Surgery
been optimised, and the hospital has no further contribution, yet have nowhere to go. Not only does this have an obvious and instant impact on NHS resources, studies show that prolonged bed rest puts adults at risk of further health issues, even if they are currently healthy.5
And, let’s not
forget that seasonal NHS pressures are nothing new. Add all that to the mixing pot and you have the perfect storm. Of course, none of these problems can
be resolved overnight, but surgical hubs can certainly help the process and ease some pressure. Methodically working through an elective surgery list, without being re-routed to deal with emergency surgery, has multiple benefits, but this will only work if resources are ring-fenced, something that a surgical hub design allows for. The hub in mind would be standalone, and (crucially) not fronted by an emergency department, which would be at a hospital nearby with separate resources. This means that the patient needing surgery will not use any unnecessary resources if the surgery is performed in a timely manner, as the hub is purposefully resourced. As an example, elective surgery patients
likely to use emergency resources include gall bladder and hernia patients. One gall bladder patient recently told me she had been through the emergency department six times before she finally underwent removal surgery. The surgery takes just two hours. I cannot even begin to estimate how much that cost the NHS in time and resources, considering the cost of imaging, pain relief, and the use of a bed. If she had gone through a ring-fenced surgical hub, her operation could have been planned with little likelihood of cancellation. It is highly likely that she would not have needed to use emergency services at all, as using allocated resources
Methodically working through an elective surgery list, without being re-routed to deal with emergency surgery, has multiple benefits, but this will only work if resources are ring-fenced.
result in reduced waiting times. A crucial thing to consider is that the impact of delaying gallbladder surgery extends beyond the impact on emergency care, as it can often lead to further health complications for the patient, including infections, bile duct involvement, and pancreatitis. From a single, relatively simple and quick
surgery, we now have more appointments, medications, hospital admissions, and an increased and profound impact on the patient and often their employment. The national target dictates that 90% of gallbladder removal surgeries should be performed within seven days of first emergency presentation, and we are not even close (locally or nationally) - we simply do not have the consistency of resources available to us.
Other examples in the same month as the
delayed gallbladder surgery include patients who hadn’t had operations in a timely fashion and ended up in intensive care for sometimes protracted stays. Again, imagine the resources used looking after these patients alone. These, often relatively simple operations, become deprioritised in favour of more pressing emergencies, leading to more visits to the emergency department and even ICU. This is unnecessary and could be avoided by protecting resources at surgical hubs. In answer to the argument that we should prioritise emergency surgery over elective surgery - it really shouldn’t
need to be one or the other. The choice could be to do both, but in a more considered way. It is a mistake not to focus on reducing elective surgery lists in all ways possible; in failing to do so, we leach resources at an alarming rate. Protecting elective surgery from emergency
surgery involves separating the two completely. We must view them as being entirely different models, involving different protocols. In Hull, we have a large acute hospital which admits all emergency medical patients, with a smaller regional facility focused on elective surgery. In separating the two, elective surgeries can be planned and carried out with no impact on emergency care resources, and do not become repeatedly postponed because of emergency demand. Without separating the two and ring-fencing resources, we would be constantly moving resources from one to the other, each negatively affecting the other. It’s a constant scenario of ‘robbing Peter to pay Paul’, yet neither Peter nor Paul has sufficient resource to meet current demands. This model is the basis for the philosophy of surgical hubs, largely divorced from the pressures of the less predictable emergency services. We mustn’t forget that this is a model that has proven to work.6
Retrospective reports on
the impact of surgical hubs in the North West demonstrate significantly reduced waiting times, increased volume of patients treated, and a higher number of operations delivered. 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. These hubs play a key, if not the main, role in reducing waiting lists, particularly for common procedures like cataract surgeries, hip replacements, and hernia operations. I’ve talked a lot about the benefits for adults
if we reduce waiting list times, mostly because adults make up the majority of those waiting for elective surgeries - in a 2022, study it was stated that 53% of people waiting for elective procedures are of working age, with the remaining 47% being over 65 or children.7
The
same study predicted that elective surgery waiting lists will triple by 2030; a date we are now uncomfortably close to. But surgical hubs
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www.clinicalservicesjournal.com I May 2025
Issara -
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