For more than a decade, the perioperative care community has been making the case for a fundamental change in how we deliver the patient's surgical journey.
The argument has always been compelling. Better perioperative care improves patient outcomes, reduces avoidable harm, supports healthcare professionals and makes better use of healthcare resources. It improves quality, efficiency and productivity while delivering a better experience for patients.
From a patient perspective, the rationale is straightforward: people deserve the best possible preparation before surgery, the safest possible care during their procedure and the support they need to recover afterwards.
From a clinical perspective, perioperative care represents what many of us aspire to deliver: coordinated, multidisciplinary, evidence-based care centred around the individual rather than the surgical intervention alone. It reflects a paradigm shift in thinking, away from isolated speciality-based care towards a connected pathway that supports patients before, during and after surgery.
For healthcare organisations, perioperative pathways offer the opportunity to reduce complications, improve recovery, optimise high-value resources and deliver more sustainable models of care.
Over the past decade, the evidence supporting perioperative care has matured considerably. We now understand that it addresses many of the challenges facing modern healthcare systems and aligns closely with the Institute for Healthcare Improvement's Quintuple Aim: improving population health, enhancing patient experience, reducing healthcare costs, supporting workforce wellbeing and advancing health equity.
Yet despite this evidence, structured perioperative care has not been universally adopted. This is why the London Declaration matters.
The Declaration does not represent the beginning of the perioperative care movement. Rather, it marks the point where years of evidence, advocacy, clinical experience and international collaboration come together with a shared ambition to turn evidence-based clinical practice into widespread and routine care.
Collaboratively developed by seven forward-thinking national and international organisations committed to advancing perioperative care, the Declaration communicates a simple but powerful message: High-quality perioperative care transforms lives.
The timing could not be more important. Healthcare systems across the world are facing unprecedented pressure. Populations are ageing. Obesity, inactivity and chronic disease continue to rise. Multimorbidity and complexity are becoming the norm, while demand for surgery continues to grow.
At the same time, healthcare organisations are expected to reduce backlogs, improve operational efficiency, support an overstretched workforce and deliver greater value from finite resources. For many patients, surgery represents hope, an opportunity to maintain independence, improve quality of life or treat life-changing conditions.
But surgery also represents something else. It is a unique opportunity to improve a patient's health and fitness for surgery before treatment even begins. The surgical event is a pivotal turning point, a profound teachable moment for both clinicians and patients to reflect, prepare and optimise.
Perhaps the biggest opportunity lies in changing how we think about the period before surgery. Traditionally, patients are placed on a waiting list. But waiting suggests passivity. Instead, we should think of this opportunity as a preparation list.
The weeks before surgery should not simply be viewed as time waiting for an operation. They represent valuable clinical time that can be used to optimise health, reduce risk and improve outcomes.
The Centre for Perioperative Care (CPOC) highlights seven key interventions patients can undertake while preparing for surgery, including increasing physical activity, improving nutrition, stopping smoking, reducing alcohol consumption, preparing psychologically and optimising existing medical conditions.
This represents a fundamental shift, from healthcare doing things to patients, towards healthcare working with patients. It also aligns closely with the prevention agenda set out in the NHS England 10-Year Health Plan.
Surgery should be viewed as a partnership between patients and clinicians. Healthcare teams commit to providing safe, evidence-based care, while patients are supported and empowered to take an active role in improving their own outcomes.
The answer to growing surgical demand is not simply to perform more operations. It is to perform surgery better. Smarter. Perioperative care recognises that outcomes are influenced by far more than technical excellence in the operating theatre.
The journey begins before surgery through shared decision-making, assessment of risk, optimisation of health and universal and potentially personalised prehabilitation. Ensuring that patients become active participants in determining their care and their surgical outcome.
It continues during surgery through evidence-based multidisciplinary care and extends afterwards through enhanced recovery, rehabilitation and ongoing support. Every stage of the pathway contributes to better outcomes.
The answer is complex. Perioperative Care is not an altogether new concept. The evidence base has been built over many years. So why has implementation been slower than many of us expected?
