Letters Response to winter crisis

Cancelling routine surgery: creating more problems than it solves

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k897 (Published 08 March 2018) Cite this as: BMJ 2018;360:k897
  1. Daniel R Gibney, locum doctor
  1. Barts Health, London, UK
  1. danielgibney{at}doctors.org.uk

Although many will have agreed with the unprecedented decision by NHS England to cancel all routine NHS operations for January 2018,1 we must consider the implications. This does not solve any long term problems—it merely creates a backlog of people waiting for surgery, some of whom will deteriorate and require emergency surgery; aortic aneurysms may rupture, for example.

Cancelling routine elective surgery has other consequences. What are anaesthetists, operating department practitioners, scrub nurses, and surgeons meant to do for the rest of the month? Some surgeons may be able to run extra outpatient clinics in lieu of theatre time, but considerable resources will be wasted. Will scrub nurses be redeployed to wards to help with nursing shortages?

Capacity and bed occupancy is the main reason for cancelling elective surgery, but this frees up surgical beds not acute medical beds, which is where the pressure currently is. Acute medical patients are, of course, managed better on a ward than in an emergency department corridor, but a surgical ward is still not the best place for them. These patients will become medical “outliers” and will need to be cared for by medical teams based on other wards—this massively increases workload for those teams and introduces inefficiencies. Outlying patients also have a longer length of stay. Cancelling medical outpatient clinics and reallocating medical staff to wards should alleviate the problem but is by no means ideal.


  • Competing interests: None declared.


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