Thousands of urgent operations building up across London as Covid pressures continue

Hospitals across London are racing to tackle a backlog of tens of thousands of urgent operations that need to be carried out in the coming weeks to prevent patients dying or losing limbs, The Independent has learnt.

The slow decline in Covid patient numbers means many hospitals across the capital are warning they will still be relying on extra staff, and “surge” beds opened at the height of the crisis, well into March.

NHS bosses have been briefed that across the city there are about 15,000 priority two (P2) patients. These are classed as needing urgent surgery, including for cancer, within 28 days, or they could die or be at risk of losing a limb.

But the lack of available operating theatres, nurses and anaesthetists mean the city has a shortfall of more than 500 half-day surgical lists a week.

The number of less urgent patients forced to wait more than a year for treatment is also growing at a rate of 2,000 a week in London, with forecasts it could reach 50,000 by the end of February.

Across England more than 225,000 patients had waited longer than a year for surgery in December, with the overall waiting list reaching 4.6 million, the largest since records began in 2007.

The problem of mounting backlogs is likely to be replicated in other parts of the country. Across England, there has been one-third more patients in intensive care in the past week than during the same period last year. In London there are 70 per cent more patients in intensive care, according to Health Service Journal analysis.

The Independent has spoken with multiple NHS insiders and seen briefing documents detailing the challenges facing the capital’s hospitals, which are expected to last up to 21 March in some areas.

One briefing warned: “Hospitals have insufficient capacity to meet urgent elective demand for P2. P2 demand is intended to be seen within 28 days, the surge has occurred for over 28 days. Patients who would normally have been seen are waiting longer than clinically advisable.

“Capacity for all P2 will not exist for another month minimum. Parts of London wont be out of surge capacity until 21 March.”

On cancer operations specifically the briefing said the backlogs were growing and that private hospitals were not delivering enough extra capacity. It warned: “Cancer capacity is constrained and this will cumulatively impact on cancer waiting list over the next few months.”

Senior NHS leaders told The Independent they were concerned patients previously classed as being a lower priority for treatment had waited so long they now needed urgent care, and that the situation would only worsen.

NHS England has asked local areas to begin work on recovery plans but early predictions show most hospitals do not expect to regain even 85 per cent of pre-pandemic activity until August at the earliest.

One NHS manager warned that while there was a consensus that more routine surgery needed to be restarted as soon as possible, it could “break people” if NHS England demanded a return to normal too soon.

The backlog of urgent P2 patients in London has led to hospitals creating a new sub-category of patients who are deemed to need treatment within 14 days, with an acceptance that not all P2 patients will be seen within the expected 28 days.

There were 2,500 coronavirus patients still in London’s hospitals on Thursday. The capital’s slow decline in numbers is due to survivors needing longer-term care in hospital before discharge.

Parts of London are currently managing only half their normal level of routine surgery.

At the Royal Free Hospital in North London, bosses have agreed to keep more than 80 redeployed staff until the start of March, including nurses from Great Ormond Street Hospital and Moorfields Eye Hospital.

Soldiers and military staff drafted into London hospitals at the start of January are expected to leave at the start of March.

One hospital boss told The Independent: “The climb down from the peak has been slow and we just haven’t had the resources to do the elective surgery we need. The recovery will be equally slow, we can’t compromise the surge capacity and frankly some of the staff need a rest.”

NHS London has told hospitals elective, or planned, surgery hubs in each of the five NHS areas should restart on 6 April, with plans for each hospital’s recovery to be submitted early in March.

A spokesperson for NHS London said: “Despite hospitals in London treating higher numbers of Covid-19 patients than in April and dealing with normal winter pressures, more elective treatments were carried out at the start of the year compared to the first wave of the pandemic, thanks to the creation of non-Covid pathways for elective care.

“Our focus is now on recovery with patients continuing to receive surgery based on clinical need and we are supporting systems to provide mutual aid to ensure equity of waiting times across London.”