It’s not over yet…we still have another mountain to climb.

How different things are now in April compared to January! The intensive care unit is back to a normal size, we’re getting way fewer COVID related admissions.  Cases have reduced dramatically thanks to the lockdown, but they’ve started levelling off now.  Despite this, the hospital admissions and deaths are still plummeting, and that’s thanks to the willingness of the British public to be vaccinated.  The public have largely listened to the experts rather than some post forwarded on a family WhatsApp group promoting the benefits of inhaled steam, or turmeric.  The public have heeded their call and attended the vaccination centre with pride, felt a part of the war effort, posted their vaccination status on social media.  Thanks to this, being vaccinated became the normal thing to do, and the UK now has a vaccine uptake rate of around 95% in the over 60’s – a staggering statistic in my opinion, beyond our wildest dreams.  

On the 12th of April, along with the opening of gyms and shops, I’m back in my normal pre-surge job plan.  We managed the surge by moving a lot of staff (including me) out of routine surgery and onto the acute COVID wards and intensive care units.  For consultants like me it’s changed the way we work during the surge, but it won’t have a longer term effect on my career.  For our trainees, however, the disruption has been considerable.  Postgraduate exams have been delayed, recruitment difficulties have been rife, training units missed will invariably extend the time spent in training posts, and the reduction in routine care has massively reduced the training opportunities. Our trainee doctors – anaesthetic, surgical and others - will feel the impact of the surges for years to come.  

We have another mountain to climb now – getting our routine services back to normal.  Many hospitals have managed to get through some routine treatments during the surge, but at nowhere near the level of throughput needed to keep up with demand.  In December 2020 – so before the latest surge disrupted elective work even more – nearly 70% of patients had to wait longer than 18 weeks before starting their treatment (our pre-covid target is to have 92% of patients treated within 18 weeks).  A staggering 4.5 million people were waiting for treatment, and 225,000 of these were waiting over a year.  By now, four months later, these figures will be much worse and even those will be an underestimate. Many patients will not have gone to their doctor yet, and GPs are still not fully back to normal face-to-face service.  

We call this “routine” surgery, but routine cases need to be dealt with in a timely manner, otherwise they become urgent and complex. Small hernias grow in size, or twist on themselves, becoming surgical emergencies.  Gall bladder disease causes infection, pancreatitis, jaundice, and prostates become larger and cause kidney failure. Delaying these operations not only increases the chance of complications, but the operations themselves become more difficult and take longer.   

One of my colleagues underwent a hip replacement in November, and I saw first hand how disabled she was becoming from the arthritis that was causing her constant pain.  She continued working through a mixture of painkillers and pure grit, but when she got her operation she wasn’t far from having to limit her working life considerably.  She was lucky, but up and down the country there will be thousands of patients in severe pain, unable to work, getting less fit by the minute, and still have no hope of getting their hip replacement anytime soon.  

Preparing for routine surgery now involves our patients taking COVID PCR tests and self isolation according to the NICE guidance, with some hospitals additionally requiring 14 days self isolation, which parents with children, people with insecure jobs or zero hours contracts, or carers, simply cannot realistically do. It also makes it extremely difficult to make last minute substitutions if a patient cancels, and therefore reduces the efficiency of our operating theatre.  Rather than insisting on PCR swabs and isolation, which is variably observed anyway, isn’t it time to update the guidance to take account of the protection the vaccine offers, and improve the access to surgery for those groups I mentioned above?  I accept it’s not 100% protection, but then nothing is, everything we do is a balance of risks, and the accuracy of a single PCR swab is much lower than the 95% protection two doses of the vaccines provide.  

We do have a mountain to climb, but we need to ensure the whole team climbs it – including our student doctors and specialist trainees.  We must give as many patients as humanly possible access to the surgery they need, and we have to get surgical and anaesthetic training back on course so our future consultants have the training they need and deserve.  These are conflicting priorities, as training opportunities reduce efficiency, because the operations take longer. It’s therefore absolutely vital that we reduce other factors that unnecessarily slow us down and reduce access to surgery.  Streamlining the COVID guidance will allow our patients easier access to our services, make us more efficient, and improve training opportunities, and our experience at work too.  

Now, let’s get back to work…