In the Herald’s health newsletter and big on their website, today:
It is fairly obvious that clearing the elective waiting list backlog depends on ramping up the number of patients getting into theatre for surgery.
Yet the results of a new workforce survey, published today, highlight that a lack of available theatre spaces is (alongside stress and burnout) the number one gripe for the nation’s surgeons.
Indeed, the most recent available data for Scotland illustrates just how much patient turnover continues to lag behind pre-pandemic levels.
As of November 2023, a total of 25,922 operations were scheduled for theatre in NHS Scotland and, ultimately, 23,645 took place (the remainder were cancelled for reasons ranging from a lack of beds or staff to patients being too ill).
This means that elective activity was nearly 13% lower than it had been back in November 2019, when a total of 27,060 operations were carried out.
I’ve highlighted the deception.
First, ‘a lack of available theatre spaces is (alongside stress and burnout) the number one gripe for the nation’s surgeons‘?
We are not told what the sample size was nor what percentage that is of the profession as a whole. Typically, like most trade union surveys, the results of another ‘squeaky wheel’ survey, will not be meaningful.
On lack of theatre space, that may well be true but, in NHS Scotland, around 2% are cancelled due to ‘capacity or non-clinical reasons.’ (98% across several sites and thousands of operations, resourced every month is probably as good as any organisation of that size could hope for):
Second, ‘how much patient turnover continues to lag behind pre-pandemic levels‘ ?
Look at the green shaded graph with a steady incline, quarter on quarter, toward the pre-pandemic level. Why is that progress not the news?
Third, ‘cancelled for reasons ranging from a lack of beds or staff to patients being too ill‘?
Patients being too ill and so not operated on because it might kill them? That’ll be a positive, I hope?
Lack of beds?
Around 50% more beds per head in Scotland.
Bed occupancy in England? 94.7%
Bed occupancy in Scotland? 88.1%
Finally, in the Herald report, strikes? Not a word.
Talking-up Scotland 'Albatraz' 
If the SNP Government had been in power in 1948 and proposed an NHS for Scotland it is clear that the Scottish media would be totally opposed .
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What they don’t mention is the number of operations cancelled by the patient themselves.
I have been following the stats on Planned Operations for quite a number of years and noticed the following:
a) the %age of ops cancelled each month is usually 8 to 9% in total irrespective of the total number of planned ops.
b) Rarely does the figure for cancellations exceed 10% and that has been true pre- and post-pandemic.
c) the two main reasons for cancellations are clinical, or the patient cancelling. Usually the %age for each is 3-4%.. NOTE if the patient cancels the they go back onto the Waiting List which has the effect of slowing down the reduction pof people on the list.
d) after that comes Resources and Other
As to the availability of operating theatres I know that FVRH had two additional theatres and surgical wards built just before the pandemic. This took its total op theatres to 16. It is also possible to change the way theatres are used to increase throughput. An example of this is Falkirk Community Hospital Ophthalmology Dept which increased its cataract surgery ops by 25% by using its theatres in Jack and Jill manner. There is also cooperation between Health Boards so that patients can be shuffled between diff hospitals to maximise use of available space/resources
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As I am sure readers of TuS are aware when the NHS talks about “beds” it is NOT talking of the physical bed itself but of a fully staffed bed – i.e. one where there also exists the correct predetermined level of staffing and other resources (Theatre spaces for surgical wards) needed by the patient. My experience is that hospital basements are stuffed full of physical beds but they are useless to patients!
When I was in the NHS, prolonged bad occupancy rates over 90% was considered a red flag issue as it indicates the likelihood that problems will routinely occur whenever the patient stay deviates above the norm, be it because of bed blocking or the patient not responding to treatments as well as others do
Stewart McMutrie
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Aye, another McArdle gargle https://archive.ph/M0333, “NHS surgery in a spiral: No recovery hope until we fix this” with the graphics editor having a giggle of concentric circles as background, having eaten all the spirals…
You can skip past all her usual rhetoric to the meat on the bones ‘Theatre space’ section, where we learn the ‘workforce survey’ is a “A report by the UK’s royal colleges of surgery – including the Royal College of Surgeons Edinburgh and the Royal College of Physicians and Surgeons Glasgow – found that 60% of those working in Scotland consider access to theatre to be the main challenge facing the profession”
Now just digest the context of this, and I’m not about to criticise the RCSEd (Est 1505) or the RPSG (Est 1599) contributions to the survey, but this is the tiniest of tiny samples Gargle could possibly have chosen for validating her bed fetish, but what or whom does her article actually inform ?
Nothing – precisely nothing other than we should be profoundly grateful Gargle McArdle pursued journalism for a career rather than training to be a registrar – Denial of the ability to shout “Oi, ref, didn’t you see that, are you blind ?” relentlessly from the sidelines might have sent her completely mad….
It rather oddly reminded me of this from way back, so appropriate for Scotland’s “voice of the people”, a paper once known for integrity, but no more…
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