NHS to help patients get fit for surgery in Leicester, Leicestershire and Rutland

A new initiative to help patients get fit for major cancer surgery in order to reduce the risk of complications following their operations is being introduced in Leicester, Leicestershire and Rutland.

The four to six week ‘prehabilitation’ programme will provide a supervised exercise regime, nutritional support, education and psychological support to improve outcomes for patients.

The programme is being provided by the University Hospitals of Leicester NHS Trust (UHL), in partnership with NHS England and NHS Improvement (Midlands), and the three Leicester, Leicestershire and Rutland Clinical Commissioning Groups.

The pilot scheme will predominantly target specific cancer surgery pathways where patients have sufficient time before surgery to benefit from the programme.

Undergoing major surgery is physically, nutritionally and psychologically demanding for patients. A stress response leads to increased respiratory and cardiac demand, and a breakdown of muscle tissue to provide energy for repair.

Patients with poor physical fitness and/or a poor nutritional state before surgery are known to have a higher risk of complications after major surgery. Patients undergoing major cancer surgery face additional demands as their surgical treatment is often combined with chemotherapy or radiotherapy.

Dr Andrew Packham, Consultant Anaesthetist, University Hospitals of Leicester NHS Trust, said: “We are really excited to be launching this project in partnership with our regional team from NHS England and NHS Improvement.

“This is particularly timely as new recommendations were issued last week by Macmillan cancer support, the Royal College of Anaesthetists and the National Institute for Health Research strongly advocating the importance of this type of scheme to help improve outcomes for patients and stating that prehab should be integrated into cancer care pathways.

“Studies have shown that patients can improve their aerobic fitness by 20% in a six-week programme before surgery. We have been carrying out formal exercise testing before major surgery for the last six years and see a great number of patients who we feel could benefit from these improvements.

“We hope that by helping patients to get as fit as they can before surgery, they will be less likely to suffer complications, recover quicker and be stronger to undergo other treatments they need for their cancer.”

Bhavisha Pattani, Associate Medical Director, NHS England and NHS Improvement – Midlands, said: “The importance of prehabilitation is increasingly being recognised, and the pilot with UHL will give us important information to develop this work. This will enable us to work with Clinical Commissioning Groups to plan services with better outcomes across the Midlands region in the future.”

Dr Sulaxni Nainani, Planned Care Lead, Leicester City Clinical Commissioning Group said: “We will be ensuring that GPs are kept informed when their patients are having the prehabilitation service and we look forward to seeing the outcomes of this new initiative. It will be of great interest to us, as the outcomes may influence our commissioning decisions in the future.”

It is intended that the programme will start towards the end of 2019 and run for two years.