The role of elective surgical hubs within the National Health Service in England: an online qualitative survey of staff

Background In England, elective surgical hubs are ring-fenced units within an acute hospital setting delivering planned surgeries, with protected staff and theatres. These form a key part of the National Health Service’s (NHS) strategy to tackle an ongoing backlog of patients waiting for elective surgeries. During a time of intense pressures on NHS staff, we aimed to understand staff perspectives on whether surgical hubs are realising their intended benefits to staff and patients, and what factors might help or hinder this. Methods Staff were invited to complete an online qualitative survey between May and September 2024. Eligible staff included adults 18 or older who were currently (or within the last three years): working in a hub or it’s wider organisation, or with a leadership or management role overseeing a hub. Participants rated a series of agree/disagree multiple-choice items and responded to open-ended questions across five key topics: productivity, staffing, management and leadership, resources and finance, and patient outcomes and experience. A codebook thematic analysis approach was used. Results Most respondents ‘agreed’ or ‘strongly agreed’ that hubs were benefitting patients, staff, and productivity in the multiple-choice items. Narratives from staff responses to open-ended questions described the value of hubs in improving staff wellbeing, patient outcomes, and productivity. These benefits were attributed to a sense of autonomy and day-to-day predictability at hubs, and this was also dependent upon the buy-in and involvement of senior leaders at the wider organisation. Staff also described how wider NHS issues, such as shortages of staff, lack of funding and resources, increasing use of independent sector providers, and poor connectivity across services were affecting hubs. Further, staff raised concerns that hubs could have unintended consequences on the staff at their wider acute organisation, training opportunities for doctors, and equity in access to care for patients. Conclusions Staff perspectives on the benefits of hubs are largely positive. However, wider NHS issues such as understaffing and underinvestment continue to affect hubs, and care needs to be taken to ensure that the development and resourcing of hubs does not come at a cost to the wider organisation.