On 1 December 2017, we implemented a health improvement initiative, called In Shape for Surgery, for people with specific risk factors, so that they can access support to improve their health prior to surgery.
This initiative is designed for patients undergoing non-urgent, elective surgery. It does not affect emergency or urgent surgery or diagnostic procedures.
It was rolled out in a phased approach, beginning with hip, knee and hernia, with the possibility of more procedures being introduced in the future.
The In Shape for Surgery pathway recommends early detection and management of risk factors. GPs work with patients to improve their health before a referral for surgery where the additional benefit of primary care treatment can be had.
This could mean helping the patient to stop smoking or manage their:
In some more complex cases, patients will be referred into secondary care to help them improve their medical health, prior to being referred for surgery.
There is support available to help people improve their health. Patients will be signposted to healthy lifestyle services by their GP and by secondary care clinicians.
An important feature of this work is consistent messages from all healthcare professionals and access to support services.
We believe that we all have a responsibility to promote healthy behaviours and integrate prevention of ill-health into our services.
We also believe that we should be encouraging people to take a greater level of personal responsibility for their health and wellbeing. This is also an important priority of the NHS 5-year forward view.
A set of criteria have been developed by primary and secondary care clinicians in Cornwall and Devon.
The criteria covers:
The criteria define the level at which a patient’s risk in surgery may be increased and are based on best practice.
This is a comprehensive attempt at improving the safety, effectiveness, experience and value for money of surgery.
There are clear benefits as it will help us reduce the risk of complications and the resulting length of stay in hospital and achieve improvements in surgical outcomes.
There are also longer-term positive impacts of controlling chronic disease and avoiding risky health behaviour. These are significant for individual patients and their families. They are also important for the NHS and for social care.
Poorly controlled diabetes, high blood pressure, anaemia, problems with heart rate and the structure of the heart and whether a person smokes or not are all shown to affect how well surgery is likely to go.
All of these aspects have the potential to be improved prior to surgery and we are now putting more emphasis on this.
There may be some financial benefits but these are difficult to quantify. If a person spends less time in hospital, or needs fewer trips to the GP after surgery, because they recover better and sooner, for example, it will effectively cost the NHS less to treat them but this doesn’t always free up any actual money.
Many of the areas we are targeting to improve before an operation are actually influential on a person’s health in the long term too. If we can support people to keep going with health improvement and management of their conditions, not just before but after surgery, we hope that this will make them healthier in the long term. Where this happens, they may require less use of the NHS in the future as a consequence of being healthier.
The key change we have made is to make sure that the messages about the importance of pre-operative health are the same across primary and secondary care. We want to make sure that patients always think of these messages when proceeding to surgery.
We have also made sure that the clinical criteria professionals use to judge fitness before an operation are consistent regardless of which GP practice or local hospital you attend. Our review has taken the latest evidence into account.
GPs work with patients to improve their health and routinely refer people to the various support services available. We have been looking at how we can help patients to recover better from surgery and doing everything possible to improve patients’ general health is one way of doing this. This initiative is designed to ensure that best practice is being followed across the county and patients realise they have an important role to play in boosting their recovery times by adopting healthier lifestyles. At present, some people’s surgery can be cancelled because of these conditions so encouraging healthier lifestyles earlier will reduce the risk of this happening.
Healthy lifestyles support and information can be found below:
More detailed information is available on the Referral Management Service website.