Thangadorai Amalesh, our Divisional Director for Surgery, has written a blog for NHS Providers, discussing some of the various ways our Trust has been reducing the backlog.

Amalesh talks about innovative initiatives such as the Covid secure green zone and super clinics, ‘Bones weeks’ and ‘prEYEority week’: 

The pandemic is the reason we, and NHS trusts across the country, are dealing with much bigger waiting lists than usual. However, it's shown our teams what they're capable of, giving them the confidence to seize new innovations and work in different ways; essentially, the pandemic has also given us a route out of our planned care backlog, and better ways of working for the future. We've held super clinics, created a 'hospital within a hospital', and invested in state-of-the-art diagnostic equipment; however, our biggest strength has been our team's abilities to use what they learned, and turn it into business as usual.

At the end of March 2021, following a difficult 12 months, two lockdowns and several variants, we had 2,430 patients waiting over a year for treatment. By the end of last December, that was down to 959. We hope to get close to zero by this summer. This has also been the first winter since 2017 (well before anyone had heard of Covid-19) that we've been able to keep planned care running, including carrying out our full list of cancer operations. A key aspect of this has been creating our 'hospital within a hospital', a Covid-secure green zone at one of our sites, King George Hospital. Zoning our hospital to reduce the spread of Covid-19 enabled us to keep surgical beds free, rather than them being used for emergency cases, often the norm during a busy winter.

It's where we focus on the six specialties which make up 50% of our waiting lists – general surgery, ear, nose and throat, trauma and orthopaedics, ophthalmology, urology and gynaecology. We carried out over 12,000 surgeries here in 2021, continuing through yet another more infectious variant of Covid-19, Omicron. It's also what has made one of our earliest initiatives to get patients the care they need possible – our 'Bones R Us' project.

As soon as we were out of the first wave, and while still dealing with complications due to the pandemic, we knew we needed to turn our attention to our waiting lists. Postponement of all non-urgent planned care had meant our surgery team were one of the worst affected. With backing from our executive team, our surgeons were given the freedom to try something new... and came up with the first of our 'Bones Weeks' (quirky names became a bit of a theme for these projects!). Held in October 2020, we carried out 135 hip and knee replacements, 88 day cases and 27 spinal procedures in just seven days, with one patient even able to go home the same day as their hip replacement, thanks to having the right support in place.

Efficiency, teamwork and better theatre utilisation made it a success; no shows were reduced thanks to a call from their surgeon the day before their operation; each theatre ran three sessions from 8am to 8pm daily with prompt starts; additional porters reduced delays in getting patients to theatre; and our COPE team, which supports patient with their rehabilitation at home, was key in maintaining patient flow throughout and ensuring safe discharges.

What we learned has helped us increase our overall theatre utilisation to more than 80%. We've since held two further Bones Weeks, in June and July 2021 and are one of the best performing trusts in London for high volume, low complexity surgery. One happy patient who has benefitted from two of our Bones Weeks (having knee replacements in October 2020 and July 2021), was grandfather Mark Well-Bolger, who called his experience 'top notch'.

Innovation hasn't just happened within our theatres either. Other examples include our Scalpel project, where six special Saturday clinics were held, seeing more than 1,000 patients, including a 103-year-old woman whose treatment was delayed by the pandemic. Our prEYEority week saw 980 ophthalmology patients in just five days, helping to set the standard for a waiting time of less than two months for surgery, while ear, nose, throat (known as ENT),  Kidz, a series of weekend super clinics, ensured our younger patients were not forgotten.

Our Theatres 3.0 project saw 32 skin cancer patients operated on in one day – triple the usual volume, and Gastronaught brought together clinical and administrative teams, working together to review patients on the waiting list. Not only did they get through three times as many patients as planned (and found over half could be redirected or discharged without needing an appointment), they found a whole new, more efficient, way of working.

A Gut Feeling week, run by our endoscopy service, also helped reduce the endoscopy backlog across north east London.

Our innovative approaches have been given the seal of approval by senior figures, including Sir David Sloman, who visited King George Hospital last September, and Professor Neil Mortensen, president of the Royal College of Surgeons of England, who came for a tour of our green zone in December.

At one point last year, three out of every four admissions from our emergency department into our surgical specialties were for patients who were already on waiting lists for treatment. It's a reminder of why we must sustain this work to reduce the backlogs.

Read more about how we're reducing our waiting lists on our website. 

You can read the full blog on the NHS Providers website.