NHS bed shortages cause late cancellation of cancer surgeries

https://www.theguardian.com/society/2019/sep/22/nhs-bed-shortages-cause-late-cancellation-cancer-surgeries

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One of the NHS’s biggest hospital trusts has apologised to a 78-year-old man after it had to cancel his cancer surgery twice in a month because of a lack of beds. On both occasions the patient, who has liver cancer, waited in the hospital for six hours and was ready to go into the operating theatre to have his tumour removed when he was sent home.

Staff at Leicester general hospital explained to him that there was no high-dependency bed for him if he experienced complications during the surgery.

“When I was diagnosed, I was told it was treatable, there was a good outcome because we’d caught it in good time. But when does good time run out? The stress levels go up every day that this carries on,” said the man, a retired electrical engineer, who did not want to be named.

“I’ve been sent home twice now after mentally and physically preparing for an operation. Meanwhile, I’m sat here, with cancer of the liver, not knowing when I will be rid of it.”

The man was initially due to have the operation on 13 August and, when that was called off, given a new date of 10 September. Both times the surgery was cancelled after he had taken drugs to prepare him for the procedure and had not eaten since the night before.

He is one of a number of people with cancer whose surgery has been cancelled by University Hospitals of Leicester NHS trust because of a shortage of high-dependency beds. He is now due to have the operation on 25 September, 128 days after he was diagnosed.

His case, first publicised by the Leicester Mercury, is a stark illustration of an NHS-wide problem, which specialists in intensive care say is worsening. People in need of a new hip or knee, or of vascular surgery, are having operations delayed as well.

“It is unacceptable that some people living with cancer are experiencing last-minute cancellations for surgery for nonclinical reasons. These people will have prepared both practically and emotionally for their operation, and this news will cause additional stress and upset at an already difficult time,” said Dr Moira Fraser-Pearce, a spokeswoman for Macmillan Cancer Support.

“We worry that these cancellations in Leicester are just one example of similar challenges faced by NHS trusts across the country, and symptomatic of a system which is underfunded and understaffed. This must not become the ‘new normal’.”

A record 4.4 million people are waiting to go into hospital in England for a planned procedure, such as a hernia repair or cataract removal. But many trusts are finding it impossible to treat 92% of those patients within 18 weeks, as they are required to do by the NHS constitution, because of bed shortages and staffing problems, which the doctors’ pensions problem has exacerbated – senior doctors have been reducing their hours and turning down extra work, to avoid large tax bills on their pensions.

Labour’s shadow health secretary, Jonathan Ashworth, a Leicester MP, said: “To have life-saving cancer operations cancelled twice like this is an absolute disgrace. I can’t imagine the anguish this gentleman and his loved ones must be going through.”

Dr Carl Waldmann, dean of the Faculty of Intensive Care Medicine, a doctors’ professional body, said that 80% of intensive care units across the UK had to transfer patients elsewhere last year because of bed shortages, and that 40% had closed beds as a direct result of staffing problems.

While the ageing population and life-extending advances in medicine have increased the demand for high-dependency and intensive-care beds, this has not been accompanied by any rise in bed numbers, leaving hospitals often struggling to cope, Waldmann said.

John Adler, the Leicester NHS trust’s chief executive, said: “Cancelling operations is not a decision we ever take lightly. We recognise the worry and distress that cancelling an operation can cause our patients and their families. But the safety of our patients is our main priority.

“Between 1 January and 17 September 2019 we carried out over 5,000 operations on patients with cancer. Regrettably, 0.2% of those patients had their planned surgery cancelled twice, but we made it a priority to rebook those operations as soon as possible.

“We cannot operate on patients if we have nowhere to care for them. We cancelled these cancer operations predominantly due to the lack of a bed in intensive care.”

The trust is building an 11-bed extension to the intensive care unit at its Glenfield hospital. It plans to add six more beds at Leicester Royal Infirmary, and hopes eventually to increase its supply of beds from 66 to 100. It may do the same at Leicester general too.

Adler added: “The key constraint is the availability of sufficient medical and nursing staff for the additional beds. But we will add extra beds if we safely can.”