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 looking at the data it is important to remember the NHS National Emergency Pressures Panel's recommendation for hospitals to defer all non-urgent inpatient elective care for the month of January 2018. This decision was made to help increase capacity and minimise disruptive last-minute cancellations over the winter period.
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.
There has been an overall increasing trend in the number of cancelled operations over the last seven years. There were 12,780 cancelled elective operations in Q1 2011/12 compared to 18,806 in Q1 2018/19 - a 47% increase.
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.
The number of patients who were not operated on within 28 days of cancellation remained relatively constant between 2006 and 2014, but has gradually increased since then. In Q4 2017/18, 2,948 patients were not operated on within 28 days of cancellation - an 85% increase on the previous quarter. This spike may reflect the NHS National Emergency Pressures Panel's recommendation to defer elective operations for the month of January 2018. However, the full impact of their decision might not be fully captured in this indicator, as the data only includes last-minute cancellations not operations that were cancelled in advance. By Q1 2018/19 the number had decreased slightly, with 2,022 patients not operated on within 28 days of cancellation.
In Q1 2018/19 there were 18,806 elective operations that were cancelled at the last-minute out of a total of almost 2 million elective admissions, accounting for 1% of these admissions. The percentage of elective admissions where the operation was cancelled at the last-minute has remained relatively steady over time, ranging from a maximum of 1.8% to a minimum of 0.7%. There is a slight seasonal variation with the proportion of cancelled elective operations marginally higher in Q4.
The proportion of cancellations where the patient was not operated on within 28 days of the cancellation, therefore breaching the standard, decreased between 2003 and 2010 but has since increased. In Q1 2010/11, 3% of patients were not operated on within 28 days of cancellation and this increased to 10.8% in Q1 2018/19.
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;
- surgeon being unavailable;
- emergency cases needing the theatre;
- theatre list over-running;
- equipment failure;
- administrative errors;
- anaesthetists unavailable;
- theatre staff unavailable;
- critical care bed not 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, Cancelled Elective Operations website.