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Objectives The aim of this study was to evaluate the differences in surgical capacity for head and neck cancer in the UK between the first wave (March‐June 2020) and the current wave (Jan‐Feb 2021) of the COVID‐19 pandemic. Design REDcap online‐based survey of hospital capacity. Setting UK secondary and tertiary hospitals providing head and neck cancer surgery. Participants One representative per hospital was asked to report the capacity for head and neck cancer surgery in that institution. Main outcome measures The principal measures of interests were new patient referrals, capacity in outpatients, theatres and critical care; therapeutic compromises constituting delay to surgery, de‐escalated surgery and therapeutic migration to non‐surgical primary modality. Results Data were returned from approximately 95% of UK hospitals with a head and neck cancer surgery specialist service. 50% of UK head and neck cancer patients requiring surgery have significantly compromised treatments during the second wave: 28% delayed, 10% have received radiotherapy‐based treatment instead of surgery, and 12% have received de‐escalated surgery. Surgical capacity has been more severely constrained in the second wave (58% of pre‐pandemic level) compared with the first wave (62%) despite the time to prepare. Conclusions Some hospitals are overwhelmed by COVID‐19 and unable to offer essential cancer surgery, but all have neighbouring hospitals in their region retaining good (or even normal) capacity. It is noteworthy that very few patients have been appropriately redirected away from the hospitals most constrained by their burden of COVID‐19. The paucity of an effective central or regional strategic response to this evident mismatch between demand and surgical capacity is to the detriment of our head and neck cancer patients.

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Oral and maxillofacial surgeons carry out the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck. They provide a critical referral service for dentists in general practice, with the most suspicious of these being sent as 'urgent suspected cancer', or 'USC'. According to national guidelines, such cases must be seen within 14 days. In January and February 2017, the oral and maxillofacial team in Morriston hospital received two such referrals from separate GDPs in the locality. Both were prioritised and seen within the two week window on consultant clinics. These two cases presented as enlarging, firm and painful neck swellings in otherwise relatively healthy adults, with no classical risk factors for malignancy, such as smoking, high alcohol intake or HPV virus. There was no dental pathology noted in either. Following clinical examination and special investigations within the OMFS department in Morriston Hospital, both patients were diagnosed, and treated under the vascular surgical team via surgical repair for carotid aneurysms. This is a condition rarely considered by dentists, and an uncommon differential diagnosis of a neck lump.