This article appears as part of the Inside the NHS newsletter
How big a difference are Scotland's available National Treatment Centres making to elective activity in the NHS?
Non-urgent, planned operations are the first to be cancelled due to bed and staff shortages or when acute hospitals have to free up space for unscheduled, emergency admissions.
NTCs provide standalone facilities where theatres, beds and staff are ring-fenced to deal with scheduled elective activity such as joint replacements and hernia surgeries without this kind of disruption.
The model is seen as key to clearing waiting list backlogs, but most of the NTCs originally planned by the Scottish Government are either delayed or in limbo due to budget pressures.
But what about the NTCs we do have?
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The Numbers
Statistics published on Tuesday by Public Health Scotland (PHS) track how many operations are being scheduled by the NHS, and how many are being cancelled.
Between July 2022 and July 2024, there has been a slow but steady increase in overall elective activity - although it remains well short of where it was supposed to be by now.
As of July this year, there were 23,813 operations scheduled - a year-on-year increase of 8.8%, and up 21% on July 2022.
The number of procedures being cancelled fluctuates, but has averages roughly 2000 per month.
The majority are postponed at the patient's request, or for "clinical reasons" - meaning the patient is not fit for surgery on their appointment date.
Compared to July 2019, the NHS in Scotland is still carrying out fewer operations than it was pre-pandemic: 21,815 in July this year (after deducting cancellations) compared to 24,545 in July 2019 - a 12.5% shortfall.
When the Scottish Government first published its NHS Recovery Plan in August 2021, it envisioned that by 2024/25 the NHS in Scotland would be completing 40,500 more inpatient and day case procedures than it was pre-Covid - a 15% uplift.
Elective activity in NHS Scotland has been climbing steadily (dotted line) but still lags behind pre-pandemic levels (Image: PHS)
The NTCs
Some of this can be blamed on the NTC delays, but not all.
In the original plan, four new NTCs were supposed to be operational by 2024: Highland, Fife, Forth Valley, and an expanded Golden Jubilee.
NTCs in Ayrshire, Tayside, Grampian, and Lothian were not due until 2025, and in Lanarkshire in 2026, so their impact would not have been felt yet anyway.
As things stand, the Highland NTC in Inverness - specialising in ophthalmology and orthopaedics - opened in April 2023, and the Fife NTC - also specialising in orthopaedics - opened in March 2023.
The Golden Jubilee's expanded unit - enabling additional orthopaedic and general surgeries - was completed earlier this year.
The Forth Valley NTC is the only centre supposed to be open by now which is not yet operational, due to building delays.
The original timetable for Scotland's NTCs set out in August 2021 (Image: Scottish Government NHS Recovery Plan, August 2021)
Figures from PHS show that the number of procedures being carried out each month at the Fife NTC has climbed from 117 in April 2023 to 221 in July 2024.
It accounts for nearly one in five of all the planned operations performed by NHS Fife.
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In Highland, the NTC has gone from completing 136 operations in April 2023 to a massive 679 by July 2024 - nearly as many as the region's main acute centre, Raigmore Hospital (717) and equivalent to 43% of all the procedures carried out in Highland.
It is clear that the NTCs can make a significant contribution.
But the biggest factor explaining why we have not yet returned to, let alone exceeded, pre-Covid activity is because our main acute hospitals are packed.
Wards are still being closed to contain Covid outbreaks, roughly one in eight beds are occupied by patients ready for discharge but waiting for social care, and staff shortages or crumbling infrastructure - from flooded operating theatres to broken equipment - lead to planned operations being cancelled.
We cannot rely on NTCs alone to fix the problem; we have to unblock capacity in our main hospitals too.
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