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Rapid response to:


Growing backlog of planned surgery due to covid-19

BMJ 2021; 372 doi: (Published 09 February 2021) Cite this as: BMJ 2021;372:n339

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Rapid Response:

Re: Growing backlog of planned surgery due to covid-19

Dear Editor,

I read with interest this editorial. A few points. I believe cataract surgery is by far the most common operation done in the NHS, usually provided by one of the smallest units consultant-wise in hospitals. It is also the operation with the highest average increase in QALYs of any operation. I think the ophthalmology waiting list would be bigger than the ones mentioned.

Early in the piece the authors allude to historical lack of capacity but end with calling for a leaner, more cost effective and more flexible. However, it is the leanest of the leanest current NHS that stopped Ophthalmology and other surgery happening as trained nurses were pulled to HTUs and ITU and to support emergency trauma theatres.

Chris Hopson of NHS care providers recounts how his German opposite number was horrified that normally the NHS runs at capacity in the high 90 percentages whereas any rational business model runs at 80% efficiency to allow for maintenance and development in good times and capacity of emergencies during bad. A routine extra scrub team and anaesthetist would very efficiently help reduce my back log; however (as I am in Scotland) there would be howls about the extra expenditure of the ‘extra‘ operation and wage bill.

What efficiency do we wish for the NHS which Covid has shown us was dangerously lean to begin with?

Yours sincerely

Charles Diaper FRCEd(Ophth), FRCOphth

Competing interests: No competing interests

24 February 2021
Charles J M Diaper
Consultant ophthalmologist