Surgeon calls for action to tackle operations backlog
ELECTIVE operations to clear a huge surgery backlog in Wales “really haven’t got going at all”, according to one of the nation’s top medics.
Since the middle of March thousands of elective operations, those waiting for non-emergency medical treatment, have had their treatments delayed amid the coronavirus pandemic.
These have included life-saving cancer operations, with some patients waiting more than five months for an operation the NHS would normally look to do in two weeks.
According to Mr Richard Johnson, a consultant breast surgeon and director in Wales of the Royal College of Surgeons of England, the Welsh Government needs to take urgent action to create so-called “Covid-light” hospitals to start to work through the backlog.
The backlog of delayed operations is enormous.
Data suggests that between March and April 2020 there were almost 21,200 fewer surgical and midwifery admissions.
Additionally, at least 16,000 fewer urgent referrals for suspected cancer have been made in Wales since the
start of lockdown, compared to the same time last year.
According to Mr Johnson, the reason it is hard to work through procedures is because of the large number of extra precautions needed because of coronavirus.
He said: “At the start of the pandemic elective services were quite rightly stopped to allow us to cope with what was coming into hospital.
“What we have found is it was been very easy to turn off services, but it is proving difficult to turn services back on.
“Because of the infection control procedures that we are following in theatres, even if we could get back to the same number of operating sessions as we had before, the turnaround times are a lot slower, at about 30%-40% less capacity, even though we have the same number of sessions.”
The Royal College of Surgeons has now called on the Welsh Government to set up “Covid-light” hospitals.
These are facilities which aim to have zero Covid-19 inside them.
They do not take emergency procedures and there is a strict testing regime. The idea is that not as many safeguards will be needed inside so that operations can be conducted quicker.
“Covid-light hospitals are hospitals where patients are screened before they go in to make sure they don’t have the virus,” said Mr Johnson. “Ideally staff will be screened as well, hopefully twice a week, but at the very least on a weekly basis.”
There was a similar dynamic at the start of the crisis when the Welsh NHS used the independent sector to carry out non-Covid procedures, but nothing like what is being proposed now.
The same is true for both Scotland and England.
At the moment it is down to individual health boards to plan how they go about making elective operations safe.
Most are doing this by creating Covid-light pathways inside hospitals, but it is feared that with a potential second spike in the winter, this will become harder to do as community cases rise.
Mr Johnson said: “Major cancer surgeries require more access to intensive therapy after the surgery and, therefore, it is very hard to create Covid-light pathways to these units because they tend to be in the centre of hospitals.
“It depends on the size of the hospital how hard it is to separate the non-Covid patients.” There is also the fear that, with each health board deciding how to bring back elective procedures, there could be a “postcode lottery”, with some people in Wales getting treatment, while others with the same condition will not.
“We would like the Welsh Government to do some demand and capacity planning,” said Mr Johnson.
“Work out how much capacity is needed for the Covid-light sites and then on a strategic basis work out where those sites should be.
“It’s difficult to say how many sites until we’ve got a better capacity and demand plan to go forward with.
“What we don’t want to see, if there is a second spike, is that if we turn everything off again, we find ourselves in the same position we were in March.
“We need a long-term plan of how we are going to reduce these elective surgeries. Imagine somebody has got a bad hip joint and needs a replacement, it will mean they can’t work and those patients cannot be left to suffer indefinitely.”
Though elective procedures are defined as non-emergency, delays to them can cause misery for the individuals involved.
Mr Johnson explained: “When we say elective we are not talking about life-threatening conditions, but joint replacement is a very good example because people can be in a lot of pain and they can’t carry on normal activities.
“They might be on strong painkillers. The conditions of the joints can deteriorate, which makes surgery more difficult for both the patient and the surgeon. It increases recovery time and adds complications of the surgery.”
A Welsh Government spokeswoman said: “Whilst urgent elective activity continued throughout the pandemic, health boards have now begun to reintroduce more elective procedures.
“Elective admissions in July this year were nearly three times higher than they were during the peak of the virus in April.”
SOME people in Wales have been asked to travel 200 miles to get a coronavirus test after a surge in demand for testing caused problems.
One Cardiff-based father of a toddler and a newborn was told to drive all the way to Blackburn – which is currently in a local lockdown – in order to access his nearest available slot at a drive-in test centre.
