FUTURE SURGE RY
the country,” he commented. This will have significant implications for the planning and delivery of surgical services, going forward. He pointed out that future geographical need for surgical interventions, for conditions and diseases associated with deprivation, is highly predictable. It has not significantly changed since the 1850s. However, there will be significant changes relating to age- related conditions and diseases, which will need to be addressed. “In London, the age structure will be much the same in the next 30 years, but the equation needs to balance elsewhere in the country,” he explained. “We are going to see accelerated ageing in semi-rural and peripheral areas, such as coastal areas. This means that surgery arising from age related diseases/conditions will increasingly need to be concentrated in these peripheral areas or we are going to have to find a way of ‘moving people around’.” “The old structure is not going to work,”
Prof. Whitty asserted. “If you look at the map where ageing is happening and the map where deprivation is happening, they are essentially different. This is going to lead to a significant a shift in the need for surgical and medical specialists. It will have important implications for surgery as the incidence of cancer and hip fracture is largely driven by age,” he continued. There are some parts of the country where diseases of deprivation and ageing overlap. But coastal towns are particularly affected by an ageing population profile (as his CMO report in 2021 pointed out). Coastal communities have tended to attract older, retired citizens, who inevitably have more and increasing health problems, yet it is harder to attract NHS staff to these areas. Furthermore, the majority of surgical training is undertaken outside of these areas. This means there is a mismatch between where surgical and medical staff are located and where there is the greatest need.
There have been some positive trends,
however. As he alluded to earlier in his presentation, cardiovascular disease has improved steadily – with a 73% reduction in mortality between 1975-2018. As a risk factor for people going into surgery, there has been a general downward trajectory for cardiovascular disease (although it increased very slightly, in the past few years). “It has been a staggering success,
overall,” Prof. Whitty pointed out. He added that there has also been “a blurring of the lines” in cardiovascular health between physicians that prescribe medication and surgical specialties. Surgery sets will become smaller and there will be a move to less invasive treatment. Figures since the 1980s demonstrate that, while coronary artery bypass operations are not increasing in volume, there has been a rise in percutaneous coronary interventions. Rates of solid cancers driven by infection are also falling. Some areas of cancer surgery will see a decrease in cases, as cancers are significantly impacted by medical interventions. HPV rates are
decreasing rapidly due to vaccination, for example. There is also better detection and treatment of
H.Pylori, which can lead to cases of stomach cancer, as well as significant improvements in some inflammatory diseases, including rheumatoid arthritis and inflammatory bowel disease. “We can now delay or stop inflammatory diseases with drug treatments, which wasn’t possible 20 years ago. I expect this positive trend to continue,” he commented. There has been other good news – smoking, which drives many cancers and can present complications for surgical patients, has seen a downward trend. This downward trajectory has been particularly rapid in the younger population. “People in their twenties are the most ‘clean-living’ on record,” he observed. While rates of smoking are “drifting down” across the whole population, this progress is “not happening fast enough”, he added. The most significant ‘headwind’ will be in terms of obesity, however. Over two decades, the percentage of people with a BMI greater than 30 has increased from 15% to 26%. Prof. Whitty pointed out that the full effect of weight increases in young people, during the pandemic, will not yet be felt. This cohort are still “young enough not to run into the big problems, associated with being obese,” he pointed out. However, Prof. Whitty warned that the impact on surgical and medical practice is going to be “extraordinary”, over time. There will be an increase in surgical procedures (including orthopaedic and vascular), but also increased risk of complications associated with diabetes. The increased risk of obesity- linked cancers will also have an impact on surgical practice. There are implications for post-menopausal breast cancer, endometrial (uterine) cancer, renal cancer, oesophageal cancer, liver disease, infections, coronary heart disease and stroke.
He commented that surgeons have a 24 l
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