Chapter 6 - The Future of the NHS

This is a summary of chapter 6 - The Future of Surgery. It was written by Professor Peter J Friend, Professor of Transplantation at the University of Oxford, Director of the Oxford Transplant Centre and a Consultant Surgeon specialising in Transplant and Hepatobiliary surgery at the Oxford Radcliffe NHS Trust.

Professor Peter Friend describes that the medical world is on the cusp of radical change and if properly implemented, will provide a better, safer service for patients and a more cost-effective service for the provider. He considers several possible areas of change for the surgical specialties, and a few of those are mentioned below.

1) The changing face of surgery
The surgeon, used to direct the progress of a patient often single-handedly, but notes the surgeon is now part of a ‘committee’ that determines how the patient should be treated. However, the multi-disciplinary team will now be the key to the way the health service of tomorrow will look.

2) Surgery as a technology-driven specialty
He believes the future of minimally invasive surgery will involve robotic procedures under video-imaging, carrying out the entire operation using robotic arms controlled remotely by the surgeon. He notes that this technology is hugely expensive to buy and operate. Therefore, it will be a challenge to deliver new technology and cost-effectiveness.

3) Surgery and training
He explains how the traditional system of apprenticeship surgical training is becoming replaced with a more active training process to enable a surgeon to achieve competence with less than half the clinical contact time of his/her predecessor. [There is nothing more important than investing in the future of training.]

4) Surgery and regulation
He describes how a surgeon's future will include a closely scrutinised performance record. In fact hospitals are subjected to ‘league table’ comparisons. He argues that although transparency is clearly a good principle, the use of such simplistic measure of outcome, such as crude death rates, could be extremely misleading. One surgeon may be the best in the country but if the most difficult and highest risk cases are referred, then the mortality may still be high. If crude mortality becomes the marker by which surgeons are judged, then there will be a natural tendency to refuse to take on high-risk or complex cases and warns this would be very much to the disadvantage of patients. He highlights the need for this to be considered.

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