NHS surgeons say productivity is 50% lower than before Covid-19

By | August 29, 2020

NHS surgeons are only working at 50% capacity because of Covid-19 – despite a record 1.85million patients waiting for routine operations, experts warn

  • The Royal College of Surgeons revealed surgeons were working at half capacity
  • Covid-19 safety measures were making it difficult to pick up services again
  • Figures show 1.85million people have waited more than 18 weeks for routine ops 

NHS surgeons are only working at around 50 per cent capacity in the wake of the Covid-19 pandemic, despite record numbers of people on the waiting list for routine treatment. 

Professor Neil Mortensen, president of the the Royal College of Surgeons, revealed surgeons ‘didn’t have much to do’ during the lockdown, as routine operations were cancelled to make room for an expected swarm of Covid-19 patients.

But they are struggling to get back to pre-coronavirus activity levels, despite barely any infected patients being in hospital. Surgeons say infection control measures and a lack of testing have left them unable to attack the backlog. 

Official figures show there are no more than 770 patients with the disease in hospital across the UK, just 64 of whom are on ventilators. 

Meanwhile, data shows 1.85million people have waited at least 18 weeks for planned surgery — the target time set by the NHS. It is the worst figure since records began in 2007.  

NHS surgeons are only working at around 50 per cent capacity in the wake of the Covid-19 pandemic, according to Professor Neil Mortensen, president of the The Royal College of Surgeons (stock)

NHS surgeons are only working at around 50 per cent capacity in the wake of the Covid-19 pandemic, according to Professor Neil Mortensen, president of the The Royal College of Surgeons (stock)

Professor Mortensen told The Telegraph: ‘Most surgeons would say productivity is around half what it was before.’

He told the newspaper that there were obstacles in restoring services to levels seen before Covid-19, which experts say is needed to clear the backlog. Health bosses fear up to 10million patients will be left waiting for treatment by this winter.

A lack of routine testing for NHS staff is hindering efforts to create ‘Covid-free’ zones in hospitals, he said.

And doctors have previously warned social distancing in hospitals will mean fewer patients can be admitted at any given time.

Medics said efforts to restore services are moving too slowly, with some likening their empty hospitals to ‘the Mary Celeste’ — a ship discovered abandoned in the Atlantic Ocean in 1872 — because so many patients are being kept away. 


More than 15million patients are currently waiting for treatment on the NHS’s ‘hidden waiting list’ – nearly four times higher than the official 3.9million, a report claimed yesterday.

Freedom of Information requests to NHS trusts have put the total number of people awaiting follow-up hospital appointments at 15.3million.

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Bahman Nedjat-Shokouhi, the chief executive of healthcare tech company Medefer, which calculated the new data, called the official list ‘the tip of the iceberg’.

Speaking to The Times, Mr Nedjat-Shokouhi said: ‘Almost four times the number of patients need appointments, as the official figures capture only the new referrals and not the patients who require ongoing care.

‘We need a plan to deal with both groups to avoid patients coming to harm.’

The official waiting list shows the number of patients yet to have their first hospital appointment after a GP referral.

It stands at 3.9million and has remained stable during the pandemic. But long waits have increased, with the number of patients waiting more than a year standing at 50,536 in June, compared with 1,643 in January, before the pandemic hit.

However, the total number of patients who are on hospital books in England and need a follow-up appointment for health problems is not accumulated centrally. This is the so-called ‘hidden’ waiting list.

The Times reported the 15.3million figure was calculated by asking NHS trusts how many patients who needed a follow-up appointment – but were not captured in the official waiting lists known as the ‘referral to treatment pathway’ – were on their lists.

They added there is no suggestion all 15.3million are overdue an appointment.

One in seven trusts replied, and analysts extrapolated the national figure by weighting those trusts’ figures according to the proportion of national GP referrals they received.


An NHS spokesperson said: ‘Actually, elective surgery has already rebounded from around 30 per cent of its usual rate during the peak of covid when hospitals were looking after 108,000 coronavirus inpatients, to over 60 per cent earlier this month, and is steadily increasing beyond that. So predictions that surgery will be stuck at 50 per cent of usual levels are already clearly false.

‘As for emergency services, we agree with the new leadership of the Royal College of Emergency Medicine that covid means safe alternatives are needed to A&E overcrowding.’

Dr Susan Crossland, president of the Society for Acute Medicine, added: ‘There is still pressure on the system due to the cautious restart of outpatient and elective work compounded by the reduction in acute beds due to the necessity of infection control and isolation.’

