A call for greater investment in surgical facilities in the UK in the wake of the COVID-19 pandemic has been welcomed by the president of the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS), who says the pandemic has highlighted the need for greater resources to support cardiac surgery.
Simon Kendall (South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK) was responding to The Royal College of Surgeons of England’s call for a “New Deal for Surgery”, issued to the UK government today, in which it called for additional funding to improve the sustainability of surgical services. Additionally, the College has backed the creation of ”surgical hubs” across the country, to deal with a backlog in elective surgical procedures, which has built up during the pandemic.
The New Deal report makes 12 recommendations to government, including both long- and short-term measures designed to improve the future sustainability of surgical services. The report details the “devastating” impact the COVID-19 pandemic has had on surgical services in England, particularly due to the cancellation of elective procedures during the early months of the pandemic.
Speaking to Cardiovascular News following the release of the College’s report, Kendall says that the delivery of cardiac surgery in particular had been severely disrupted due to COVID-19. He also suggests that patients may have been reluctant to seek care during the early months of the pandemic, for fear of contracting the virus within healthcare facilities, which has had knock-on effects for cardiovascular care.
“I think what we are finding now is that patients are presenting who have been hiding their symptoms at home, who were frightened of COVID-19,” Kendall comments. “We are now finding patients with more advanced disease, who are sicker and frailer, so we feel that the risk score has changed, because of the pandemic.”
Kendall adds that the pandemic has highlighted a need for more intensive care beds for patients, including those undergoing cardiac surgery, commenting that there is a need for investment in these facilities particularly in congenital cardiac surgery.
And, he says, the pandemic has put a strain the delivery of Level 3 critical care which is required for cardiac surgery patients. “You have got a lot of surgical teams who are ready to operate and get back to full speed, but we cannot push too hard because those Level 3 facilities have had a really rough year, and there is a balance between treating patients who need cardiac surgery, and also not overburdening the teams in critical care that have been so put upon,” he said.
The establishment of surgical hubs—secure facilities to facilitate COVID-19-free environments for the treatment of patients—has been touted as a potential option for cardiac surgery practices, to mitigate against the impact of the pandemic and as a means of continuing to provide care, if healthcare services are once again overburdened with COVID-19 cases.
In a press release promoting the College’s recommendations today, the organisation’s president, Neil Mortensen (University of Oxford Medical School, Oxford, UK), notes: “The ‘surgical hub’ model is the best way we can keep treating people who need operations, regardless of future pandemics. But it requires being open to doing things differently. Throughout the pandemic, staff have gone wherever they are most needed, working flexibly and collaboratively to put patients’ interests first.”
Commenting on this proposal, Kendall says that the need to offer Level 3 care to patients undergoing cardiac surgery could make its implementation challenging in the cardiac specialty. Instead, Kendall advocates the need for significant investment in Level 3 facilities, staff recruitment, and retention—but also that the professional teams of anaesthetists, surgeons and practitioners work together to embrace enhanced recovery after surgery (ERAS) pathways, “to give patents better care and experience as well as making best use of our limited Level 3 care”.