Cancelled elective operations are an indicator of hospital capacity, as operations may be cancelled because of a lack of ward beds, equipment 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, during the coronavirus (Covid-19) outbreak, hospitals were asked to postpone all non-urgent elective operations to help increase capacity. To further free up capacity, NHS England has suspended data collection from 1 April to 30 June 2020 for some of their performance statistics, including cancelled operations. The latest data presented here is from December 2019, before the outbreak took place.
These indicators use NHS England data to measure elective operations which have been cancelled for non-clinical reasons on the day of admission or later (including the day of surgery). The total number of cancelled operations is not currently published.
The number of cancelled elective operations fluctuates from quarter to quarter, but there is generally a peak in Q4 of each year (January to March). This is likely due to hospitals dealing with winter pressures.
The overall number of cancelled operations decreased between 2000 and 2007, but they have since increased again. There were 15,640 cancelled elective operations in Q3 2007/08 compared with 23,503 in Q3 2019/20 – a 50% increase.
The total number of elective admissions to hospital has increased over time, from around 1.3 million in Q1 2000/01 to over 2 million in Q3 2019/20 (data not shown). To account for this, it is useful to look at cancelled operations as a percentage of elective admissions. The two lines follow a very similar trend. However, in recent years the number of cancelled operations has increased at a faster rate than cancelled operations as a percentage of elective admissions. This indicates that while cancelled operations have increased over the last seven years, some of the increase may have been expected proportionally.
As of April 2003, the NHS Constitution pledged that if a hospital cancels your operation at the last minute for non-clinical reasons, they should offer you a new date for your operation. This date should be within 28 days of the date your operation was originally booked for.
There was a sharp decrease in patients not being operated on within 28 days of cancellation prior to the introduction of the standard in Q1 2003/04. After this, the number continued to decline overall, falling to a low of 343 patients not being operated on within 28 days in Q2 2009/10. Since then, the number has gradually increased again. There was a spike of 2,970 patients not operated on within 28 days of cancellation in Q4 2017/18, which may reflect the NHS National Emergency Pressure Panel’s recommendation to defer elective operations for the month of January 2018. Most recently, there were 2,138 patients not operated on within 28 days of cancellation in Q3 2019/20.
The proportion of cancellations where the patient was not operated on within 28 days follows a very similar trend. In Q3 2019/20, 9.1% of patients were not operated on within 28 days of cancellation.
About this data
Elective operations are operations that are organised in advance.
Cancelled elective operations are defined as those which have been cancelled by the trust for non-clinical reasons on the day of admission or later (including the day of surgery).
Some common non-clinical reasons for cancelled operations include:
- ward beds being unavailable
- surgeons being unavailable
- emergency cases needing the theatre
- theatre list over-running
- equipment failure
- administrative errors
- anaesthetists being unavailable
- theatre staff being unavailable
- critical care beds not being available.
A breach is counted at the point it occurs, i.e. if after 28 days of a last-minute cancellation the patient has not been treated then the breach should be recorded. The 28-day period does not stop at the end of a quarter, but is continuous.
Further guidance can be found on the NHS England website.