The dramatic reduction to operations in Scotland across specialisms including cancer and cardiology has been revealed by new health board figures, as the impact of the Covid-19 pandemic on the country’s NHS is laid bare.
The insights come from comprehensive Public Health Scotland data, obtained and analysed by The Ferret. It shows a huge drop in planned procedures across a range of specialisms since the coronavirus pandemic began in March this year, with dentistry the worst hit.
The figures, which cover all operations planned at Scotland’s hospitals between February and August 2020, show that when compared with statistics for the same period in 2019, dental procedures – such as fillings, crowns and implants – fell by 83 per cent.
They also highlight how badly children’s operations were affected, down by 68 percent in the same period. Trauma and orthopaedic surgery, which covers procedures following bone breaks and hip and knee replacements fell by almost two thirds.
Anaesthetics, which covers specialist medics who provide anaesthetics to patients for operations but also deals with pain management and intensive care, reduced by 72 percent.
General surgery, which includes a wide range of treatments from cancer surgery to gallstone operations, reduced by more than half (54 percent).
Some specialists fear that the delays to surgery caused by the pandemic and the associated lockdown restrictions will take up to four years to redress.
Despite Scotland also being in the grip of a mental health crisis, general psychiatry services to treat mental ill health also dropped by 57 per cent year on year.
Ear nose and throat (ENT) operations fell by 62 per cent and gynaecology by 60 per cent. Even cardiology, surgery done to address heart conditions, fell by almost a third.
Professor Michael Griffin OBE, president of the Royal College of Surgeons of Edinburgh, said the figures were “disappointing” and “very concerning” if not surprising.
He added: “While many surgical procedures restarted over the summer, and progress was made in clearing the initial backlog of patients waiting for surgery, the second wave has placed hospitals under great strain again and has impacted progress. It could take up to three or four years to fully address the surgical backlog.
“At the moment, large numbers of the NHS workforce are being forced to self-isolate because of a lack of routine testing for healthcare workers in Scotland, meaning increased absence rates.
“It’s vital that more stringent testing measures are implemented within NHS hospitals to create environments with low incidences of Covid where operations can safely take place. This includes stemming the increase of Covid transmission amongst staff and more regular, robust testing.”
The data – which is broken down by hospital and provides numbers of both planned and cancelled operations – showed that in April, when the restrictions were at their tightest, 3,406 operations were booked into theatres across Scotland compared with 9,363 the year before.
From March to September, 123,500 fewer planned surgeries have taken place compared to the same period in 2019, a drop of 38 per cent.
The data also revealed the impact of the crisis has lasted many months with operating theatres still carrying out fewer than half the number of planned procedures they normally would in October.
Opposition parties warned of a ticking time bomb of cases, with the human cost of the cancelled operations still largely unseen.
Scottish Greens co-leader Patrick Harvie said: “The delaying and rescheduling of less urgent procedures was inevitable at a time when protection from a deadly virus became paramount, but it will likely take years for us to know the human cost of this.
“What needs to happen now is that the NHS and other support services are adequately resourced to deal with a perfect storm of addressing any backlog, delivering the vaccine, winter pressures and complications resulting from a needless and damaging Brexit.
“We also need to recognise that NHS staff will be exhausted and demoralised at this time, so we need to look after their wellbeing too, managing workloads and staffing levels.”
Scottish Conservatives health spokesman Donald Cameron said the figure raised “major concerns” about the backlogs the NHS was facing. “We need to hear SNP ministers set out detailed plans to tackle waiting times, which were already too long before Covid struck,” he added.
NHS Greater Glasgow and Clyde said that since the start of the pandemic the health board has implemented various measures across acute sites to allow elective surgery to restart, including ear marking hospitals dedicated to routine procedures.
A statement added: “In March, in line with the rest of Scotland, we followed national advice to pause routine elective procedures to ensure those in need of the most urgent care could be prioritised.
“While this prioritisation means that some patients are regrettably having a longer wait, these decisions are made in accordance with national clinical prioritisation guidelines.”
The Scottish Government spokesperson said: “Screening services have resumed in a phased, careful and prioritised way, as part of the remobilisation of the NHS in Scotland.”
They claimed a national framework “sets out the principles that the NHS should follow when taking decisions on prioritising their elective care activity during the current pandemic”.
