NHS waiting lists: a new approach to elective care

Article Summary

This article explores how the NHS is responding to record waiting lists through new models of elective care, including dedicated surgical hubs, Community Diagnostic Centres and virtual wards. Drawing on insights from Tim Mitchell, President of the Royal College of Surgeons; Pradip Karanjit, Deputy Chief Operating Officer at North West Anglia NHS Foundation Trust; Philippa Slinger, former Chief Executive across acute, mental health and community trusts; and Isabel Lawicka, Head of Policy and Analysis at NHS Providers, who reflect on progress, challenges and what is needed next for sustainable elective recovery.

NHS waiting lists remain one of the most pressing challenges facing the health service. With more than 7.5 million people now waiting for treatment, it is clear that reducing backlogs cannot be achieved through incremental change alone. Across England, the NHS is deploying new models of care, from dedicated surgical hubs and Community Diagnostic Centres to virtual wards and outpatient clinics in non-traditional settings, to increase capacity, improve flow and protect elective care from disruption.

In the September edition of FORTIS magazine, experts Tim Mitchell, Pradip Karanjit, Philippa Slinger and Isabel Lawicka reflect on how these innovations are performing in practice, and what still needs to change to get ahead of demand.

Tackling NHS waiting lists through surgical hubs

Speaking at the launch of the surgical hubs last year, Health and Social Care Secretary Steve Barclay was determined to take on the waiting list of 7.3 million, a figure that has since continued to rise. “In order to bust the Covid-19 backlogs and keep pace with future demands, it can’t simply be business as usual. Surgical hubs are a tangible example of how we are already innovating and expanding capacity to fill surgical gaps across the country, to boost the numbers of operations and reduce waiting times,” he added.

Surgical hubs, typically elective-only, ringfenced from emergency pressures, are designed to protect theatre time and improve productivity. For Tim Mitchell, President of the Royal College of Surgeons and a leading advocate of the model, this separation is critical.

We’ve had difficulty with surgery for many years, particularly during the winter months when there is extreme pressure from emergency care, which clearly must be dealt with. The consequences of that have been that theatre time for elective surgery is taken up by emergencies.

Setting new standards through accreditation and teams

Surgical hubs are being accredited through Getting It Right First Time (GIRFT), an NHS England initiative developed in consultation with the Royal College of Surgeons. Professor Tim Briggs, Chair of GIRFT and NHS England’s National Director for Clinical Improvement and Elective Recovery, has overseen site accreditation visits across the country.

“All of the sites we accredited are focused on providing an excellent patient experience and several are setting new standards for day case surgery and innovative models of care. We want to provide the assurance for patients and staff that these sites are delivering safe and high-quality care and will continue to accelerate their progress and productivity in the future.”

For clinical teams, the appeal of hubs is clear,

“On the whole, surgical teams have been very positive about setting up hubs, as the thing they like to do is operate,” Tim Mitchell notes. “It’s devastating for the patients if their surgery is cancelled on the day, but it’s also frustrating for staff who are ready and prepared to deliver care.”

Cannock Chase Hospital: elective surgery and diagnostics aligned

Cannock Chase Hospital is one of the sites to receive national GIRFT accreditation, enabling it to operate as a dedicated elective surgical hub. Surgical hubs like this, which are separated from emergency services, are part of plans nationally to increase capacity for elective care with more dedicated operating theatres and beds. With no A&E or emergency provision, the hospital focuses exclusively on planned surgery, particularly high-volume, low-complexity procedures across ophthalmology and orthopaedics.

Professor David Loughton CBE, Group Chief Executive of Royal Wolverhampton NHS Trust and partner Walsall Healthcare NHS Trust, describes the impact,

I’m delighted to have secured this national accreditation for our excellent facility at Cannock. With no emergency provision or A&E department, efforts have been focused on elective surgery both during and after Covid-19 at Cannock. This accreditation will only enhance the tremendous work being delivered there by a fantastic group of staff and enable our patients to continue to see the benefits of this.

