioperative Care and consultant orthopaedic surgeon, Prof. Scarlett McNally, said: “The significant crisis facing us in elective care is a huge threat to our NHS, but it also represents an opportune moment to reconsider how we optimise patients for surgery.
“By increasing day case procedures, implementing shared decision-making between clinicians and patients, and standardising best practice across pathways, we can reduce waiting lists. As clinicians, we want to provide the best care we can for our patients – this report sets out recommendations to improve the patient’s experience of surgery, while improving efficiency and tackling the backlog to reduce pressure on the NHS.” The Recovering Elective Care report discusses the health service’s learnings from COVID-19, calling for a renewed focus on increasing collaboration among the workforce and protecting staff from burnout. The report also explores how planning for surgeries and investing in innovative practices can support the elective care recovery.
The report issues eight recommendations for the Government, NHS, and industry partners to support the recovery of the surgical backlog, including: 1. Working groups should be created within hospital Trusts to establish new protocols and ways of working based on best practice organisational improvements to elective care departments. This could include supporting measures, technologies and processes that have been demonstrated to drive organisational and operating efficiency, and the working groups should be driven forward by Trust leaders.
2. Guidelines on shared decision-making should be developed to ensure greater access to acute surgery, with further consideration given to greater patient choice and participation (in line with the GIRFT report, ‘Post-COVID Elective Surgery Recovery & Transformation’).
3. Surgical skills training and re- acclimatisation programmes should be established to ensure that staff returning to elective teams from critical care are
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