Following all the shenanigans of last week, I have been telephoned and emailed by various a couple of surgeons and others at the hospital. They were anxious to explain the workings of MDTs, of Covid restrictions and they certainly did not want to cause offence to their colleagues. I have therefore decided to write to Mr Hancock. This is my draft letter and any comments hints tips would be gratefully received and anonymised!

Dear Mr Hancock

Goodness with a name like that I bet you are a delight for a urological surgeon. ( I promise I will not write that ! )

I totally understand that Covid, lockdown 1 , lockdown 2 and tiers are unprecented, uneconomic and out of your direct control.

What is in your control is the NHS.

As we approach the end of Covid lockdown 2 we face ever lengthening NHS waiting lists. It is apparent that NHS has been advised to grade patients. Grade 1 Covid patients. Then, those who need surgery within a month. Grade 2 needs surgery for cancer. Grade 3 needs surgery for urgent quality of life issues and Grade 4 …all the rest. 
It does not take rocket science to work out that Grade 3 and 4 patients will be waiting a very long time before they see any sign of intervention. Elective surgery has evaporated for all but Grade 1 and 2.

What provisions have been made to ring fence ICU beds for cancer or other patients?

What on earth are surgeons doing if they are not in the operating theatre?

What then happens to all we chronic patients. Many of us you categorise as extremely vulnerable. We patiently self isolated in Lockdown 1. You even sent us tins of spam to spur us on. In Lockdown 2 you have told us to self isolate but go outside for an hour. No spam.

But what happens next? Here we are approaching the end of a whole year of little or no elective surgery for chronically ill patients. Personally I know I will not have surgery to remove and replace my own bladder implant, known as an SNS. It ran out of useful life a year ago. That means I will. have increasingly resistant and frequent urinary tract infections. That often means hospital admission. That will mean more cost to NHS. I understand that in urological departments there are few if any patients in Grades 1 or 2. So all the 3 and 4 grades are waiting and waiting and becomingmore acute than chronic. What can you suggest?

I use this article in the Lancet to support my thoughts:

It is important to note that patients (especially those with cancer) who are being denied treatment due to the fear of SARS-CoV-2 infection are at a greater risk of morbidity and mortality as a result of the primary pathology, and delaying surgery for these patients will create a huge backlog for health-care services.² Informed decision making, use of appropriate protective measures by the patients and health-care workers, and careful selection of patients for low-risk elective surgery (especially in regions with low prevalence of SARS-CoV-2 and low case fatality) might therefore aid in providing timely treatment.

1. • COVIDSurg CollaborativeMortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study.Lancet. 2020; 396: 27-38View in Article
2. 2.
   • Myles PS
   • Maswime SMitigating the risks of surgery during the COVID-19 pandemic.Lancet. 2020; 396: 2-3View in Article