RCoA response to the Elective Reform Plan

Measures to optimise perioperative care are promising but more anaesthetists are urgently needed to meet waiting list targets.   

The Elective Reform Plan published on 6 January 2025 sets out how the government and NHS England plan to achieve the 18-week referral to treatment time for 92% of patients by March 2029. This includes an interim target of 65% of patients by March 2026 with all trusts expected to deliver at least a five-percentage point improvement.

The plan includes commitments to expand the work of Community Diagnostic Centres, establish additional Surgical Hubs and give patients greater choice in accessing treatment, tests and scans, amongst other things.

These commitments include welcome measures to optimise perioperative care, which the College and the Centre for Perioperative Care have long argued is essential for improving patient outcomes and increasing NHS efficiency.

We support the commitment to reduce waiting times for patients but investment in more anaesthetists will be necessary to meet the target. Most operations and procedures require an anaesthetist but there is clear evidence that the shortage of anaesthetists is limiting the ability of the NHS to tackle waiting lists for elective care.

Dr Claire Shannon, President of the Royal College of Anaesthetists said:

“With 7.6 million patients on waiting lists in England, the Elective Reform Plan is a much-needed intervention from the government and NHS England.

“As anaesthetists, our members play a leading role in the provision of care for patients before, during and after surgery. We have consistently highlighted how this care can be improved in ways that would reduce complications and cancellations that are costly for patients and the NHS.

“Our evidence shows the clear benefit for patient outcomes and NHS efficiency of measures such as helping patients better prepare for surgery, facilitating shared decision making and earlier discharge planning.

“It’s positive to see NHS England prioritise those areas, for example by emphasising the need for pre-operative assessments to be undertaken prior to scheduling a date for surgery, extending support for patients preparing for some types of treatment and training clinical and operational leaders in effective pathway management.

“However, trusts may struggle to implement changes without additional investment in digital services and service startup costs.

“It’s also essential that the government takes action to address the shortage of anaesthetists, which is currently preventing around 1.4 million operations and procedures taking place each year. Without urgent investment in additional training places for anaesthetists, the ambitious targets set out in the Elective Reform Plan will not be met.”