In March, all routine surgery was postponed to free up 30,000 beds for Covid-19 patients who were expected to flood hospitals. 

Hospitals in England were told to postpone all non-urgent elective operations from 15 April at the latest, for a period of at least three months.

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Joint replacements, cataract removals and hernia repairs were all among the elective surgery postponed in order to free up beds. 

In May, health leaders set out a series of measures to help hospitals increase routine operations and treatment, to get back to normal activity levels.

But patients who need important planned procedures will be put in the diary first, leaving millions who are not in urgent need — but still possibly in pain — waiting. 

Professor Mortensen, a colorectal surgeon, said many patients had been left distressed following the decision to suspend routine surgery for months.

Data revealed last month showed around 1.85million people have waited more than 18 weeks for routine treatment in England — the most since records began more than a decade ago. Under the health service’s own rulebook, patients should be treated within 18 weeks of a GP referral.  

Experts fear 10million people may be waiting for treatment by Christmas as hospitals grapple with the resume of non-urgent care while maintaining social distancing. 

And cancer charities have warned of a ticking time-bomb of the disease because so many appointments and procedures had to be cancelled by the NHS so hospitals could make way for an expected deluge of coronavirus patients. 

However, it is also estimated one million Covid-19 patients could have died had there not been efforts to protect the NHS, according to reports. 

A potential second wave in the autumn and winter, coinciding with the flu season, will cause even more chaos in the NHS, experts fear. 

It had been hoped the private sector would help deal with non-Covid patients during the pandemic.

Private hospital beds were bought by the NHS — 8,000 at an estimated cost of £2.4million a day — in anticipation of NHS hospitals being overwhelmed.

The idea was to use private hospitals as ‘Covid-free hubs’ to take on the load of other care for vulnerable people, such as for cancer patients. 

But the health service’s intensive care wards were not overrun during the peak of the pandemic and the majority of the private beds went unused — even though thousands of operations were cancelled.  

Consultants have warned few private hospitals are now operating as Covid-free hubs to get back up and running, and claim hundreds of the country’s best doctors have been left ‘twiddling their thumbs’.

It comes amid fears the strategy to ‘protect the NHS’ actually cost lives.

Recent government figures revealed the lockdown killed two people for every three that died of the coronavirus between March 23 and May 1.

Some 16,000 are thought to have died because they didn’t get medical care for problems such as heart attacks while 25,000 died of the virus, according to a report given to SAGE, the Government’s Scientific Advisory Group for Emergencies.

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The 16,000 people who died included 6,000 who didn’t go to A&E during lockdown because they feared catching the virus.

Another 10,000 people are said to have died in care homes after being discharged early from hospital and having a lack of access to care.

The ‘stay at home’ message was driven hard throughout March, April and some of May, and statistics show A&E attendances dropped massively as a result. 

Casualty departments in England recorded just 1.53million attendances in March, down 22 per cent on February and 29 per cent on March 2019.

A&E visits were 57 per cent lower in April 2020, when up to 1,000 Covid-19 deaths were being reported per day, compared to April 2019.    

Dr Chris Moulton, former vice president of the Royal College of Emergency Medicine, said he feared Covid-19 safety measures being made by the NHS were now putting patients at far greater risk.

The A&E consultant said too great a reliance on ‘virtual’ consultations meant people were being denied basic care. 

Dr Moulton said: ‘My worry is that a number of organisations, including the NHS, are using Covid as a reason to distance themselves from people and that carries risks.’

Policies which encourage patients to book an A&E appointment by calling 111 will also make it challenging to access immediate care, he said.  

Plans for a ‘phone first’ model are set to be rolled out across the NHS before December, according to board papers seen by The Times in July, in order to relieve pressure on the NHS.

Pilot studies of the ring-ahead scheme at casualty departments in Portsmouth and London have reportedly produced good results.

Stephen Powis, NHS England’s national medical director, told the Commons Health and Social Care committee that the NHS wanted to move towards a phone-ahead scheme.

He revealed at the end of June: ‘We want to move — as we did before Covid — increasingly to a 111-first model, which ensures that we do everything we can to give appropriate advice to signpost people to the most appropriate place for treatment.’ 

Dr Moulton said: ‘The last thing [you want] when you are in an emergency is to make a phone call; if you’ve chopped your fingers off you don’t want to phone before you go,’ said Dr Moulton, an A&E consultant at Bolton NHS Foundation trust.

‘I worry that under the guise of a post-Covid world we are making it harder and harder for people – especially the elderly – to access hospital and GP care, making people navigate online and with videos.’ 

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