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The Surgical Backlog: After the Clapping Stops

Nearly one year ago, we discussed some of the implications of the COVID-19 pandemic in our blog How Knock-On-Effects Challenge “the New Normal,” which specifically addressed the backlog of postponed surgical procedures, as well as longer wait times for treatment and the significant delays for outpatient clinic appointments across the nation.  

At that point, some planned surgery had been initially postponed from April 2020 in England and Wales, in order to free up heath service resources to focus on the pandemic. Many planned surgeries were once again postponed in December 2020 in response to the second wave, exacerbating the already fraught situation.

Despite encouraging numbers in the uptake of vaccinations over the last months, increasing concerns about the Delta variant’s proliferation and reports of the UK’s highest daily totals of COVID-19 cases since February 2021 have once again brought the topic of the surgical backlog to prominence in media discussions, as the nation faces the reality of a third wave of infections.

Although strenuous efforts have been, and continue to be, undertaken to innovate new systems; to create additional clinics; and extra clinical capacity in order to cope with both the backlog, and the increased demand that has built up, inevitably an element of clinical prioritisation is always needed, to ensure that the patients who most urgently need care will receive it.

For patients whose treatment has been delayed (sometimes more than once), this complex and unprecedented situation is not always easy to understand, and their stressful experiences can be amplified when confronted with reports that hospitals have completed ~33% fewer surgical procedures than would have been expected from trends in previous years.

Whilst those involved in performing surgical procedures can recognise the myriad factors contributing to these statistics (for example, individuals deterred from attending hospital by their fear of contracting the virus, or lockdown limiting the opportunities for accidents), as indeed many others in, or adjacent to healthcare can, when the NHS is seen to attribute the shortfall to patients themselves ("because fewer people came forward for care,") it is understandable that the public may misinterpret that information, but nevertheless, such misinterpretations and ensuing sentiments can be discouraging. One aggravating example of how these distortions can become problematic are the videos shared across social media at various stages over the last year, showcasing “empty” hospitals. Such misrepresentations naturally elicited the ire of many in healthcare, and beyond. 

Whilst those of us in Medicine are united in the undertaking of extensive work to provide the best and most efficient clinical care in spite of these challenging times, dissonance between the public’s understanding of media messaging and the realities of the situation represent an additional factor that contributes to many surgical colleagues’ existing frustrations.

It is not easy to explain to individual patients and their families that they must continue to wait because there is no alternative – never mind sometimes needing to convey that message to multiple patients in the same week, on top of managing exhaustion from negotiating relentlessly busy theatre and clinic schedules as well as ‘the new normal’ of balancing work and home life. This situation also magnifies serious effects already taking a toll on frontline staff.

In the July 2020 blog, we noted that increasing strains on the health service had, at that time, already been impacting surgical teams over the preceding years; and that though the pandemic, strains had been amplified to a call that could no longer be ignored.

One year on, although we have more data and practical experience working in pandemic conditions, as well as better refined systems that continue to evolve, many of our colleagues are needing to fight for the support needed to tackle the backlog.

In order to meet the challenges ahead, we must continue to build, reinforce, and call for solid foundations of support, and these must include promoting greater public understanding: disruptions to surgery will continue to affect millions of patients and their families as well as those providing treatment for years to come, long after the clapping has stopped.

As always, we invite you to share your views and comments to our social media platforms @UKsurgeons; and encourage you to spread the word about CBS to encourage awareness and membership to your colleagues.

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