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How Knock-On Effects Challenge “the New Normal”

As lockdown has eased and the UK cautiously returns to a ‘new normal,’ the work involved in providing essential care has not subsided for surgeons or for other essential key healthcare workers - whether on the national service or in private care homes, clinics and hospitals.

In earlier blogs, we have previously noted that the challenges of meeting a ‘new normal’ are arguably made more complex with many members of essential hospital staff suffering from the effects of illness and burnout – but circumstances are made substantially more challenging now that hospitals are facing a backlog of operations delayed due to C19; and, as many of the essential workers who’ve battled tirelessly on the front lines are denied protections, and additional compensations their efforts ought to afford them.

During these last months, the Confederation of British Surgery have championed the efforts of the UK surgical community, as well as the wider communities of medical professionals and healthcare support workers throughout the c19 pandemic. We are therefore incredibly dismayed by the inadequate protections and provisions that have been made as of yet for individuals who continue to risk their health, as well as the health of their families, in order to diligently perform above and beyond the call of duty.

It is no less than shocking that after making much show of the empty gesture of “clapping for carers,” the Government has failed to appropriately financially recognise the efforts and sacrifices of nurses; care workers; AHPs; and essential hospital staff such as porters and cleaners. It is particularly galling to see those outside of healthcare pre-emptively rewarded, while those who continue to risk the most exposure to the virus are expected to perform for applause. CBS stands in solidarity with those whose essential work supports care homes, hospitals and operating theatres.

While we hope that ongoing talks will work quickly toward resolving these unfair arrangements, and CBS supports the efforts of all concerned; we recognise that during this same period, a backlog of surgical procedures will certainly affect surgeons and surgical teams not only in the UK, but across the globe.

A modelling study from the CovidSurg Collaborative published in May in the British Journal of Surgery projected that, based on a 12-week period of C19’s peak disruption to hospital services, 28.4 million elective surgical procedures worldwide would require cancellation or postponement in 2020 alone.

In the UK, early estimates stated that C19 would result in 516,000 cancelled surgical procedures (including 36,000 cancer procedures), and it was proposed that when the disruption caused by c19 ended, NHS hospitals would increase the number of operations performed each week by 20%. Under that proposal, it was estimated that it would take 11 months to clear the backlog – but depending on resources, and on how the pandemic progresses, it could take even longer.

While admission rates have now more or less stabilised, they dropped significantly lower than average in the early weeks of the pandemic, as Britons either did not want to attend hospital because of c19, or may have minimised more serious health concerns. This too may have implications for surgical referrals and waitlists, as delays in receiving diagnoses may cause complications, or result in advanced stages of disease.

The knock-on effect from postponed surgical procedures will be long-lasting, and will be particularly difficult in instances where there were already existing backlogs – for example, infants needing cleft surgery were already facing a two-year wait before the pandemic. Although the teams working with these infants and their families are immensely dedicated, the impact of pre-existing surgical delays and the knock-on effects of the pandemic could potentially result in children being left with lifelong speech issues, even after surgery.

The increasing strains on the health service have already been impacting surgical teams over the last several years. Through the pandemic, these strains have been amplified to a call that can no longer be ignored. It suffices to say that we do not yet understand what impact the colder months will have on the C19 virus, or how hospitals will respond should we face further complications or illness; however, we need to also recognise the impact of the actions, or failures to act to protect healthcare workers will have upon not just on their morale, and on the morale of entire nations - but on outcomes. We therefore wish to show our solidarity, support and compassion for colleagues across healthcare in the UK, and beyond.

As always we welcome your views and comments, please link with us via @UKsurgeons across social media platforms.

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