The Case for Surgical Hubs: Reducing Waiting Lists and Protecting Emergency Care

04 February 2025

By Peter Sedman, General Surgeon, MB ChB, FRCS (Gen)Edinburgh, FRCS(Gen)England

Keir Starmer has promised more surgical hubs, greater use of the private sector, and more choice for patients as to where they have their operations in a bid to reduce elective surgery waiting lists.

There are arguments from multiple critics stating that opting to prioritise elective surgery over emergency care is a misallocation of resources. They argue that non-urgent procedures should take a backseat to lifesaving interventions, particularly as emergency departments are struggling.

But that is just one part of a much bigger picture. The whole picture comprises the impact on emergency departments of delaying elective surgery, the effect on the economy from multiple months off sick with something that could be fixed sometimes in an hour or two, and the misconception that surgeons trained in specific procedures can simply be reassigned to different departments when they are not operating.

Firstly, it’s helpful to understand some reasons why we find ourselves in this crisis. Since 1960, life expectancy has increased by 20 years, yet half of those are often spent in poor health. An ageing population adds pressure to the healthcare system in its entirety. On top of that, obesity causes health problems that we didn’t face in the past, and the care crisis means that older patients are left ‘bed-blocking’. And, let’s not forget that seasonal NHS pressures are nothing new. Add all that to the mixing pot and you have the perfect storm.

None of these problems can be sorted out overnight, but methodically working through the elective surgery lists has multiple benefits. A surgical hub allows for resources to be ringfenced. The hub won’t be fronted by an emergency department; that would be at a hospital nearby. The patient needing surgery, if it is performed in a timely manner, will not use any unnecessary resources as these hubs are purposefully resourced. Elective surgery patients likely to use emergency resources include gall bladder and hernia patients; one gall bladder patient told me she had been through the emergency department six times before she finally underwent removal surgery. The surgery takes just two hours. Other examples in the same month included patients who hadn’t had operations in a timely fashion and had ended up in intensive care for sometimes protracted stays. Imagine the resources used looking after these patients alone. The national target dictates that 90% of gallbladder removal surgeries should be performed within seven days of first emergency presentation, and we are not even close - we simply do not have the resources available to us. These, often relatively simple operations, become deprioritised in favour of more pressing emergencies, leading to more visits to the emergency department and even ICU. It is a mistake not to focus on reducing elective surgery lists in all ways possible; in failing to do so we leach resources at an alarming rate.

Protecting elective surgery from emergency surgery involves separating the two. A surgical hub is one way of doing exactly this. In Hull, we have a large acute hospital which admits all emergency medical patients with a smaller regional facility focussed on elective surgery. In separating the two, elective surgeries can be planned and carried out with no impact on emergency care resources, and do not become repeatedly postponed because of emergency demand. Without separating the two and ringfencing resources, we would be constantly moving resources from one to the other, each negatively impacting the other. It’s a constant scenario of robbing Peter to pay Paul, yet neither Peter nor Paul has sufficient resource to meet current demands. This model is the basis for the philosophy of surgical hubs, largely divorced from the pressures of the less predictable emergency services.

The key to NHS efficiency is not just in reducing waiting lists, it is in providing healthcare to our population as effectively as we should. We have not been achieving this, and it is time that changed.

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