Surgery
The case for surgical hubs: reducing waiting lists
Peter Sedman, from the Confederation of British Surgery, discusses the case for surgical hubs and highlights some of the successes that have been achieved, using this approach, across the UK.
Keir Starmer has promised more surgical hubs, greater use of the private sector, and more choice for patients as to where they have their surgeries, in a bid to reduce elective surgery waiting lists.1
This strategy is designed to reduce
the 7.5 million patients who are waiting for planned treatment, in turn freeing up resources in order to once again meet the 18-week standard for planned treatment.2
This strategy, they say, will
protect planned care from seasonal pressures, allowing surgeons to work through elective appointment waiting lists without being forced to postpone appointments due to pressures on other departments, such as A&E or Emergency Medicine. If this works, the Government could deliver two million extra appointments in the first year. That’s quite a commitment. However, there are arguments from multiple
critics stating that opting to prioritise elective surgery over emergency care is a misallocation of resources. They argue that non-urgent procedures should take a backseat to lifesaving interventions, particularly as emergency departments are struggling. Although at face value this argument may appear to make sense, it is short-sighted and flawed as just one part of a much bigger picture. It fails to view the surgical hub as a standalone entity, instead merging it with the unpredictability of the emergency department and emergency surgery. I can see how, in doing so, a chaotic picture is created, rather than a much calmer one of systematically reducing the waiting lists that have been blighting the NHS for so long. The whole (calmer) picture comprises the impact on emergency departments of delaying elective surgery, the effect on the economy
from multiple months off sick with something that could be fixed sometimes in an hour or two, and the misconception that surgeons trained in specific procedures can simply be reassigned to different departments when they are not operating. The latter is an almost laughable fallacy; akin to expecting a car mechanic to fix your washing machine, simply because they both deal in repairs. Specialised surgical skills are honed over years, often decades, of training and cannot simply be transferred from, say, knee to gall bladder. To do so would not only waste their expertise, but also undoubtedly impact patient outcomes. It’s helpful to understand some reasons we find ourselves in this crisis. Since 1960, life
Trusts with pre-pandemic hubs reported 11.2% more surgeries post-lockdown - equating to 51,000 more surgeries - than those without these facilities, highlighting the model’s robustness and ability to weather unforeseen challenges.
expectancy has increased by 20 years, yet half of those are typically spent in poor health.3
This
longer life span results in an ageing population living with multiple chronic conditions that require ongoing and increasingly complex healthcare. How can this not add pressure to GPs, A&E, elective surgery waiting lists, consultants, and long-term care? In short, the healthcare system in its entirety. On top of that, obesity causes health problems that we didn’t face in the past, with a significant proportion of the population living with obesity-related disease, such as type 2 diabetes, hypertension, cardiovascular disease, and joint issues. In fact, a Swedish study carried out in 2024
predicted a concerning public health trend - that by 2050, six in ten adults and a third of children will be overweight or obese.4
In the UK, that
equates to 50 million people living with obesity and its co-morbidities. The cost of this on the NHS - in both money and resources - is unthinkable. As always, the time to change is now. In addition, the care crisis means that older patients are left ‘bed-blocking’. These are patients for whom medical treatment has
May 2025 I
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