Theatre delivery and COVID-19 recovery, then vs now

Jonathan Stickland, November 2022

Introduction

Rotamap provides twice-yearly benchmarks for our client hospital organisations. This benchmark data was used at our Autumn 2022 forum to compare theatre delivery prior to the outbreak of COVID-19 with the initial 'living with COVID-19' period in the first half of 2022. This has been done through the lens of Anaesthetic department delivery, and with the delivery plan for tackling the COVID-19 backlog of elective care in mind.

At the time of writing, NHS waiting lists for consultant-led elective procedures are at a record high. In July 2022 over 6.84 million people were waiting for treatment, with 2.67 million people waiting longer than 18 weeks.[1]

To combat this, the NHS published a Delivery plan for tackling the COVID-19 backlog of elective care which states that:

"The ambitions for patients are supported with a clear plan, aimed at delivering around 30% more elective activity by 2024/25 than before the pandemic"

Although some of this increase is expected to be met by purchasing private sector elective capacity, a significant proportion is set to be delivered by existing departmental resource. For the 2022/2023 period, the NHS has set an expected baseline delivery of 104% of pre-pandemic levels, with additional funding available for departments that deliver more.[2]

Where is the data from?

Rotamap currently rosters over 85% of the UK NHS Anaesthetist workforce, with 128 UK anaesthetic departments using our rostering service CLWRota both prior to the COVID-19 pandemic and now. We have drawn comparisons between two 26 week periods, the first spanning late January to late July in 2019 and the second spanning late January to late July in 2022.

Of note, consultant staff numbers in these departments have grown by roughly 10% over the period. Furthermore, specifically how departments use CLWRota, and what they record in the system may have changed over the two periods due to the rapid changes in service delivery required over that time. Accuracy of the data, in particular the classification of types of activity delivered and leave taken, depends on accurate input from the departments analysed.

The numbers below represent the total number of sessions delivered over the two periods described above. They represent all sessions delivered in “Standard” locations in CLWRota, and so should be reflective of normal DCC (Direct Clinical Care) activity delivered by anaesthetic departments.

Total delivery

Figure 1. Total sessions delivered in both reporting periods, alongside the percentage change in total session delivery.

Figure 2. The percentage change in total session delivery, broken down by speciality.

Despite efforts to tackle the backlog, elective specialities are clustered on the left hand side, delivering significantly fewer sessions than before the pandemic.

Extra delivery

Extra sessions in CLWRota ordinarily represent work delivered by a consultant for additional payment, above and beyond their normal contracted hours.

Figure 3. Extra paid for sessions delivered in both reporting periods, alongside the percentage change in extra paid for session use.

Figure 4. The percentage change in extra paid for session use, broken down by speciality.

As above, elective specialties have a comparatively low change in extra paid for session use. Conversely, cancer led specialities like colorectal and breast have seen an increase so as to be able to maintain the largely stable service delivery seen in Figures 1 and 2.

Solo delivery

Solo sessions (otherwise known as trainee led lists) in CLWRota represent work delivered by a trainee without the direct supervision of a consultant.

Figure 5. Solo sessions delivered in both reporting periods, alongside the percentage change in solo session delivery.

Figure 6. The percentage change in solo session delivery, broken down by senior and junior trainee grades, as specified by CLWRota users in system.

Delivery over time

Figure 7. Total sessions delivered over time across the CLWRota cohort.

From 28th January, 2019 to 24th July, 2022, each data point on the graph represents one week of delivered sessions for the 128 anaesthetic departments included in the data set. The shaded areas show how the sessions were delivered (either as normal DCC work, extra, or solo).

Individual department delivery over time

The picture for individual departments is, naturally, more varied. Also of note is a significant drop in delivery over the June 2022 Platinum Jubilee bank holiday, in many cases comparable to the Christmas drop in previous years.

Figure 8. Four departments whose session delivery has not recovered since the start of the COVID-19 pandemic.

Figure 9. Four departments whose session delivery has remained stable over the course of the COVID-19 pandemic.

Figure 10. Four departments whose session delivery has increased since the start of the COVID-19 pandemic.

Figure 11. A department whose session delivery has not recovered since the start of the COVID-19 pandemic, showing how sessions have been delivered.

Figure 12. A department whose session delivery has remained stable over the course of the COVID-19 pandemic, showing how sessions have been delivered.

Figure 13. A department whose session delivery has increased since the start of the COVID-19 pandemic, showing how sessions have been delivered.

Sessions missed due to leave

Sessions missed due to leave represent approved leave booked over scheduled work, according to a Consultant's templates in CLWRota. Planned leave will typically be made up of Annual leave and Study leave. Unplanned leave typically represents types of sick leave, and includes COVID-19 related absence.

Figure 14. Sessions missed due to planned leave in both reporting periods, alongside the percentage change.

Figure 15. Sessions missed due to unplanned leave in both reporting periods, alongside the percentage change.

The increase over time in sessions missed due to both planned and unplanned leave is likely to be higher, as departments that moved to flexible annualised job plans will reduce the 2022 figure.

Conclusions

Overall, the picture across these 128 NHS anaesthetic departments is one of increased extra session usage, alongside a much smaller increase in total output; 3% less than the 104% elective baseline delivery set by the NHS for this year. Increases in both total output and extra use lie with reactive urgent care led specialties like Obstetrics and Gynaecology, Trauma, and Emergencies, rather than elective specialities. According to the data, the increased expenditure we are seeing on extra sessions does not directly correlate with a reduction in the elective backlog.

An increase in unplanned leave is possibly part of the reason for the aforementioned trends, and is likely to reflect the high incidence of COVID-19 related absence that has hit the NHS workforce this year. Anaesthetic departments that we contacted have additionally suggested early consultant retirement as a reason for high extra use. Though CLWRota does not hold suitable data on this, the BMJ indicates the number of doctors taking early retirement from the NHS has more than trebled over the past 13 years,[3] and 43% of respondents to a BMA survey in September 2021 agreed with the statement 'I plan to retire early'.[4]

We are interested to hear the experiences of individual departments or organisations to see how they match up to our findings, and to find additional reasons behind our conclusions that we have not been able to determine.

Contact us

If you have any questions about your department's benchmarking pack, or would like graphs showing a longer spread of historical data, please contact the Rotamap support team at support@rotamap.net or +44 (0) 20 7631 1555.

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