He was later offered a slot at Western-super-Mare because it was only “11 miles away” – as the crow flies across the Bristol Channel.
The Welsh Government said a spike in demand for testing had caused the problems and left reduced capacity for processing tests across the UK.
BBC presenter Will Millard welcomed the birth of his second child on August 24.
Shortly afterwards, his two-yearold daughter started feeling unwell and had a really y high temperature.
“We were talking king 39°C,” Mr Millard told the Western n Mail.
“The rules are, re, if they have a temperature immediately mmediately get a test.
“Those are the he words. We had to do it just ust because it’s the right thing to do in terms of our civic duty, uty, but also my parents were coming oming to visit on the weekend to see their new grandson and my dad is in the high-risk category, ory, so it’s a double reason to make ke sure we are safe.”
Unfortunately, y, Mr Millard was directed ed to a testing centre an eight-hour round nd trip away.
He said: “When we went on the website, it said we had to go to Blackburn in Greater Manchester. I thought, ‘That is absolutely insane and there must be a problem with the system’. Bear in mind how are we supposed to get tested immediately if a test is four hours’ drive away? Especially if we have a sick toddler? I rang 111 and then got redirected to 119.
“I couldn’t believe it – was there no way to get tested in the whole of south Wales or the whole of the south-west of the United Kingdom?”
Mr Millard was told to keep trying and eventually was offered two other slots which were still miles away.
“The next one I got offered was Oldham, so still in Greater Manchester!” he said. “After a few hours I got Nottingham which is still a long way away. away.”
After repeated calls to 119 Mr Millard was told that the system resets at 8pm and that is when they release all the new slots. “At 8pm, when the system was reset, I got offered Weston-super-Mare which is an hour and 10 minutes drive,” he explained.
“It looks like they’re working out the distance as the crow flies and obviously it said it was 11 miles away, but that is only true if you draw a straight line. Unless you’re going to scuba dive or get a motorboat across the Bristol Channel, that’s not very useful is it?”
Mr Millard was desperate for a test at this point.
“Our newborn is only a few days old and at five days they get a heelprick test. Without a clear Covid test no-one would have been able to come in and give him the heel prick test.
“I then went on Twitter and, infuriatingly, people were tweeting from the south-west of England saying they had been directed to Cardiff for their tests!” he said.
But Fiona Kinghorn, executive director at Cardiff and Vale Health Board, then contacted him and arranged for him to go to one of the community testing centres in Whitchurch, Cardiff, the next day.
Testing in Wales is conducted both through Welsh labs and through the UK Government’s Lighthouse Labs.
Almost all of Wales’ large-scale drive-in centres such as the Cardiff City Stadium are not run by the Welsh Government and instead report to the UK Government though the Lighthouse Labs.
According to the Welsh Government, these labs had been unable to keep up with demand.
A Welsh Government spokesperson said: “The UK Government experienced a spike in demand for testing through their Lighthouse Labs over the weekend, which led to reduced capacity for processing tests across the UK.
“The UK Government has assured us they are working on increasing capacity and expect these issues to be resolved shortly. Testing is con
tinuing as usual and we would urge anyone with symptoms to arrange a test as soon as possible.”
“We have recently announced £32m to increase capacity to process tests at laboratories in Wales, which includes extending our regional labs to 24-hour operation and six new “hot labs” at hospitals across Wales. This investment will increase our testing resilience ahead of the winter.”
Meanwhile, Mr Millard’s two-yearold’s test was negative and she is now doing well.
Despite his experience, Mr Millard does not want people to put off getting tested.
“People have been in touch saying the same thing happened to their family,” he said.
“I do think it is a glitch just on that day, but that does not help when it is your moment of need. I don’t want to put people off getting a test. It is really important that we all engage with this system to get on top of Covid.”
A Department of Health and Social Care spokesperson said: “NHS Test and Trace is working – we are working to increase national testing capacity and hundreds of thousands of people are being tested every day.
“There is a high demand for tests and our laboratories continue to turn test results around as quickly as possible.
“To make sure we stay in control of this virus we are targeting our testing capacity at the areas that need it most, including those where there is an outbreak, as well as prioritising at-risk groups.
“We are expanding testing capacity to 500,000 tests a day by the end of October – as well as bringing in new technology to process tests even faster.”