What were you doing in November 2024?
Kemi Badenoch took over running the Tory party. Gary Lineker ended his run on Match of the Day and Queen Camilla cancelled some engagements because…
… she had a chest infection…
… she wasn’t the only one. The NHS was choc-a-bloc with respiratory infection customers, occupancy well over 95%.
NHS staff sickness was running north of 5% and the system was still recovering from a bout of junior doctors’ strikes.
These issues were significantly impacting NHS surgery cancellation rates.
At the same time…
In light of recent events, it’s important to address NHS surgery cancellation rates and their impact on patients.
… researchers for the National Institute for Health and Care Research Central London patient safety research collaboration, NHS England, University College London and the Royal College of Anaesthetists examined planned surgery data over seven days in November 2024.
They found one in ten NHS operations are cancelled at the last minute.
They published their results last week and made a big thing of it. Rightly so…patients prepared, families arranged, beds booked… and then, nothing.
Another date, more anxiety, more waste.
What they never thought to mention is; internationally, last-minute surgical cancellation rates typically sit somewhere between 5% and 14%.
On that measure, the NHS… at around 10%… is not uniquely bad. It’s average. Not good but…
… factor in the time of the study and the extraneous aggro the NHS had to put up with… it’s not too bad a result, but…
… since silly boy decided to badmouth the NHS with his ‘broken’ schtick, it’s open season for the posh boys of academia to pile in with flaky studies.
Is there anything to see here? Not in the report, but…
maybe…
… when you look at the best-performing systems, which this dodgy report really doesn’t … Denmark, the Netherlands, parts of Scandinavia, you do see something different.
They don’t accept last-minute cancellations as routine… they design them out;
Patients are properly prepared before they ever get near a theatre list.
Pre-operative assessment happens weeks in advance.
Comorbidities are stabilised early.
Diagnostics are completed in time to matter…
… by the time a patient is listed, they’re ready to go.
In those systems, the theatre is not where problems are discovered. It’s where care is delivered.
Contrast that with the NHS.
Too often, pre-op acts as a filter rather than a preparation process.
Problems such as;
blood pressure,
anaemia,
incomplete tests,
unresolved clinical questions
… are discovered sometimes on the day.
The result is predictable; lists overrun, patients are stood down, and expensive theatre time is lost.
The data behind the study suggests up to 40% of the 10% cancellations could be avoided. That’s about one in every 25 planned operations is cancelled unnecessarily.
Other countries face the same challenges. Emergency pressures.
Workforce constraints. Patient complexity. None of this is unique to the NHS, but …
…they respond differently.
Canada and Australia, for example, accept variability and manage it.
They use standby lists of ready patients and build flex into schedules. If one patient falls away, another takes their place. It’s not perfect, but it limits waste.
The best systems go further. They reduce variability upstream… treat patient readiness as a core operational discipline. Cancellation is not an inconvenience, it’s a signal of pathway failure.
The uncomfortable truth… the NHS has known this for years.
In the era of the NHS Modernisation Agency, and subsequent improvement programmes, we saw productive theatre initiatives. Robust pre-operative assessments reduced cancellations, improved utilisation and delivered better outcomes.
Not headline-grabbing, but effective. Why didn’t it stick?
Because… doing it properly is hard.
It needs;
coordination across the system including primary care,
diagnostics,
anaesthetics,
surgery.
Investing upstream in pre-operative clinics and
patient optimisation…
… much of which creates double-running costs.
It needs the NHS to behave like a system rather than a collection of organisations and the answer to that might be vertical integration of primary and secondary care.
Under pressure, the instinct is always the same…
… fill the lists. Chase the numbers.
Preparation gets squeezed. Pre-op moves closer to the day. The system becomes brittle…. when it fails, it fails at the most expensive point.
We are not uniquely bad. We are consistently average at something the best systems treat as unacceptable.
Cancellations can be designed out, but in the NHS, they are managed.
The consequence… a system where one in ten theatre slots is lost at the point of maximum cost.
The researchers have taken since 2024 to figure this out.
It took me about ten minutes to find out how to fix it.
Please put my PhD in the post.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
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