Changes in Surgery over 46 yearsA personal perspective

Robin SouterMilton Keynes

Graduation Day

Changes;Surgical

Peptic ulcer diseaseGeneral – sub specialistsAuditNurse specialistsMorbid obesity

Interventional/diagnostic radiologyVascularNeuroBreastGeneral/hepatobiliaryMR scansCT scansDigital imagesImage transfer

Astonishing general changes

Public HealthEpidemiology Doll and HillGenetic understanding - Double helix-

human genomeOrgan transplantation- immunosupressionJoint replacement

General public

Expectation LitigationPolitical interferenceInternet trawlersUnderstanding/misunderstanding

Some Glasgow contributions

GCSGriseofuelvinU/S scansTIVABio engineering

Short stay surgery/ RGS

RAF Gan, Maldives 1975

NDS Oxford5 years in a fast developing environmentEmbryonic day surgeryJulian Britton LA day case hernia repairs in

Abingdonfacility availableexpediencyday case nylon darn hernia repairs

Jean Miller in the Churchill hospital “Do not use opiates”

From the dreaming spires to the concrete cows!

Milton Keynes Hospital 1983

Exciting times

MK HospitalConcept

2/3 patients treated locallyremainder to travel to Northampton and Stoke Mandeville1.6 beds:1000 population2.4:1000 national norm

Concept fatally flawed!

Partial solution – move to day case surgery

Portakabin 1985. Fight for pipes!Mainly paediatrics and scopesCore enthusiasm for day care surgeryOriginal protocols extremely cautious

Milton Keynes HospitalGreen field site opened April 19841.6 beds/1000 populationNational norm 2.4/1000Concept 1/3 of patients continue to travel

to Northampton or Stoke MandevilleConcept doomed to failure

Drivers for change

RCS working partiesAudit commissionPoliticiansVFM BADS directory “aspirational targets”Improved techniques

Surgery/anaesthetic/analgesiaPublic wish

Public issues

Concerns about hospital cleanliness and outcomes

Worries about chaotic in patient wards- mixed sex, mixed elective emergency care

MRSA/ C.diff. (we were warned!!!)

Where am I now?Ramsay NHS ISTCBlakelands, Milton Keynes

ISTC NHS treatment centre Day case surgery onlyTIVAEnhanced recovery / Australian model

hernia repair 4 hours door to door!Careful follow up and auditHigh patient satisfaction

Where next ?Joint re-modellingImprovements in minimally invasive

procedures

And that reminds me!