An essential component of healthcare

Operating equipmentIt is often so easy to forget how lucky we are here in the UK and what benefits we, as a nation, enjoy through the NHS service available to us all. Established around an ideal that good healthcare should be available to everyone, regardless of wealth, the NHS was launched 5 July 1948. The government thereby took over responsibility for all medical services with free diagnosis and treatment for all. Having exceeded 60 years of service the NHS, whilst under continual media scrutiny, continues to provide an excellent standard of care to our population – old or young.

When health secretary Mr Aneurin Bevan, the son of a welsh miner, opened the Park Hospital in Manchester, Britain embarked on a hugely ambitious plan to bring together for the first time hospitals, doctors, nurses, pharmacists, opticians and dentists, as one organisation that would be free for all at the point of delivery. The plan was, and still is, that the service would be financed entirely from taxation.

The concept was created to meet the critical need for improved healthcare in a post war Britain. It has been faced with ever increasing costs as a result of advances in medical knowledge, medicines and technology. To the contrary it is faced with financial restrictions that are inevitable in a centrally funded service, with changing management perceptions and political beliefs. I wonder if Mr Bevan in 1948 had been blessed with the power of foresight whether he would have led Britain down the same health pathway.

As a nation we all use the service whether it is through primary care or secondary care intervention and I am sure we can all sight cases of good and bad service. A lot depends on where we are placed geographically in the country and how well or badly the Primary Care Trust is managed in that area. Generally speaking, however, we take for granted that if we need to be seen by a doctor, we are seen at no cost.

In an ever-changing healthcare environment it is important that standards are set to meet the changing needs. Innovation in healthcare commissioning means that an increasing diversity of providers will tender to deliver minor and intermediate surgical services.

Implementation of government targets requires an ongoing need to assess and improve the efficiency of care and that patients are treated safely by dedicated healthcare professionals motivated to deliver the highest standard of care to everyone. The NHS operating framework 2010/11 confirms that focus remains on stability and improvement in terms of front line services:
“We must continue to:
• Deliver safe, high quality service with rapid improvement where there are unacceptable levels of variation
• Deliver on those priorities that matter most, both nationally and locally, and
• Provide cost-effective services to keep people well, along side delivering appropriate care at the earliest opportunity when it is needed”

Innovation in surgery

Innovation in surgery has meant that more people’s lives are being changed or indeed saved. During a recent visit to the Thackray Medical Museum in Leeds I was reminded of how far we have come in such a short space of time. Technology has revoluntionised surgical care through advances in monitoring, infection prevention, training, safety standards, less invasive intervention – the list is endless. Technology has also provided our patient population with the wherewithal to understand better the care/interventions required and with this has come high expectations and the knowledge to be able to question and challenge over the care provided.

At The Association for Perioperative Practice (AfPP) our aim is to advance health by improving patient care in the perioperative environment. We do this through determining standards and promoting best practice through training and education for our membership which is made up of theatre practitioners working in operating departments, associated areas and sterile services departments.

As part of AfPP2010 we challenged our medical device partners to show us their best innovations and we were pleased to see that even in the 21st century there are changes and improvements still being made to ensure safer surgery for patients. Our winning entries ranged from efficiency gains through collaborative working; to a retractor used in gynecological procedures to improve patient safety and reduce needle stick injury; to an infection prevention solution to cut down on surgical site infection; to a single use intubating scope and also a single use tray made from recycled products.

Recently, the BUPA Foundation has awarded a grant of over £200,000 over three years to a study that is seeking to develop an endoscopic instrument for keyhole surgery that will give surgeons information they can usually only obtain by touch when performing conventional open surgery. If successful, this will dramatically increase the diagnostic value of keyhole surgery.

As I touched upon above information technology is also assisting surgical outcomes and patient efficiencies through the use of SMS messaging surveillance and studies have shown that this has decreased the outpatient waiting times and increased the quality of post surgical care.

