Important new research has provided evidence that NHS surgical hubs increase treatment volumes and reduce the length of time patients spend in hospital, helping to speed up efforts to tackle waiting lists.
GIRFT has worked with The Health Foundation’s Improvement Analytics Unit (IAU) to support its independent evaluation of the impact of elective hubs on trust activity levels – the first systematic assessment of the impact of hubs on this scale.
The research – preprinted in The Lancet – examined the impact of surgical hubs on the rate of operations carried out by NHS trusts, comparing those that had recently established a hub and those that had a hub before the pandemic. It concluded that:
- In their first year, the 31 trusts in England with newly opened hubs undertook 21.9% more high volume low complexity elective surgery (such as hip replacements and cataract removals) than they would have done without a hub. This amounts to around 29,000 more procedures than expected at these trusts during this time.
- In the year following the last Covid lockdown, the 23 trusts which had established a hub pre-pandemic undertook 11.2% more elective surgery (of all kinds) than they would have done without a hub. This amounts to around 51,000 more procedures than expected at these trusts between April 2021 and March 2022.
As well as higher treatment volumes, evidence was found of shorter stays in hospital, suggesting that hubs also have the potential to improve efficiency in elective care delivery.
In 2018, GIRFT began piloting hot and cold sites for trauma and orthopaedics in six hospital trusts in England. The aim was to replicate the success of longer-established NHS elective hub sites such as the South West London Elective Orthopaedic Centre (SWLEOC). Six months after they were set up, the pilot trusts reported a reduction of cancelled operations by 50%, reduced waiting lists and shorter length of stay as well as a positive impact on emergency care flows at their ‘hot’ sites.
The outbreak of the Covid-19 pandemic led to another wave of trusts setting up separate elective sites to be able to continue planned surgery in a Covid-free setting – many of these hub sites have matured into established surgical centres.
Since 2021, the GIRFT programme has worked with all 42 ICBs in England to further expand the elective hub model as a key lever to tackle the elective backlog and to support providers with the biggest pressures. The GIRFT hub accreditation scheme, supported by the Royal College of Surgeons of England, enables trusts to seek formal assessment of their hub sites against a defined set of clinical and operational standards relating to the patient pathway, staff and training, clinical governance and outcomes, facilities and ring-fencing, and utilisation and productivity.
As of September 2024, there are now 108 elective hubs operational across the country. A further 29 hubs are due to open by the end of 2025. At the end of June 2024, there were 1.2 million patients in England waiting to be admitted to an NHS hospital for an inpatient procedure.
"The IAU’s findings are hugely encouraging and support the case for additional investment in more elective hub capacity as well as in the workforce, hub management expertise and improvement support. By 2025, we estimate that at least 11% of elective procedures will be carried out in a surgical hub setting. We now have a growing evidence base to demonstrate that elective hubs are not only making a significant contribution to tackling the elective waiting list but are also driving a fundamental reform of the way that we deliver elective care across the NHS.”
