The case for surgical hubs: reducing waiting lists

Keir Starmer has promised more surgical hubs, greater use of the private sector, and more choice for patients as to where they have their surgeries, in a bid to reduce elective surgery waiting lists.¹ This strategy is designed to reduce the 7.5 million patients who are waiting for planned treatment, in turn freeing up resources in order to once again meet the 18-week standard for planned treatment.² This strategy, they say, will protect planned care from seasonal pressures, allowing surgeons to work through elective appointment waiting lists without being forced to postpone appointments due to pressures on other departments, such as A&E or Emergency Medicine. If this works, the Government could deliver two million extra appointments in the first year. That's quite a commitment.

However, 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. Although at face value this argument may appear to make sense, it is short-sighted and flawed as just one part of a much bigger picture. It fails to view the surgical hub as a standalone entity, instead merging it with the unpredictability of the emergency department and emergency surgery. I can see how, in doing so, a chaotic picture is created, rather than a much calmer one of systematically reducing the waiting lists that have been blighting the NHS for so long.

The whole (calmer) 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. The latter is an almost laughable fallacy; akin to expecting a car mechanic to fix your washing machine, simply because they both deal in repairs. Specialised surgical skills are honed over years, often decades, of training and cannot simply be transferred from, say, knee to gall bladder. To do so would not only waste their expertise, but also undoubtedly impact patient outcomes.