As part of a wider system strategy, a permanent Community Diagnostic Centre (CDC) is also being developed on the site, replacing a temporary facility. The aim is to separate acute and elective diagnostics, align with the government’s Rapid Diagnostic Centre strategy and redesign pathways to increase capacity. Glen Whitehouse, radiographer and Group Manager for Diagnostics, explains “Having a CDC on the site will be absolutely ideal for the elective surgery hub, because to have something like that you really need access to CT and MRI scanners on the site as well, so we have designed it to support that type of work alongside the traditional community diagnostic work.”

The new centre is expected to deliver around 35,000 diagnostic tests a year, while also improving staff productivity and wellbeing through modern facilities.

Scaling surgical hubs across systems

NHS systems are rapidly expanding surgical hub capacity:

At King George Hospital, a £14 million expansion has added new operating theatres and doubled recovery bed capacity.
North West Anglia NHS Foundation Trust is redeveloping Hinchingbrooke Hospital as an accredited hub focused on HVLC surgery.
A new surgical hub is planned for Cambridgeshire in 2025, with further redevelopment under consideration at Stamford.
The Cheshire and Merseyside Surgical Centre at Clatterbridge is a £10.6 million modular development treating an additional 6,000 patients a year, supported by strong clinical engagement and successful workforce recruitment.

Innovations to tackle the waiting times

While surgical hubs are central to elective recovery, they are only one part of a broader strategy to reduce NHS waiting lists.

Community Diagnostic Centres are being rolled out in accessible locations – including shopping centres and football stadiums – with a national target of 160 sites delivering up to nine million additional tests annually by 2025. In Dorset, repurposed high street retail units are now hosting diagnostics and outpatient services, improving access while easing pressure on acute sites. At Barking Community Hospital, a CDC established in 2021 has significantly reduced waits for cancer and cardiovascular diagnostics while improving health equity.

Virtual wards are also playing a growing role. West Hertfordshire Teaching Hospitals NHS Trust was among the early adopters, initially supporting patients with respiratory conditions and heart failure during Covid-19. More recently, Leicestershire Partnership NHS Trust and Northamptonshire Healthcare NHS Foundation Trust have expanded virtual ward models collaboratively, reducing pneumonia length of stay from 12 days to seven and achieving high patient satisfaction.

Next Steps

For Pradip Karanjit, Deputy Chief Operating Officer at North West Anglia, the next phase of recovery requires pace and discipline.

We need to move away from a culture of saying we need more evidence and pilot schemes when they have already proven to be successful elsewhere When we have evidence, we should move quicker.

He points to GIRFT benchmarking as a powerful tool for improving productivity, “When you look at productivity, some Trusts are good at cataracts and do eight a day and others are celebrating doing four – clearly, it’s not good enough.”

Crucially, he argues improvement must be clinically led, “Our job is to facilitate, not dictate. Consultants can lead MDTs, but the whole team including ward nurses must understand the problem and buy into the solution. You can have all the robotic gadgets in the world, but if patients can’t be recovered safely, surgery can’t go ahead.”

Progress, pressure and the long view

Despite ongoing industrial action, workforce shortages and winter pressures, Isabel Lawicka, Head of Policy and Analysis at NHS Providers, highlights tangible progress, “The first milestone of virtually eliminating two-year waits was met, and although 18-month waits weren’t eliminated on time, the number waiting that long was cut by 91%. A remarkable achievement.” However, she cautions that significant backlogs remain in community and mental health services, and that recovery depends on staff morale, workforce supply and sustained capital investment.

Former chief executive Philippa Slinger agrees that the challenge is structural rather than temporary, “Nobody is shrugging their shoulders, this is a mammoth task and it’s not static. It’s not a backlog that’s going to reduce every time you do an operation, because it’s about flow – the number of patients that are being referred onto the list versus the number who you can manage to operate on.”

From Tim Mitchell, the human impact must not be forgotten, “It’s very easy to forget the impact of waiting on patients. They are waiting in limbo; they don’t know what is going to happen and in many cases their condition may be getting worse the longer they wait.”