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RCS publishes Principles for Reshaping Surgical Services

07 Jan 2013

The Royal College of Surgeons is today publishing our 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, this document asserts that any discussions about reshaping services must be open and transparent. It firmly states that patients should be at the centre of all decision making. 

Key points include:

  • 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 patient 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 re-shaping 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.

Also, writing to NHS managers today the President of the Royal College of Surgeons, Professor Norman Williams, outlined why the greatest challenge in health is tackling service redesign - without it many of the inherent problems in the system will continue. 2013 has to be the year when politicians, clinicians, and managers come together to support historic change in the NHS and create a long-lasting legacy for all of our population.

Commenting on the challenges of reshaping surgical services, Professor Norman Williams said: 

“The College’s prime responsibility is the maintenance and improvement of surgical standards to deliver high quality patient care. It is important for us to set out the challenges facing the health service when considering any reshaping of surgical services.
With many reconfigurations currently planned for the NHS in England and Wales, and with many more likely in the near future, the impact on patients, their families and all NHS staff must be carefully assessed. We know from the comprehensive evidence currently available that for many procedures and conditions concentrating specialist surgical services into fewer, larger centres of excellence can improve outcomes, and often save lives. The focus when reshaping services must be delivering improvements in patient care, and patients and their families must be fully involved in this process.”

Notes to editors

View the full report Reshaping surgical services: principles for change

The Royal College of Surgeons of England is committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care. Registered charity number: 212808

For more information, please contact the RCS press office on:

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