ENT Workstream - Getting It Right First Time

Ear, Nose and Throat (ENT) Surgery

There are 330,000 admissions to ENT departments every year, 76% of which are elective. Around 17% of the elective work relates to tonsillectomy (43,000 admissions). There are also 2.8m outpatient attendances, including 960,000 outpatient procedures.

The GIRFT review of ENT services in England examined ways to deliver improvements for patients through shorter stays, fewer admissions, fewer repeat visits and potentially shorter waiting times. The report was written by Andrew Marshall, a consultant ENT surgeon at Nottingham University Hospitals NHS Trust, and published in 2019.

Jeremy Davis

ENT clinical lead

Consultant ENT surgeon at Medway NHS Foundation Trust

Jeremy is a consultant ENT surgeon at Medway NHS Foundation Trust, specialising in thyroid and parathyroid surgery.

He has previously held national leadership roles, including president of the British Association of Endocrine and Thyroid Surgeons (BAETS) and chair of the Specialty Advisory Committee (SAC) in otolaryngology. With experience across the specialty, he collaborates with colleagues representing the main areas of special interest in otolaryngology.

Jeremy has previously chaired the regional tumour site specific groups (TSSG) for both thyroid and head and neck cancer in Kent and Medway. He has served as Clinical Director of cancer, enhancing cancer pathway performance, and is currently a deputy chief medical officer in his trust.

He has had direct involvement in national outcome registries and advocates the use of data to improve performance, including the Model Health System and the National Consultant Information Programme (NCIP).

Sujata (Su) De

Paediatric ENT clinical lead

Paediatric ENT surgeon at Alder Hey Children’s Hospital

Su has been a paediatric ENT surgeon at Alder Hey Children’s Hospital in Liverpool since 2007. Her clinical interests include paediatric airway surgery, microtia, bone conducting hearing implants and the ENT care of children with Down’s syndrome and craniofacial syndromes. She also has an interest in the safe delivery of non-specialised paediatric ENT care.

Su is the national specialty adviser for specialised surgery in children for NHS England and was a co-clinical lead of the northwest surgery in children Operational Delivery Network, producing service specifications and guidelines for specialised and non-specialised surgery in children.

She is an active member of ENT UK and will be president of the British Association of Paediatric Otolaryngology in 2025-26.

Annakan Navaratnam

ENT clinical advisor

Consultant ENT surgeon at University College London Hospitals NHS Foundation Trust, and an honorary consultant at Great Ormond Street Hospital for Children

Annakan is an ENT consultant surgeon at the Royal National ENT Hospital, University College London Hospital, and an honorary consultant at Great Ormond Street Hospital for Children, with a subspeciality interest in rhinology and facial plastic surgery.

He is the England representative on the British Rhinology Society council and was previously a member of the Royal Society of Medicine Laryngology and Rhinology section committee.

He was the National Medical Director’s Clinical Fellow at NHS England and GIRFT in 2019/2020 during which time he led the COVID-19 workstream and was lead author of a COVID-19 clinical practice guide.

His interests include evaluating sinonasal surgery outcomes using large national datasets, optimisation of patient pathways in ENT using digital tools and the adoption of technological innovation in surgical practice.

Francis Stafford

ENT clinical lead

Consultant ENT and head and neck surgeon at South Tyneside and Sunderland NHS Foundation Trust

Francis (Frank) is a consultant ENT and head and neck surgeon at the South Tyneside and Sunderland NHS Foundation Trust, having trained in the north of England, Scotland and the USA. His first consultant post was in Aberdeen in 1989 and since then he has held substantive consultant posts in Sunderland, Newcastle, Chelmsford and Abu Dhabi, with stints in Egypt, Dubai and Barbados.

He is currently (2022) Chair of the Otolaryngology Surgical Specialty Board of the Royal College of Surgeons of Edinburgh (RCSEd), and a member of ENTUK Council and ENTUK head and neck group. He was formerly the Chair of the complex head and neck clinical reference group (CRG) and a member of the specialised cancer surgery CRG. He has also acted as advisor to NICE and National Confidential Enquiry into Patient Outcome and Death (NCEPOD) and is a regional advisor in ENT to the Royal College of Surgeons of England.

Andrew Marshall

Former ENT clinical lead and national report author

Consultant ENT surgeon at Nottingham University Hospitals

Andrew has been a consultant ENT surgeon at Nottingham University Hospitals since 2006. An expert in implantation otology and paediatric ENT, Andrew has an interest in medical management and service improvement. He has been both head of service and clinical director for head and neck services in his trust.

Andrew sits on the council of the section of otology at the Royal Society of Medicine, is past treasurer of the British Cochlear Implant Group, and sits on the clinical reference group for specialised ear surgery and ophthalmology. After specialist training on the South Trent ENT rotation, Andrew undertook a skull base and cochlear implant fellowship at Sunnybrook Hospital in Toronto.

In October 2021, Andrew retired from his role as GIRFT clinical lead for ENT surgery.

Increase in day case surgery would improve care for ENT patients

Both patients and hospital trusts will benefit if more ear, nose and throat (ENT) surgery in England is carried out as a day case, according to GIRFT’s national report for ENT.

The GIRFT review of ENT services visited 126 units across the country and found that thousands more people could be treated on a day case basis rather than having an overnight stay in hospital. Through a series of recommendations and by sharing the good practice of units with higher-than-average day case rates, GIRFT aims to:

ensure more patients are treated without the worry or inconvenience of a stay in hospital;
make ENT departments more resilient to pressures on beds;
allow trusts to free up beds for use by other specialties.