Comment EDITOR’S COMMENTwith LOUISE FRAMPTON THE CLINICAL SERVICES JOURNAL Editor


Louise Frampton louiseframpton@stepcomms.com


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The impact has been dramatic and the team have even broken records, including the most ever robot prostatectomies done in one day (8) – a European record; the most ever aquablation cases done in one day (10) – a world first; and the most cochlear implants place in one day (10) – also a UK record. We need to learn from Guy’s and St Thomas’ example. While HIT is not suitable for all


procedures or all sites, many more hospitals could benefit from this approach. Ultimately, investment and workforce planning are key to building back, in the long term, but in the short term, innovations such as this – if scaled-up – could go some way towards moving the mountain we face ahead.


louiseframpton@stepcomms.com Get in touch and give us your views, email me:


September 2023 I www.clinicalservicesjournal.com 5


Moving mountains: thinking differently could prove a HIT


At the time of writing this column, the backlog had hit 7.5 million. Despite the best efforts of a burnt-out workforce, the total just keeps on rising. It must seem like an insurmountable mountain to climb, to all those working in the NHS. With the health service facing a huge challenge ahead, the Government has announced plans for 900 new hospital beds as part of £250 million funding to help treat patients more quickly and help cut waiting lists. While the investment was warmly welcomed, organisations such as the NHS Confederation and the King’s Fund have questioned how these beds will be safely staffed, given that the NHS is currently facing 112,000 vacancies. Nihar Shembavnekar, Economist at the Health Foundation’s REAL Centre, said: “The NHS


Long Term Workforce Plan is a major milestone and is rightly ambitious about increasing the number of trained NHS staff. However, the implications for universities and healthcare providers, and the speed at which they will need to increase capacity for training healthcare workers, should not be underestimated. “Boosting healthcare training places is vital to address chronic staff shortages and meet


the future needs of the NHS but it is just as crucial to improve staff retention. The government should also commit to the long-term capital investment needed to give the NHS the modern buildings, equipment, and technology it desperately needs to make the plan work.” While it is clear that plans to tackle the backlog need to go further, there are examples of


clinician-led innovation that could make a significant impact on reducing the ever-growing waiting list. I have just returned from the Association for Perioperative Practice (AfPP) annual


conference, where I had the pleasure to listen to Dr. Imran Ahmad, a consultant anaesthetist, at Guy’s and St Thomas. Speaking at the event, he suggested that we could use our resources differently. Guy’s and St Thomas are using high intensity theatre lists – known as HIT lists – to help reduce the backlog for non-emergency surgery and the results have been impressive. Staff looked into innovative ways to tackle the waiting list for routine operations and


procedures, and developed a super-efficient but safe programme to maximise the number of patients treated in one day. The HIT lists focus on one type of procedure at a time and take place at weekends. They require careful planning to select suitable patients – and in most cases have been able to treat at least three times the number of patients compared to a regular surgical list. The HIT lists involve:


l Increasing the number of anaesthetic, surgical and theatre staff in order to minimise the turnaround time between cases, making more time available for the surgeon to operate.


l Using two theatres and three teams, the surgeon can go between cases without having to wait for the patient – this allows for many more cases to be done in the same time period.


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