Elective recovery of care

John Skinner

I hope that we are now through the worst of the storm season and along with Dudley and Eunice arriving, February saw the publication of the much-awaited NHS Elective Recovery Plan (ERP). It was delayed by the Omicron wave of COVID-19, and real uncertainty regarding what will happen to the 10 million missing patient referrals that didn’t happen during the pandemic. Some of the best brains and modelling systems have been deployed to try and predict what will now happen to these patients.

Many of these patients will have musculoskeletal conditions and we know that the NJR is already short of 200,000 joint replacement operations that would normally have been performed by now. There are 6.1 million patients on all waiting lists and if just over half of those 10 million patients were to come forward, the waiting list could double. We won’t know for sure until early next year. We are aware of the particularly difficult situations that affect colleagues and patients in Wales, Scotland and Northern Ireland and continue to work with them to influence change throughout the United Kingdom.

The NHS had already committed to increase elective care delivery by 30% compared to pre-pandemic activity in the 2021 government spending review and this is now timetabled to happen by March 2024. March 2024 is also the date by which the Recovery Plan mandates that waiting lists will start to reduce. It is acknowledged that waiting list numbers will rise before they fall, and we know that many of our patients are waiting too long already. The plan stipulates that no patients will wait beyond 104 weeks by July this year. Currently that represents 4,400 T&O patients who must be treated by July, but this number rose by 12% in the last month. The other headline target is that no-one will wait more than 52 weeks by March 2025. At present there are 60,000 T&O patients in this category.

Increased investment in the NHS is welcome but comes at a time when the cost of living, fuel prices and individual tax burdens are rising. This will mean increased scrutiny and rising expectations for healthcare, as suggested when the Daily Mail reported the launch of the Elective Recovery Plan with “Is that all we get for £12 billion?”

Investment to increase elective orthopaedic capacity nationwide is essential. Developing hub sites and theatre provision in all regions is welcome as it appears to be the only way that we can guarantee high quality elective surgical provision year-round. The term ‘winter pressures’ justified suspending surgery for patients with end stage arthritis for several months, each year. This is not acceptable, and these patients need and deserve timely surgery. Joint replacement and many other orthopaedic operations transform lives and represent some of the best value healthcare interventions in all surgery. We know that many non-cancer diagnoses are in no way benign conditions for patients. We deliver important and effective healthcare.

As we traverse the new health landscape of ICS working, surgical hubs, elective care prioritised and the massive backlog, orthopaedic surgeons must be empowered to deliver for our patients. We must take this opportunity to influence and improve our working day, to lead efficient theatre teams that maximise surgical throughput and minimise delays in the working day. We’ve addressed long waiting lists before and I know that we will do it again. I hope that this time it comes with NHS investment and leaves a legacy to future proof the system.

This will improve job satisfaction for the whole team, and we must grab all opportunities to train the next generation of surgeons as we help them to catch up the lost theatre cases that came with COVID. Our patients need their operations and I hope that this represents an opportunity for us to do what we enjoy doing best. Rest assured that the BOA will continue to represent you as we go forwards addressing these challenges in the recovery of timely elective orthopaedic surgery.