RCoA Manifesto, Anaesthesia: solutions for an NHS in crisis

Ahead of the general election, we have published our manifesto, 'Anaesthesia: solutions for an NHS in crisis'.

We are urging political parties to develop and fund a plan for more doctors to train as anaesthetists, improve the working lives of doctors to enable more of them to stay in the NHS and invest in measures proven to improve NHS efficiency and patient outcomes.

In summary:

• NHS waiting lists are at crisis levels. Anaesthetists are key to addressing this, as most operations cannot take place without an anaesthetist and there is clear evidence that the UK needs more of them.
• The UK has a shortage of 1,900 anaesthetists (14%). We estimate that this prevents 1.4 million operations and procedures taking place each year.
• The NHS currently lacks a plan for training enough doctors in specialties such as anaesthesia, but such a plan is urgently needed.
• Measures must also be taken to boost retention, including better rest and refreshment facilities.
• Anaesthetists play a leading role in initiatives to boost NHS efficiency, such as turning waiting lists into preparation lists, which can reduce surgical complications and cancellations and reduce length of hospital stay.
• Start-up costs to these initiatives are a barrier. We recommend a £100 million ‘NHS efficiencies transformation fund’ to overcome initial financial obstacles.

Fixing the anaesthetic workforce shortage

Despite the essential role of anaesthetists, there is a large and growing shortfall across the UK. Our 2020 medical census data revealed a UK wide shortfall of 1,400 anaesthetists, which rose to at least 1,900 in 2022. This is equivalent to 14% of the UK’s total anaesthetic workforce. We estimate that current workforce shortages prevent roughly 1.4 million operations and procedures per year.

We call on all political parties to:

• Urgently develop and fund a plan for specialty training, including more places for doctors to train as anaesthetists. This is vital for reducing waiting lists and bolstering the existing NHS Long Term Workforce Plan.

Better retention

The NHS needs to be a competitive and attractive place to work; however, at present it loses too many staff and is set to lose more. In 2021, one in five anaesthetists planned to leave the NHS within five years.

We call on all political parties to:

• Prioritise, implement, and fund the retention measures proposed in the NHS Long Term Workforce Plan.
• Expand on the commitments in the NHS Long Term Workforce Plan to ensure SAS-grade doctors are valued, respected, and treated fairly and consistently.
• Maintain the 2023 reforms to pension taxation, or provide a clear alternative solution that achieves the same ends.
• Get around the negotiating table and arrive at a fair pay deal for doctors of all grades.

Improving NHS efficiency and patient outcomes

The NHS loses an estimated £400 million annually due to on-the-day cancellations of surgical procedures. Additionally, complications occur in 10–15% of operations, resulting in extended stays in hospital and unnecessary suffering for patients. 45% of hospital costs can be attributed to care costs for 3% of patients, often those with complications. Reasons behind this include modifiable issues such as frailty, lifestyle factors, or unmanaged co-morbid conditions.

Interventions such as turning waiting lists into preparation lists (prehabilitation), enhanced recovery programmes and earlier discharge planning have been shown to reduce waiting lists and improve patient outcomes. The evidence for this is set out in more detail by our Centre for Perioperative Care. 

We call on all political parties to:

• Establish an NHS efficiencies transformation fund, of at least £100 million, to help NHS trusts get prehabilitation schemes and other interventions off the ground.
• Ensure that regulators, such as the Care Quality Commission (CQC), incentivise the implementation of surgical pathway efficiencies through their assessment frameworks.

Dr Fiona Donald, President of the Royal College of Anaesthetists said:  

“The shortage of anaesthetists has reached crisis levels and is preventing patients from getting the operations they so desperately need.

“During the election campaign I’m sure we’ll see all parties pledge to reduce NHS waiting lists but unless their policies include plans for more anaesthetists they will have limited impact.

“There are plenty of doctors who want to train as anaesthetists but we need funding for more training places. There is capacity within our training system for at least an additional 140 places, but we need a commitment from the government to provide the funding. In particular, it is unacceptable that so many doctors are unable to progress to the higher stages of their training, leaving them stuck in bottlenecks and uncertain about their future.”

Jenny Westaway, Chair of PatientsVoices@RCoA said:

“Long waits for surgery are too familiar an experience for patients and their families and can have a devastating impact on their mental and physical wellbeing. There is a moral and economic case for patients to receive the surgery they need in a safe and timely way.

“Addressing the shortage of anaesthetists is a vital practical step to cut these painful waits and to enable the millions of people waiting for surgery to fulfil their lives’ potential.”