“Patients will be categorised based on their particular clinical needs and this will ensure patients with the greatest need are treated quickest.”
The NHS also said it opted to use the private sector “up to the end of September” by providing a Covid-free environment for urgent elective – primarily cancer – procedures to be undertaken.
Cancer treatment and general surgery
From February to August 2020, clinical oncology, using chemotherapy and radiotherapy to treat cancer patients, is the only specialism that saw an increase in activity year on year – up 45 per cent.
Specialists said that was likely to be due to all but emergency surgery being cancelled, with patients offered ongoing chemotherapy treatment instead.
Glasgow-based artist Joanne Neill, who was diagnosed with Stage 3 breast cancer last October, is one patient who experienced the distress that his decision to delay surgery caused.
Her double mastectomy was due to take place in May at Glasgow’s New Victoria hospital, one of at least three hospitals where no operations took place in April 2020. But as theatre doors closed, her operation was put back and did not take place until September at Gartnavel, a delay of four months.
Meanwhile she was offered continued chemotherapy medication, which she had to pick up alone, and which stopped working before she was given a new surgery date.
Pre-pandemic, she was being reviewed once a month but following the Covid-19 outbreak staff concerned for her health and welfare were reluctant to give her a face to face appointment until June.
“If the pandemic hadn’t happened, my surgery would have gone ahead and I’d have rung that bell to mark the end of my surgery,” she said.
“I didn’t have an issue just continuing on chemotherapy medication. But my tumour started growing again and the medication stopped working.”
She was given an appointment for surgery at the end of June, which was put back again, with another offered in August.
However, on the morning of her surgery Joanne had a slightly elevated temperature and her surgery couldn’t go ahead.
She said: “I had prepared mentally. I had been told I would have to come back to get both my breasts cut off. I was ready, lying in bed. Then [her temperature was checked and] I was sent home. It was really difficult.”
Following her surgery in September, she suffered some infections which delayed her commencing chemotherapy again but she has now completed two of six sessions and is feeling more positive. She said: “It is horrendous, but doable.”
In a statement NHS Greater Glasgow apologised to Joanne and other patients who had their treatment disrupted due to the pandemic.
The Scottish Government said it has continued to treat cancer patients during the pandemic and said its priority has been to ensure cancer services have been delivered based on clinical urgency.
Ophthalmology, which covers conditions like cataracts, was also badly affected by pandemic with planned procedures dropping by more than 55 per cent between 2019 and 2020.
Figures from April 2020, just after Covid-19 restrictions took hold show that at NHS flagship Golden Jubilee hospital in West Dunbartonshire there were 635 ophthalmology operations pencilled in for April 2019 with just 13 of those cancelled.
This April, just 17 were scheduled and all were cancelled.
There were 271 ophthalmology operations due to take place at Queen Margaret Hospital in the Fife health board area, 15 of which were cancelled. There were none listed for April 2020 in the figures obtained by The Ferret.
Consultant Ophthalmologist Jonathan Ross believes it will take more than two years to get eye surgery back on track.
He said: “Stopping surgery has never happened before and that had a profound effect so things like cataracts worsened in terms of severity while patients weren’t being seen.
“There is also no up to date data on how long waiting lists for cataracts operations are, and in some cases they were a year [long] before the pandemic. It could be two to three years to get us out of this.”
He says he has seen a big increase in patients requesting private treatment, assuming the wait within the NHS will be too long.
Data for February and August 2020, shows that when compared with statistics for the same period in 2019, dental procedures such as fillings, crowns and implants fell by 83 per cent.
Community dental practice, for those needing specialist dental care, fell by 70 percent.
Monica Lennon, health spokesperson for Scottish Labour, claimed her party had warned “months ago” that Scotland would be facing a “dental health disaster” if services remained in lockdown. “It’s extremely worrying that so many dental operations have been cancelled this year,” she added.
“Restrictions on dental treatment should be based on scientific and clinical advice, but it’s not right that there’s one set of rules for private dental work and those who can afford it and another set of rules for everyone else.
“Sufficient PPE should have been in place to enable NHS dental work and operations to proceed as normal.”
Image thanks to iStock.
This story was published in tandem with the Sunday National.