Beyond theatres: Vanguard's role in enhancing ophthalmic surgical output

Introduction

After COVID-19, the backlog of elective surgeries in the National Health Service (NHS) remains substantial, with approximately 6.26 million patients awaiting care as of December 2024 (NHS England, 2025a). Cataract surgery, the most commonly performed NHS operation, faces growing demand, projected to increase by 25% in the next decade and 50% over the next 20 years (Royal College of Ophthalmologists, 2022).

Vanguard Healthcare Solutions, a UK-based company specializing in mobile modular healthcare facilities, provides additional surgical theatres to increase capacity and reduce waiting times in hospitals. In addition to infrastructure, Vanguard offers clinical staffing support, including experienced nurses and theatre practitioners, to facilitate efficient surgical workflows. The Vanguard model has been implemented at Princess Alexandra Hospital (PAH) to improve efficiency in ophthalmic lists, with the aim of decreasing surgical waiting lists. This baseline audit evaluates its impact on waiting lists compared to standard ophthalmic lists in the Ambulatory Day Surgery Unit (ADSU).

Methods

A retrospective audit was conducted comparing ophthalmic waiting list numbers prior to the introduction of the Vanguard theatres and after 7 months of utilisation. Anonymised data was collected via Ormis (PAH theatre documentation software) and analysed using Microsoft Excel. Statistical analysis was conducted using an unpaired t-test.

Results

Since Vanguard’s implementation (August 12^th 2024), the number of patients on ophthalmic waiting lists decreased 29.8% by March 24^th 2025 (p<0.01), with the amount of ophthalmic procedures conducted increasing 82% (p<0.01).

Conclusion

The Vanguard model significantly reduced ophthalmic waiting lists and significantly increased the number of ophthalmic procedures that could be done per month. A re-audit is planned following process refinements to further assess the project’s impact. These findings present a possible solution to the growing backlog of ophthalmic procedures in the UK.

Dr. Zamin Shabir is a Clinical Teaching Fellow in the UK and a graduate of the University of Oxford, with a strong interest in paediatric ophthalmology and global access to affordable cataract surgery. His commitment to global eye health began pre-medical school, volunteering at a cataract camp in Kibaha, Tanzania, and was further shaped during a medical elective at Good Shepherd Hospital in Eswatini. These formative experiences continue to drive his academic and clinical focus on equitable surgical care for children and adults worldwide. He aims to pursue a career in ophthalmology that bridges frontline clinical teaching with sustainable, accessible eye care globally.