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JJMD partners with PanSurg to highlight recommendations for surgical services in the COVID-19 ‘aftershock’ landscape.
As the lead industry partner to PanSurg, we are delighted to share the full COVID-19 Aftershock Report that sets out a series of recommendations for UK policy makers to support with navigating the opportunities and barriers for the restructuring of surgical services within the NHS in the COVID-19 ‘aftershock’ landscape.
PanSurg is an academic project launched by the Department of Surgery and Institute of Global Health Innovation at Imperial College London in response to the COVID-19 pandemic. Its goal is to create data to inform health policy and to create a knowledge-sharing platform to deliver education, insights and best practice for surgeons responding to the crisis.
The PanSurg Aftershock Symposium was held on September 18th 2020 with the primary goal of assessing the impact of the COVID-19 crisis on elective surgical and interventional services. On the basis of the session analysis as well as previous PanSurg studies, the team have made 13 independent recommendations to policy makers to support the safe and efficient re-structuring of surgical and interventional services within the NHS as the pandemic continues to impact all areas of healthcare.
We are supporting the PanSurg team in raising awareness of these recommendations amongst senior NHS stakeholders, healthcare policy makers and healthcare industry.
1. Surgeons have a critical role to play in defining the national response to COVID-19 and to future health crises. There should be representation of surgical specialties within national advisory committees (e.g. the Strategic Advisory Group for Emergencies) and within those setting national pandemic research response priorities (e.g. NIHR). Surgical research during COVID-19 has been underrepresented in the national portfolio and this should be urgently addressed.
2. We propose the creation of an NHS surgical pandemic operating model based on an integrated crisis management framework (ICMF) to augment existing surge initiatives, such as the development of NHS Nightingale capacity. This approach recognises the interdependent nature of being part of a highly complex healthcare system. An enhanced approach is needed to bring together all available NHS operating resources to serve one clear strategic aim – to minimise harm to all patients.
3. All hospitals performing elective surgery must therefore now have a strategy for maintaining surgical activity in the event of further surges or future pandemics. The private sector has played a significant role in maintaining our national operative output and where this has been performed successfully this should be continued in future surges.
4. PanSurg data suggests that for some interventions, even short cessations of elective care may have an exponential impact on waiting lists. We propose pooled waiting lists for low risk elective procedures and patients across integrated, expanded natural surgical community networks. These have the potential to increase efficiency by innovatively flexing existing supply to better match demand.
5. Local plans for maintaining operative capacity must be communicated consistently and effectively to all team members and patients.
6. Macro incentives to deliver operational efficiencies in response to the COVID-19 aftershock should be reconsidered. Surgical efficiency should be locally led through engagement with clinical leaders.
7. Surgical associations and bodies must establish novel cross specialty working groups to limit the influence of siloed working between trusts and between specialties. These groups should actively engage with NHS England and wider policy makers to ensure that key learnings from future crises can be rapidly disseminated and applied to response strategies.
8. Current national surgical audit mechanisms have been too slow to respond to the pandemic. The government must reduce the barriers to accessing national health data on surgical services and it should establish novel data sets that provide greater granularity in real-time. Future data should be collected with international cooperation where possible and these data should be immediately available as an open source for emergent scientific research in times of crisis.
9. Surgical and clinical leaders should be trained and supported to adopt innovations in an agile manner at a local level. Where barriers have come down to surgical innovation during COVID-19 they should remain down.
10. NHS Trusts should offer routine COVID-19 testing to staff. This is fundamental to maintaining trust in our systems for staff and patients. Staff should be further prepared and resourced to perform the functions within an integrated operating model with particular regard to PPE requirements. Surgical working patterns should be managed long-term to minimise fatigue, viral impact and lessen further spread.
11. Healthcare providers must acknowledge the high rates of burn out and the stress caused by re-deployment and disrupted working conditions. We propose that NHS organisations establish COVID-19 rotas that provide appropriate rest, and should consider introducing freedom to speak up officers and mental health first aiders if not already available.
12. Surgical training must be urgently prioritised. Digital technologies that improve the quality and safety of surgical training should be adopted, and new national initiatives should be implemented to improve the quality and consistency of training, ensure its timely delivery and reduce its duration.
13. Diagnostics – screening for chronic disease and access to urgent diagnostics should have the same importance as COVID-19 testing. The government should adopt the recommendations of Professor Mike Richard’s report. Increasing capacity and efficiency in services such as endoscopy is now a national priority in view of the additional delays caused by the pandemic. These diagnostic pathways however require much more integration with primary care and should be moved out of hospital wherever possible.