The Royal College of Surgeons (RCS) has published its principles for the reshaping of surgical services. Reshaping surgical services: principles for change makes the case for a different approach to reconfiguration from one which has been taken in the past.
The RCS believes that if surgical, and indeed all medical services, are to change then the whole pathway of care for patients must be considered. From primary care delivered by GPs to diagnostic tests, hospital treatment, discharge, follow-up and rehabilitation, the document asserts that any discussions about reshaping services must be open and transparent. It states that patients should be at the centre of all decision making. Key points highlighted in the report included:
• The reshaping of services must not be triggered by financial pressure leading to the piecemeal dismantling of services and loss of patient care. Rather, any decisions to reconfigure services must be based on sound clinical evidence, have clinical backing and focus on ensuring the highest quality of care.
• Reshaping of surgical services should only take place where improvements in quality of care are needed and can be realised.
• Patients and the public need to be at the centre of the debates surrounding the reshaping of local services and their concerns must be listened to. Engagement with patients, their carers and families must not be ‘tokenistic’.
• More consideration needs to be given to how to support communities in rural areas who need access to good emergency surgery. Strengthening of ambulance services and emergency care networks will help ensure patients needing immediate access to emergency surgery, or other specialised services, can be routed appropriately and quickly.
• Transport infrastructures must be in place for any reshaped service.
• Commissioners also need to ensure that any removal of services, brought about by reshaping, does not affect the stability of related services.
