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Study reveals widespread cancellations of NHS elective surgery
The first national overview covering NHS hospitals across England has shed new light on the extent and causes of surgical postponements and cancellations. The clinical investigation, published in the British Journal of Anaesthesia, is a seven-day snapshot evaluation of 91 participating NHS Trusts, conducted from 11-18 November 2024. The project was a collaboration by the National Institute of Health Research (NIHR) Central London Patient Safety Research Collaboration, NHS England, University College London and the Royal College of Anaesthetists. It’s estimated that over six million patients are on a waiting list for elective care in England, with NHS Trusts still struggling to tackle the vast backlog caused by the COVID-19 pandemic. England’s programmes to reduce waiting times for planned surgery have not met their goals and in late 2025 the Public Accounts Committee reported that progress in reducing waiting times appeared to have stalled, with “too many people still waiting too long for diagnostic tests and treatment.” For individual patients, the wait for procedures
such as hip or knee replacements can be many months. So, when surgery is either postponed at the point of their pre-operative assessment appointment, or cancelled within 24 hours of surgery, the result is not only anxiety and frustration for the patient, but may result in deteriorating health and worse clinical outcomes. Key findings included:
Cancellations l Data from 91 NHS Trusts finds 9% of operations postponed at pre-operative assessment clinic.
l The study found national cancellation rate of 10% within 24 hours of planned surgery.
l Nearly 40% of last moment cancellations were deemed to be potentially avoidable.
l Almost a quarter were due to acute medical
Operating list inefficiencies l 25% of operating lists were reported as running inefficiently. Reasons included scheduling, organisational issues, delays in patients arriving and staffing issues.
conditions, meaning with earlier recognition, the problems could have potentially been resolved and the procedure gone ahead. With robust systems to identify such patients before the day of surgery, they could have been replaced with patients deemed ready to proceed - thereby avoiding wasted theatre time and staff deployment.
Postponements l The study found that 9% of pre-operative assessment appointments resulted in postponement.
l Most postponements occurred because patients had not been adequately prepared and were not in the best medical condition for an anaesthetic or surgery by the time of their pre- operative assessment.
l Over half of postponements (61%) were due to patients needing further tests or specialist anaesthetic or medical review, often as a result of the patient’s other medical conditions.
l The authors highlighted the need for earlier, robust processes to ensure underlying health issues are identified at the time patients are added to the waiting list. This would enable them to be treated and where possible their health issues resolved before surgery.
In a linked BJA editorial, Professor Scarlett McNally OBE, Consultant Orthopaedic Surgeon, writes: “The findings underscore the scale of systemic inefficiencies, unacceptable waste of public money and emotional toll experienced by patients.” She sees a compelling mandate for change and also comments: “NHS England has spent billions building new surgical hubs, but such standalone units do not operate on patients at greater risk of complications, those who are older, or living with underlying health conditions and in need of the additional backup of an NHS hospital. Without a different approach that focuses on supporting and preparing these patients, waiting lists will remain unacceptably high, as procedures are too frequently postponed or cancelled.” Commenting on the study findings, Dr. James
Bedford, University College London and Lead Author of the investigation, said: “This detailed clinical investigation underlines the need for better implementation of patient care ahead of surgery, across the NHS. In particular - and in keeping with standards issued by NHS England - we need to ensure we identify health problems, which put patients at risk of post-operative complications, as early as possible, so that these can be improved while they are waiting for their operation. “The process of early screening also helps
to identify patients who are low risk, who can potentially be called to have surgery at short notice, therefore reducing their waiting time, and improving service efficiency.” View the full paper at:
https://tinyurl.com/y3drhzzd
NHS overhauls clinical standards to reduce maternal deaths
Every maternity service in England will need to meet new clinical standards, set out by the NHS, to significantly reduce the number of women who die each year during or after pregnancy. All pregnant women will be offered an early risk assessment for venous thromboembolism – which is now the leading cause of maternal mortality – before their first antenatal appointment. Anyone identified as high risk will be offered thromboprophylaxis (blood thinners to prevent clots) within 72 hours. Every woman with epilepsy will have access to
a local specialist team for managing epilepsy in pregnancy and will be offered a tailored plan to help control seizures, including timely access to medications that are safe to use in pregnancy. Women will also be routinely assessed for their mental health with a consistent set of questions and a report provided at their antenatal appointment and referred to specialist NHS perinatal mental health if needed. Women experiencing a haemorrhage or significant bleeding after birth will also receive care from specialist obstetricians and anaesthetists
sooner, with new guidelines and thresholds for significant blood loss to be escalated earlier. Progress against each clinical standard must be presented to NHS Trust boards with escalation to regional and national level if local delivery does not meet expected plans. Full roll out of these national measures by
March 2027 is expected to reduce the number of deaths caused by blood clots, strokes, cardiac disease, suicide, sepsis, obstetric haemorrhage and pre-eclampsia, which account for 52% of maternal deaths.
June 2026 I
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