Robot-assisted surgery

When I was a girl I watched a TV programme called the ‘The Six Million Dollar Man’, about a man who was rebuilt following an horrific accident – he was said to be ‘bionic’. They used robotic techniques to put him back together which left him with the ability to, amongst other things, leap great heights, run amazingly fast and lift cars at the touch of a button, yes, the touch of a button on the back of his neck.

Today we use the word robotic freely when referring to medical innovation and robotic prostatectomy is real procedure for patients with prostate cancer. Robot-assisted surgery was developed to overcome limitations of minimally invasive surgery. Instead of directly moving the instruments the surgeon uses a computer console to manipulate the instruments attached to multiple robot arms. The computer translates the surgeon’s movements, which are then carried out on the patient by the robot.

Other features of the robotic system include, for example, an integrated tremor filter and the ability for scaling of movements (changing of the ratio between the extent of movements at the master console to the internal movements of the instruments attached to the robot). The console is located in the same operating room as the patient, but physically separated from the operative workspace, or in another place. Since the surgeon does not need to be in the immediate location of the patient while the operation is being performed, it can be possible for specialists to perform remote surgey on patients.

We now have the technology to put people back together similar to that which Steve Austin the Bionic Man experienced. I heard an amazing story this week about a woman who lost both her legs in the 7 July 2005 London bombings. In an attempt to bring communities together she walked 200 miles from Leeds to London over a period of a month. Only in my lifetime has healthcare become so advanced. Truly amazing.

Surgical site checklist
Often, through adversity good things are achieved and the surgical site checklist is one innovation that was introduced by the World Health Organization (WHO) and it identifies three phases of an operation, each corresponding to a specific period in the normal flow of work:
• Before induction of anaesthesia
• Before the incision
• Before the patient leaves the operating room

The checklist allows the surgery team to complete listed tasks before the operation proceeds, thus ensuring safety to the patient.

WHO has undertaken a number of global and regional initiatives to address surgical safety. The Global Initiative for Emergency and Essential Surgical Care and the Guidelines for Essential Trauma Care focussed on access and quality. The Second Global Patient Safety Challenge: Safe Surgery Saves Lives addresses the safety of surgical care. The World Alliance for Patient Safety initiated work on the Challenge in January 2007.

Developing the service

In his latest missive about the NHS reform plans, Andrew Lansley has stated that sticking to the status quo for the NHS is not an option. By 2030, the number of over-85s requiring expensive healthcare is projected to reach 3.5 million, or one in 20 of the UK population, said Mr Lansley in an article for the Daily Telegraph.
As a result, the NHS will have to perform an additional two million operations a year and health spending will double to £230 billion – the equivalent of £7,000 a second – in real terms, a figure the UK “simply cannot afford”, he said.

These comments only enhance the need for surgical procedures; whether they are interventions, care pathways or processes, to be better and more efficient to ensure that patients are getting the best possible care available.

Our invitation to apply for to our Innovation Awards this year will soon be going out to our medical device colleagues and I can’t wait to see what new innovations will be put forward to our panel of experts. The winners will be announced and recognised at AfPP 2011.

For more details about our Innovation Awards and AfPP 2011 please visit

AfPP2011 47th Congress & Exhibition will take place 19-21 October at
Bournemouth International Centre.

In the current climate change is affecting the whole of the healthcare environment and the sessions will give an insight into the key issues that affect practice for the whole perioperative team. The conference programme takes a look at the developing NHS, challenging clinical issues and aspects of patient safety. It will also provide opportunities to think creatively, to develop skills and knowledge which will better equip members of the perioperative team to manage the change agenda as it affects them and the patients that they care for. In addition, there are some uplifting and motivating sessions for personal development.

The congress programme comprising of over 30 sessions will include general, specialist and master classes. The event is suitable for practitioners working in NHS acute and primary care or independent theatre settings and includes topics relevant to medical sales representatives.

Network with over 90 medical device companies at the UK’s showcase exhibition for innovation and excellence. Attend innovative workshops on the show floor arranged by our event partners.

Find out more and book on

Written by Dawn Stott, managing director, The Association for Perioperative Practice