Claire Rawes on the challenges faced by surgical teams in existing hospitals

Claire Rawes has been the Matron for theatres at Royal Lancaster Infirmary (opens in new window) for two years, having previously worked in orthopaedics and intensive care at the hospital. Here, she talks about the challenge of trying to maximise surgical capacity, as well as the constraints of space and flexibility due to the size and layout of the existing hospital, and how the New Hospitals Programme could address this.

What are the main aspects of your role as Matron for theatres?

The experience of our patients is very much at the forefront of my thoughts, and as a team we work extremely hard to try and minimise delays and the need for last-minute cancellations. I know how distressing delays and cancellations are for people waiting for surgery.

We have an increasingly busy surgical service at Royal Lancaster Infirmary. My role is to ensure that we make the very best use of available theatre capacity to carry out planned operations in a timely manner, as well as ensuring urgent operations can go ahead as soon as possible. A significant number of staff are needed in each theatre for each operation, and theatre time is carefully scheduled to make the most of capacity.

Can you tell us a bit more about how surgery is organised at Royal Lancaster Infirmary?

We have four theatres in the Centenary Building for various specialties such as ENT (ear, nose and throat), orthopaedics, urology, maxillofacial, colorectal and general surgery, as well as two theatres for maternity and gynaecology in a separate building alongside women’s services. We have four main surgical wards, but only one is available for elective patients currently.  The rest are used for emergency surgery and trauma patients. Although, as in many hospitals, sometimes high levels of unplanned admissions mean our wards also take medical patients admitted through the Emergency Department.

What are the current challenges for the surgical service?

Like most other hospitals across the NHS, our ability to undertake surgery was significantly reduced because of the Covid-19 pandemic. Some of our theatres were converted to provide extra intensive care capacity to deal with an expected rise in demand, and theatre nurses were redeployed with extra training to support these patients.

Regrettably, this has left us with a growing list of patients waiting much longer for surgery. At the moment we are doing everything we can to deliver more theatre sessions, including undertaking more elective surgery at weekends to try and help clear our waiting lists and reduce delays.

This is not straightforward as hospitals nationally remain under pressure. We still regularly face a situation where more patients are admitted to the hospital through the Emergency Department than we have beds for. This means they are sometimes accommodated in the beds we are keeping for patients who have a date for planned surgery.

How does the age and layout of the current buildings impact on patient care?

The design and size of our current facilities means we lack space, storage and flexibility. Our theatres are smaller than the current recommended building regulations size and that also applies to wards, which lack the space for specialist equipment, for example, if a patient needs hoisting. We are also short of side rooms, which are very important in helping with infection control.

Although theatre equipment is on a rolling service and replacement programme, some is old and nearing the end of its life.

What opportunities do you think the New Hospitals Programme offers for changing the way the surgical service is delivered, and what would be your key priorities for new hospital facilities?

New investment is a fantastic opportunity to improve what we have, and also to look at ways of doing things differently to make services work better for patients and improve the working life of our staff.

Currently, our general and maternity theatres are split between two buildings, so we could work much more efficiently if everything was together under one roof. For all staff, a big advantage would be to have training facilities on site as well. Overall, we need a larger space for all our surgical facilities.

We also need to think about the opportunities to make our working environment more attractive for staff. Due to lack of space, many ward staff rooms have been lost and there are few places where the teams can take their breaks.

As well as those physical opportunities to make hospitals better, we also need to take the opportunity to look at what can be done differently to address the reasons why operations are cancelled and look at ways of reducing length of stay for patients. This could include the chance to invest in rehabilitation and physiotherapy services, intravenous antibiotic services and community support, which would in turn make a big difference to overall patient outcomes and satisfaction.

It is important that as a hospital we find better ways of ring-fencing surgical beds and find new ways of tackling the causes of the rise in unplanned admissions. Similarly, we need to find new ways to plan facilities to support our patients in the community, enabling minor procedures needed after surgery to be done close to home rather than requiring patients to stay longer in hospital than necessary. Whatever changes are made now and in the future, we will ensure our patients remain at the heart of everything we do.