Planning a mountain ascent

All of our analysis on the impact of Covid-19 on the NHS is shared here – this includes our regional tracker. For further information please contact George on 07980804956 or [email protected]

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Published 23 April 2020

Over a month ago, trusts were told to assume that they would “postpone all non-urgent elective operations from 15th April at the latest, for a period of at least three months”. 

While GP referrals have dropped off as operations have been cancelled or postponed. 

Usually there are around 700,000 planned and elective operations per month. So over three months, that is a total of 2.1 million operations that will not take place. There might be some attrition to this demand, but it could also be higher as conditions worsen and need increases. These are in addition to the current 4.5 million people on a waiting list – a mountain as the chart below illustrates.

With the delay to the activity being at least as long as the postponement, median waiting times will increase from 8.5 weeks to 13.5 weeks.* This delay will be longer if urgent cases are prioritised – assuming 20% of cases are urgent, these would fill the first two months. By design, this would be unconstitutional. 

How best to clear the backlog of demand from the 2.7 million people within a year?** 

• Option 1: NHS runs at 125% capacity for the whole year
• Option 2: increase the number of cases going through theatres (perhaps with a technology solution), so there is not a single wasted minute
• Option 3: commission activity from the independent and private sectors
• Option 4: ration access (i.e. give up on going up the mountain)

Option 1 seems unreasonable, given the lurking presence of Covid-19 and pressures staff have endured. Option 2 was pursued pre-crisis with some successes. Option 3 would require an additional 700 theatre’s worth of capacity for a year – this would cost over £1 billion (it also assumes the capacity can be created).***

A hybrid that does not involve rationing would be to do what is needed to increase theatre capacity and efficiency – we saw South Tees do this by 13% with SpaceFinder and this is in line with the theatre efficiency report that has a foreword from Professor Briggs. This would mean only needing another 360 theatres – that’s about nine per STP – for a year.

This all assumes that the postponement of electives lasts three months. Without some tangible steps to remove the lockdown, this looks less and less likely. 

Read our full analysis on the impact of Covid-19 on elective procedures here: https://www.edgehealth.co.uk/post/covid-19-impact-on-waiting-times-for-elective-procedures

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* This assumes only 91% of people waiting still need treatment after such a long pause.
** 2.7 million as there are 1 million people joing the waiting list per month, although there is some attrition due to death and decision. 
** The average cost of an operating theatre was £1.5 million in 2013. Adding some inflation gets us to £1.7 million.