Healthcare is rightly cautious. Patient safety depends on robust evidence, careful evaluation and responsible implementation. But healthcare is also one of the most complex environments in which to introduce change.
New models of care require more than evidence alone. They demand changes in culture, education, organisational priorities, workforce roles, traditional funding models or streams and established ways of working, including professional identity.
The history of healthcare demonstrates that even interventions that later become accepted as essential often take significant time to become embedded into routine practice.
The challenge with perioperative care has not been a lack of understanding of its value.
The challenge has been translating that understanding into consistent delivery of a new way of working, whilst recognising that traditional targets and goals may be affected until new processes become established. That mindset now needs to shift.
The challenge has been translating evidence into consistent practice across healthcare systems. That mindset now needs to change, not because change is easy, but because the consequences of failing to change are becoming increasingly difficult to justify.
The costs of inaction are high. For patients, clinical teams, organisations, and national and international healthcare systems.
They are measured in avoidable complications, delayed recovery, reduced independence and unnecessary pressure on health and social care systems. They are measured in healthcare professionals working within increasingly stretched services. They are measured in additional treatment, readmission, longer hospital stays and healthcare resources that could be used more effectively. Within the UK, we already have an unsustainable social care and welfare burden.
Perioperative care is therefore not simply a clinical improvement programme. It is a healthcare transformation programme. That requires attention from leaders at every level.
Healthcare leaders should recognise perioperative care as a strategic priority, not as an anaesthetic initiative or an additional service, but as a whole-system opportunity to redesign surgical pathways around better outcomes, improved patient experience, workforce sustainability and greater productivity.
Every Chief Executive should now be asking their Chief Medical Officer or Medical Director and Chief Operating Officer: Why does our organisation not yet have a structured perioperative care pathway for every patient undergoing surgery?
And if one is already being developed: When will it be operational, measurable and delivering benefits for our patients, our workforce and our organisation?
This is no longer a question about evidence. The evidence exists. It is now a question of leadership, prioritisation and implementation.
Healthcare improvement does not only happen from the top down. Patients also play an important role. Preparing for surgery should not mean passively waiting for an operation.
Patients should expect support to optimise their health, understand their risks, prepare physically and psychologically and become active participants in their recovery.
Patients and families should feel confident asking: "What can I do to prepare for my surgery?" and "Does my healthcare organisation provide a structured perioperative care pathway?"
High-quality perioperative care should not depend on where someone lives, which hospital they attend or how well they understand the healthcare system. It should simply be the standard of care.
Delivering personalised perioperative care at scale requires more than good intentions. Digital transformation is becoming a critical enabler of modern perioperative pathways.
Digital solutions can help identify risk earlier, coordinate multidisciplinary teams, improve communication with patients, collect meaningful data and provide greater visibility across the patient journey.
They can support personalised preparation pathways while helping organisations measure outcomes and continuously improve performance.
Technology alone, however, is not the answer. Transformation comes from redesigning pathways around patients, supported by strong clinical leadership, engaged teams and digital infrastructure that enables new models of care, provides smarter operating systems that interact and provides obtainable data easily to track improvements in real time. The opportunity is not simply to digitise existing processes. It is to create a fundamentally better way of delivering perioperative care.
Having spent many years advocating for perioperative care, as Director of the Centre for Perioperative Care (CPOC), as a senior clinician, healthcare leader and now Chief Medical Officer at Buddy Healthcare, I have seen both the strength of the evidence and the challenges of achieving meaningful system-wide change.
I have also seen that transformation is possible when clinical evidence, patient priorities, organisational leadership and digital innovation come together. The question is no longer whether perioperative care matters. The evidence is clear. The opportunity is clear. The need is clear. The challenge now is implementation.
For healthcare leaders, the priority is to make perioperative care part of organisational strategy. For clinical teams, it is to embed perioperative care into everyday practice. For patients and patient groups, it is to expect it, ask for it and help drive it forward. Because high-quality perioperative care transforms lives. Every patient undergoing surgery deserves the opportunity to benefit from it. It is what I would want for my family, my patients and myself.
That is the ambition of the London Declaration.
The time to turn evidence into action is now.