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Anaesthetist Shortage Could Prevent "Surgery Hubs" Clearing NHS Backlog

4 min read

The government has been criticised by a leading medical body for putting "cash on the table" for surgery hubs to clear the NHS backlog without considering the current lack of highly trained staff needed to run them.

The UK is currently 1,400 anaesthetists short with one-in-ten positions vacant, and it could take up to two years for enough doctors to complete their training to build up workforce numbers in operating theatres, according to the Royal College of Anaesthetists.

Chancellor Rishi Sunak announced this week that the treasury has set aside £1.5 billion in the Budget and Spending Review this week for increased hospital bed capacity, equipment and new hubs equipped with four to five surgical theatres to be used for critical elective surgeries. He hopes this will support efforts to clear the NHS backlog. 

But Professor William Harrop-Griffiths, Vice President of the Royal College of Anaesthetists, told PoliticsHome that they have seen no coherent plan detailing how the hubs could run, especially in the current staffing shortages in the NHS.  

Building the new theatres would be a short term solution, he suggested, but staffing them is a "medium term project" at best. 

"The plans have to go hand in hand [with staffing]," he said.

"Surgery hubs are certainly something we support but where are the theatre nurses going to come from, the anaesthetists and the health care assistants?

"There's no coherent plan we can see. We would like the government to talk to us about how they are going to do this." 

Earlier this year The Royal College of Surgeons of England released their report A New Deal for Surgery, which set out how surgical hubs running separately to emergency services could help the NHS withstand infectious outbreaks, including Covid-19. They asked the government to widen the hub model and include specialities like cancer surgeries and orthopaedics.

However they also stressed that there must also be a long-term plan to increase the number of doctors, including anaesthetists and surgeons, from 2.8 to 3.5 per 1,000 of the population, in line with the Organisation for Economic Co-operation and Development average.

Professor Harrop-Griffiths said: "I understand what motivates the government - they are keen to get the backlog down. I'm not saying we can't make inroads into the backlog. We hope Covid numbers go down to allow us to do procedures that are needed but there's a limit to the amount we can work. 

"Anaesthetists worked on the Covid response in critical care and are a tired, and some of them are a demoralised workforce at the moment.

"It's not as simple as putting cash on the table."

Harrop-Griffiths said there are hundreds of doctors who want to specialise in anaesthetics, and it is a popular choice for junior doctors, but that training posts just aren't available at the moment.

"Citing figures from May's recruitment round for ST3 training places, he said 865 doctors applied for the 359 posts on offer, meaning 506 people missed out.

A survey by The Royal College of Anaesthetists taken in 2020 also found issues with finding enough senior staff. Anaesthetic departments reported an 8% consultant-anaesthetist gap, with over 90% of departments having at least one consultant vacancy.

The survey also showed that 25% of consultants and 29% of anaesthetists in training plan to leave the NHS within five years, further contributing to a shortage of those in senior positions.

Professor Harrop-Griffiths said more training places need to be created as soon as possible as well as ramping up work on diversifying who can deliver anaesthetic medicine. He wanted to see more training as "anaesthetic associates" – highly skilled medical staff who can work in a specialty other than their own under a consultant. 

President of the Royal College of Surgeons of England Professor Neil Mortensen has also welcomed the surgery hubs but said staff re-deployed during the pandemic need support to get back into the operating theatre. 

He said: "To staff the hubs, surgical trainees who were re-deployed during the pandemic should be supported to return to surgery.  They are essential members of the surgical team. Senior consultants considering retirement need to be persuaded to stay on and help tackle the record backlog.”

A Treasury spokesperson said more details on how the hub model will work will be released following the Spending Review on Wednesday October 27 when full departmental spending settlements will be released. 

The Department for Health and Social Care has been approached for comment. 

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