Written evidence submitted by The Society for Cardiothoracic Surgery UK and Ireland (WBR0036)


Dear Sir / Madam,

This is the response from SCTS - the Society for Cardiothoracic Surgery UK and Ireland.

We represent surgeons, trainees and allied health professionals that deliver:

Lung and chest surgery including Lung Cancer Surgery.

Adult heart surgery

Children's heart surgery

Lung surgery and Heart surgery for adults and children is intimately linked with the availability of level 3 and level 2 care (Intensive Care and High Dependency Care)

How resilient was the NHS and social care workforce under pre-COVID-19 operating conditions, and how might that resilience be strengthened in the future? 

Delivering heart and lung surgery in the NHS has taken a great deal of perseverance and resilience in the face of a reduced bed capacity - in terms of ward beds, level 3 and level 2 beds, with increased demand from acute medicine. It is draining on a day to day basis struggling to find beds for post-operative care and to avoid patients being cancelled. This is most applicable to congenital cardiac surgery where the cancellation rate for children is unacceptably high.

This has been extremely draining for the clinical teams and made them less resilient - as seen by the passive reluctance to get back to pre Covid levels of activity.

This has been added to by the impact of feeling under valued: Pension changes, salary freezes, changes to excellence awards.

What has the impact of the COVID-19 pandemic been on resilience, levels of workforce stress, and burnout across the NHS and social care sectors?

Our view is that our specialty responded very positively and proactively to the pandemic. The specialty has readily and eagerly delivered their level 3 and level 2 capacity to help non-Covid care and ready for Covid care. Lung cancer surgery was moved out to the private sector where possible.

Consultant surgeons volunteered to help with Covid care including level 3 and level 2 care.

Trainees were willingly redeployed to Covid care, often on level 3 and level 2 care.

Allied Health Professionals including specialist nurses volunteered and were redeployed to Covid care including Level 3 and level 2 care.

Overall, despite the chronic weariness in the specialty, there was an extraordinarily positive and proactive response from the professionals in the specialty of cardiothoracic surgery.

There is a sense now that the positive and energetic response to the crisis, on the background of a chronic struggle to deliver care, leaves the work force somewhat depleted and will take time to restore the energy and full commitment required to deliver pre-Covid levels of care.

What is the current scale of workforce burnout across NHS and social care?  How does it manifest, how is it assessed, and what are its causes and contributing factors?  To what extent are NHS and care staff able to balance their working and personal lives?

What are the impacts of workforce burnout on service delivery, staff, patients and service users across the NHS and social care sectors?

Cardiac surgery in particular is highly challenging surgery and high stakes are involved on a day to day basis. The length of the days are always unpredictable. Over years this has made it a less attractive specialty for staff to join the team compared to less intense more predictable specialties. The out of hours commitment for ITU and anaesthesia is onerous. This applies particularly to the anaesthetic colleagues who have the preferred choice of general anaesthesia and can avoid the major stresses of cardiac surgery. Burnout post Covid will almost certainly deter potential future colleagues from joining the specialty.

What long term projections for the future health and social care workforce are available, and how many more staff are required so that burnout and pressure on the frontline are reduced? To what extent are staff establishments in line with current and future resilience requirements?

There are two significant areas of concern for the specialty following Covid and the further stress it inflicted on the specialty:

Cardiothoracic anaesthesia

Level 3 facilities and staff to provide the necessary post-operative care

There is a need for reflection what will make the role of a cardiothoracic anaesthetist attractive and fulfilling. Currently the role has become that of a senior registrar with 'shift work' and very 'hands on'. Delivery of care needs more critical care practitioners and the level 3 facilities need ring fenced for post-operative care (possibly including major surgery from other specialties - ie vascular surgery) that avoids cancellations.

There is a need for more level 3 and level 2 beds for cardiac and thoracic surgery to avoid cancellations.

To what extent are there sufficient numbers of NHS and social care professionals in training for service and resilience planning? On what basis are decisions made about the supply and demand for professionals in training?

Will the measures announced in the People Plan so far be enough to increase resilience, improve working life and productivity, and reduce the risk of workforce burnout across the NHS, both now and in the future? 

What further measures will be required to tackle and mitigate the causes of workforce stress and burnout, and what should be put in place to achieve parity for the social care workforce?

Workforce is continuously assessed by SCTS and its specialty advisory committee for training (SAC). The Association of Cardiothoracic Anaesthesia (ACTACC) also tracks its work force and training numbers.

Currently there remains good interest and competition to become surgeons in the specialty. However those surgical trainees need more time in theatre to become competent and confident which can only be achieved with more allied health professionals being trained to deliver the service.

The current issue regarding stress and burnout is the workforce for cardiothoracic anaesthesia in terms of interest and recruitment, especially after the rigours of the pandemic. This may need an urgent review how the service is delivered and make the role more fulfilling and attractive. This will require training more critical care practitioners and anaesthetic practitioners leaving the consultant in a more supportive and fulfilling role.

Underlying all the work force issues is the particular need for more level 3 and level 2 beds so that each day isn't spent trying to find a potential bed to give a patient their major surgery.Over the last few years SCTS has taken a keen and active interest in the cardiac surgical unit at St George’s. We have been concerned on behalf of our members in the unit and also the ‘alert’ notifications at a unit level. We have endeavoured to be responsive and give appropriate advice and support.

 Yours sincerely,

Simon Kendall

President SCTS

Sept 2020