NHS recovery? Fewer operations in 2022 than a year ago

The hub, based in Livingston, was originally earmarked to open in 2025, providing additional capacity for planned surgery including orthopaedics, urology, colorectal and gynaecology.

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However, requirements that the facility be “net zero” in terms of energy use and a request to include ophthalmology have slowed progress.

The papers also state that it is “not achievable with current constraints” to have no-one on inpatient and day case lists by March 2023 who has been waiting over two years for their procedure.

This contradicts a target set by the Scottish Government last month to eliminate two-year waits “in most specialties” by the end of August this year for outpatients, and the end of September 2022 for inpatient/day case lists.

The National Treatment Centres are a key plank in the effort to ramp up elective activity (Source: Scottish Government NHS Recovery Plan)

A 24-bed National Treatment Centre for Highland patients in Inverness, due to open in 2022, is already delayed. The

£32 million facility, with five theatres specialising in simple joint and eye operations, will not admit its first patient before April next year,

The rollout of a network of dedicated elective centres across Scotland was a key plank in the Scottish Government’s five-year NHS Recovery Plan, published in August 2021.

The goal was to ring-fence staff and beds in facilities separate from acute sites, to reduce the disruption caused to planned care by emergency admissions or spikes in flu and Covid.

Year one of the plan envisaged an extra 27,500 inpatient and day case elective procedures taking place on NHS Scotland in 2022/23 through a combination to increased activity at health board level and the creation of NTCs, rising to 55,500 by 2025/26.

Elective activity has remained largely unchanged over the past year, and remains below pre-pandemic levels

The former is equivalent to a 10 per cent annual increase in inpatient and day case activity compared to pre-pandemic levels.

However, the latest figures from Public Health Scotland show that the total number of elective procedures which took place during April, May and June this year – 55,758 – remained 27% below the same three-month period in 2019.

It has also declined slightly – by 1.6% – compared to April-June last year, when 56,672 procedures were carried out.

Dr Lewis Morrison, chair of the BMA’s Scottish Council, said: “There is clear evidence that the NHS in Scotland is struggling – and close to failing in some place.

“It’s August and yet it feels like the middle of winter, with elective work being cancelled, high waits in A&E and demand for GP time spiralling.

“Staff are exhausted, and despite the workforce working flat out, it comes as no surprise that last year’s Scottish government pledge to increase hospital activity by 10% has not happened yet.”

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The total number of people being admitted to hospital for any reason - emergency and elective combined - remained 11% below the pre-pandemic average by the end of June, according to the most recent update by PHS.

The figures fly in the face of efforts to ramp up activity as part of the NHS remobilisation, but have coincided with record Covid infection rates over the past year - especially during 2022 - as precautions were lifted and Omicron began to spread.

The number of available beds has also reduced due to factors such as increased levels of delayed discharge, ward closures linked to requirements to isolate Covid positive patients, and staff absences due to the infection.

Total A&E attendances have remained below, or on a par, with pre-pandemic levels, indicating that a shortage of beds rather than increased demand is to blame for an increase in people spending over 12 hours in A&E

As a result, even with admissions running below pre-pandemic levels hospital occupancy is routinely exceeding the 85% threshold considered safe.

In a joint editorial published in July, the editors of the BMJ and the Health Service Journal warned that persistently high Covid rates are “the main reason that the NHS is nowhere near reaching the activity levels needed to begin to recover performance”.

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Professor Mike Griffin OBE, president of the Royal College of Surgeons of Edinburgh, said tackling staff shortages by making the NHS an "attractive working environment" would be vital ahead of a "tough winter" to come.

He said: “These latest figures paint a deeply concerning picture of the colossal pressure being felt by healthcare workers across the whole system.

“Surgeons and their brilliant teams have been working tirelessly, providing a 24/7 service throughout the pandemic, to ensure that planned surgery and treatment are rolled out despite the huge challenges being posed by the Covid-19 pandemic.

“We have been vocal about the fact that this is an issue that has been mounting even before the pandemic, and one that is impacting healthcare workers and patients across the country.

“Despite the challenges being posed, the surgical profession is one that is a stimulating and highly rewarding career, but the workforce is becoming increasingly stretched and there are issues surrounding staff retention."

Total hospital admissions, for elective and emergency combined, are still around 11% below pre-Covid averages (Source: PHS)

NHS Fife, which was due to open an NTC this year specialising in orthopaedics, is now expected to complete building work in October but does “not yet have a confirmed date agreed for launch”.

The NTC in Forth Valley - also earmarked for 2022 - is partially up and running with two additional operating theatres and the installation of an additional MRI scanner to increase surgical and diagnostic capacity. However, its new inpatient ward will not be operational before early 2023.

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Jim Crombie, deputy chief executive of NHS Lothian, said: “After we were asked to review our initial plans, we can confirm that the Full Business Case (FBC) is underway.

"This includes a full review of the proposed service model and building design. An opening date will be confirmed once the Full Business Case, and its associated funding, has been approved by the Scottish Government.

“While our services undoubtedly remain under significant pressure, we continue to review provision to maximise the number of patients we can see, and to help reduce waiting times.”

A Scottish Government spokesman said the April to June statistics cover the "peak of the latest Covid wave".

He added: "Despite high rates of Covid-19 and seasonal pressures including increased staff absence, more than 90% of operations were performed as planned – an average of 636 a day. The most common reason for cancellations of operations were for clinical reasons.

“The first annual update on the Recovery Plan will be published in September after summer recess.

"However, we remain committed to increasing capacity and reducing long waits for people waiting for appointments and treatment and will continue to work with boards to support delivery of the targets announced last month.”