Cancelled operations

Background

Cancelled elective operations are an indicator of hospital capacity, as operations may be cancelled because of a lack of ward beds, equipment (e.g. anaesthetics), or theatre staff.

The cancelled elective operations standard is a pledge in the Handbook to the NHS Constitution which states, “all patients who have operations cancelled, on or after the day of admission (including the day of surgery), for non-clinical reasons to be offered another binding date within 28 days, or the patient’s treatment to be funded at the time and hospital of the patient’s choice”.

When resources are constrained, people who are admitted to hospital in an emergency are prioritised, so more elective operations are cancelled. In March 2020, after the outbreak of coronavirus (Covid-19), trusts were asked to postpone all non-urgent elective operations to free up capacity. In May 2020, hospitals began to restart planned procedures, prioritising those with the most urgent clinical need. However, in winter 2020/21, some planned surgeries were postponed due to another Covid-19 outbreak corresponding to an increase in the number of Covid-19 hospitalisations.

The collection and publication of cancelled elective operations statistics was paused at the start of the Covid-19 pandemic, to free up capacity in the NHS. NHS England resumed the publishing of cancelled elective operations data from Q3 2021/22. For that reason, no data is available between Q4 2019/20 and Q2 2021/22.

Cancelled elective operations

The cancelled elective operations dataset records the number of last-minute cancelled operations. A cancellation is considered last-minute if the patient is told about the cancellation on the day of surgery. The NHS standard is that, in the event of a last-minute cancellation, a patient should receive their treatment within 28 days of cancellation.

The number of cancelled operations fluctuates a lot within a given year. They are usually higher in Q3 and Q4, which cover the winter months.

In the third quarter of 2001, there were 21,687 cancelled operations which gradually decreased over the next 6 years to 13,042 in the third quarter of 2007. Since then, there has been an increase in the number of cancelled operations to 21,591 in Q3 2019/20, reaching levels similar to the peak observed in 2001. This high number might be related to the growing waiting times seen in both elective care treatments and in diagnostics. Since Q3 2021/22, the number of cancelled operations has remained below 20,000; latest figures show that it was 18,780 in Q3 2023/24. It is worth noting that 645,665 more elective operations took place in Q3 2022/23 than in Q3 2001/02, a 33% increase.

The number of patients who did not receive their operation within 28 days of cancellation follows a similar trend. In 2001/02, an average of 4,772 patients each quarter did not receive their operation within 28 days of cancellation, which then declined to below 1,000 patients between 2006/07 and 2013/14. Since then, there has been a gradual rise in the number of patients who waited longer than 28 days for their rescheduled operation. After the coronavirus (Covid-19) pandemic, around 4,000 or more patients did not receive their operation within 28 days of cancellation, double the number observed in the pre-pandemic period (2,138 in Q3 2019/2020). In Q3 2023/24, the number of patients who did not receive their operation within 28 days of cancellation increased to 4,913, 24% of all cancelled operations. The reported waiting time for operations has also been affected by NHS strike action, which has caused disruption throughout 2023 and 2024. NHS trusts pre-emptively plan around the strikes by not scheduling slots that would have been used for elective activity. Had those slots been booked, the number of cancelled procedures would have been higher.