COVID-19 and UK Surgery
Over the last several weeks, the impact of the coronavirus COVID-19 has necessitated dramatic changes across the United Kingdom, both for the British public; and for healthcare systems and medics, who face the highest risks while continuing to provide care on the front lines.
The Confederation of British Surgery is supportive of, and encouraged by, the efforts of surgeons, as well as of surgical trainees, working under some of the most challenging conditions the UK has ever faced. Equally, CBS appreciates of the tremendous work being conducted by the royal colleges of surgery and by surgical associations, who have collectively endeavoured to convey advice on best practices in a landscape that seems to shift from moment to moment.
CBS recognises the formidable tasks, significant adjustments and necessary adaptations that have gone into meeting challenges raised by the pandemic, and we applaud these efforts. Additionally, CBS acknowledge that surgeons and surgical teams face different frustrations within specialisms, and in different regions; and that despite the efforts being made, rapidly evolving circumstances and Government policies considerably impact the situation for surgeons across Great Britain and Ireland.
The month began with broad recommendations issued jointly from the royal colleges of Great Britain and Ireland. This intercollegiate guidance discussed adapting surgical services to cope with COVID-19; the triage of non-emergency surgery; the delivery of surgery within networks; necessary adjustments to rotas; and instructions on carrying out virtual outpatient clinics. It further touched on issues to take into account when working outside one’s comfort zone in an extended scope of practice, which included advice for trainees and for surgeons returning to practice after retirement. Critically, the guidance aimed to protect the surgical workforce, to prevent infection, and to prioritise surgeons’ and surgical teams’ well-being.
Just days after this was issued, updated guidance from the UK Government necessitated changes and clarifications regarding the use of PPE in common general surgical settings - including wards, admission areas, endoscopy and operating theatres.
With the support of the four surgical royal colleges, NHS England published its clinical guide to surgical prioritisation during the COVID-19 pandemic, and the colleges have since been impressively adapting content to support surgeons and surgical trainees through webinars.
On April 12th a survey conducted by the Royal College of Surgeons of England
decried PPE shortages as a ‘postcode lottery’ of the essential safety equipment, when a third of surgeons and trainees across the UK said they did not believe their Trust to have an adequate supply, risking their safety.
Additionally, almost 60% of respondents said they had seen shortages in the preceding 30 days. The data demonstrated wide regional variation, with more than half (52%) in the Thames Valley saying they currently had access to adequate PPE, but little more than a third (34.7%) saying the same in the North West. In London, a third of respondents said they did not believe their Trust had an adequate supply of PPE. After health officials had admitted earlier in the month that only 2,000 of half a million frontline NHS staff had so far been tested, more than half of the respondents were also sceptical about their chances of being tested for COVID-19. These sentiments were particularly prolific in the East of England, where 75% of surgeons said they believed they would not get access to a test.
On April 17th the UK Government released yet another update to PPE guidance, which put forth guidelines reviewed by the Health and Safety Executive, citing the ‘exceptional circumstances…that do not reflect HSE’s standard approach.’ This document has received substantial criticism from medical professionals, including the royal colleges.
The following day, Professor Neil Mortensen, President-elect of the Royal College of Surgeons of England made a statement expressing that the College was “deeply disturbed” by the latest change to PPE guidance, which was issued without consulting expert medical bodies. Professor Mortensen stated that after weeks of working alongside sister medical colleges to help Public Health England deliver the correct PPE guidance, the new update risked confusion and variation in practice across the country.
According to Professor Mortensen;
“The new guidance implies that, even in the operating theatre, surgeons and their teams may not require proper PPE. This is simply unacceptable. Whilst we appreciate that waterproof laundered gowns may still be available in many operating theatres, the proposed alternatives to fluid repellent gowns or coveralls are wholly inadequate for an operating theatre environment.
“Theatres are high risk areas where surgical teams are inevitably exposed. Like all doctors, surgeons are committed to their patients. We know many will put themselves in the firing line. However, if fluid repellent gowns or coveralls are not available, then surgeons should not risk their health.
“We must not forget either the desperate needs of thousands of patients who still require life-saving surgery - road accident victims, people with severe appendicitis or those needing urgent cancer operations. If these operations can’t go ahead, many will die. We are calling on government to ensure that the depleted PPE supplies that remain, are used to maintain the most urgent and emergency services.”
At the time of writing of this blog, surgeons have not as yet had a public response from the UK Government.
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