Managing surgical demand when needs outstrip resource: qualitative investigation of colorectal cancer surgery provision in the first wave of the COVID-19 pandemic

Background
At the onset of the COVID-19 pandemic, elective surgical provision was severely impacted by the
need for hospital reorganisation to care for critically ill patients. In response, NHS England issued
national guidance proposing acceptable time intervals for postponing different types of surgical
procedures. This study reports healthcare professionals’ private accounts of the strategies adopted
to manage the imbalance of demand and resource, using colorectal cancer surgery as a case study.

Method
Twenty-seven semi-structured interviews were conducted with healthcare professionals between
June – November 2020. A key informant sampling approach was used, followed by snowballing to
achieve maximum regional variation across the UK. Data were analysed thematically using the
constant comparison approach.

Results
In the context of considerable resource constraint, surgical teams overcame challenges to continue
elective cancer provision. They achieved this by pursuing a combination of strategies: relocating
surgical services, prioritising patients within and across surgical specialities, adapting patient
treatment plans, and introducing changes to surgical team working practices. Despite national
guidance, prioritisation decisions were framed as complex and the most challenging of the strategies to implement, practically and emotionally.

Conclusion
There is a need to better support surgeons tasked with prioritising patients when capacity exceeds
demand.