More capacity, same standards: expanding cataract surgery in three weeks

The need:

When Newmedica was awarded a contract to provide thousands of NHS cataract procedures, it faced an immediate challenge. Existing theatres were operating near capacity, leaving little opportunity to deliver the additional surgical volume while maintaining services for patients across Bristol, Bath, Somerset, Gloucestershire and Wiltshire.

A permanent extension was impossible within the required timescale. The solution, high-quality surgical capacity, had to be operational within weeks.

The plan:

Vanguard Healthcare Solutions would deliver a fully equipped mobile operating theatre with an integrated modular staff and storage facility. Vanguard would also provide clinical support during the initial operating period, including a clinical practitioner who worked alongside the Newmedica team during the first few weeks.

While Vanguard provided the theatre, Newmedica made ready to accommodate the massively increased patient numbers, making provision for the increases in usage of equipment and consumables, and additions to staff in admin and portering roles, as well as in the surgical teams.

Delivered to site outside of Newmedica's operating hours, the facility would be commissioned, equipped, provisioned, cleaned, and receiving patients within three weeks of the decision to proceed being made.

The solution:

The decision to proceed was made on 1st November and the first theatre patient was treated in the Vanguard surgical theatre on 21st November. The theatre provided the space, environmental control and functionality required to support safe surgery at considerable volume.

For clinicians and patients unfamiliar with mobile facilities, there can be assumptions about how the environment will compare with a conventional operating theatre. Newmedica's experience challenged those perceptions. Stuart Guthrie, Clinical Director at Newmedica Bristol, had not previously worked in a mobile operating theatre and recalls his reaction when he first entered the facility, “It felt like you were in a normal theatre, to be honest. Better than a lot of theatres that I’ve worked in in the past.”

The operating area accommodated the surgical team, microscope and phacoemulsification equipment while allowing staff and patients to move safely. Temperature and humidity were controlled, and Kevin Walsh recalled that the environmental systems performed reliably throughout the deployment, including through significant changes in external weather.

The patient journey closely reflected Newmedica’s established pathway, helping the additional capacity feel like an extension of the existing service rather than a separate experience.

The design of the facility supported the rapid patient flow required for high-volume cataract surgery. A ramp enabled patients to enter and leave the facility easily, while the internal layout supported a straightforward progression through admission, treatment and discharge.

Guthrie said, “For us, in cataract surgery, it’s important for a flow of patients to come through. That’s really important and the unit provided that flow.”

The outcome:

The additional theatre became part of an intensive surgical programme. Around 20 patients were treated on a theatre list, with activity sometimes increasing to 25 or 30 patients and extending into evening sessions. Operating 7 days per week, the Vanguard theatre saw 600 cataract surgeries in January alone.

But throughput is not the single most important measure of success in a surgical service. The programme had to demonstrate that higher activity could be achieved while maintaining clinical standards and the patient experience.

The team was treating patients who in some cases had experienced long waits and consequently presented with more advanced cataracts. This could make procedures more challenging for surgeons and theatre teams, making the emphasis on preparation and safety particularly important.

At the same time, patient feedback remained extremely positive. Phillips recalls: “The feedback was absolutely tremendous. It’s easy to say that, but you rarely see 100% feedback month after month after month, recommending it to their friends and family.”

People who played important roles in the establishment of the additional theatre and who worked within it, spoke about their experiences: