Author: Professor Denny Levett, Director, Centre for Perioperative Care

Taking on the role of Director of the Centre for Perioperative Care (CPOC) is both a privilege and a responsibility.

CPOC was created in 2019 to improve outcomes for patients undergoing surgery by championing patient-centred, integrated care across the perioperative pathway. As surgical patients become older and more multimorbid, perioperative care is evermore essential to delivering safe, effective and sustainable surgical services. A particular strength of CPOC is that it brings together patients, clinicians, professional bodies, and system leaders from the full range of specialties involved in perioperative care.

Perioperative care starts with patients at its heart. Our recently published Perioperative Care Patient Charter sets out what patients and families should expect from good perioperative care: clear information, proactive optimisation, partnership in decisions, and coordinated support through recovery. The Charter provides a shared standard for patients, clinicians and systems, anchoring perioperative care around experience, dignity and equity.

The UK government’s 10-Year Health Plan for England describes three shifts required to build an NHS fit for the future: from analogue to digital, from hospital to home, and from treatment to prevention. Similar ambitions exist across the devolved nations. Perioperative care is uniquely positioned to deliver all three. Surgery is one of the most common interactions people have with the NHS, and the perioperative period offers a powerful opportunity to improve outcomes, reduce harm, and support long-term health at scale.

From analogue to digital

Too many patients still reach the day of surgery without objective assessment of risk or timely optimisation of reversible conditions such as anaemia, diabetes, malnutrition or functional impairment. The consequences are familiar: avoidable cancellations, complications and prolonged recovery.

Digital perioperative pathways offer a clear solution. Early digital screening and triage can identify risk sooner, target resources more effectively and streamline preoperative assessment. When designed well, digital tools allow clinicians to focus on complex decision-making while supporting patients to engage in their own preparation for surgery. CPOC will continue to support digital perioperative models that improve efficiency while maintaining safety, equity and personalised care.

From hospital to home

Much of what determines surgical outcomes happens outside hospital. Prehabilitation, optimisation of long-term conditions and behaviour change are most effective when delivered early and close to home. The perioperative pathway therefore, aligns naturally with the ambition to shift care from hospital to community.

CPOC will prioritise scalable community-based and virtual approaches that support patients to prepare for surgery and recover well at home. Digital delivery can widen access, but only if digital exclusion is actively addressed. For patients at highest risk, blended models combining digital tools with clinician-led support will be required. Supporting local teams to design inclusive pathways that integrate remote, community and face-to-face care will be a core focus.

From treatment to prevention

Perioperative care reframes surgery as an opportunity for prevention, reducing postoperative complications, preserving independence and improving long-term outcomes. Surgery is often viewed as a discrete episode of treatment, but it can also act as a catalyst for sustained health improvement.

The perioperative period is a powerful teachable moment when patients may be particularly receptive to changes in physical activity, nutrition, smoking and alcohol consumption. Prehabilitation provides an effective framework for this, and CPOC has recently supported national clinical and implementation guidance for prehabilitation in people with cancer, helping to translate evidence into practice at scale.

Shared decision-making underpins all perioperative care. It ensures patients understand not only the risks of surgery, but also the potential benefits of optimisation, delay, or alternative approaches, while incorporating individual values and preferences, empowering patients to take an active role in their care.

Supporting delivery and implementation

Perioperative care is inherently multidisciplinary and multiprofessional. Its strength lies in collaboration across anaesthesia, surgery, medicine, nursing, allied health professions, primary care, and management, though this breadth can make implementation challenging.

CPOC will invest in workforce development, including the development of a certification in perioperative care, and will strengthen networks of local CPOC leads, including surgeons and allied health professionals, to support shared learning and accelerate adoption of effective practice.

CPOC has helped define what good perioperative care looks like through national guidance. The next phase is about embedding this consistently. Our focus will increasingly be on implementation support: practical toolkits, business case templates and real-world examples to help organisations translate guidance and the Patient Charter into everyday practice. Working with the NHS and professional bodies across the four nations, CPOC will align perioperative care with elective recovery, productivity and prevention priorities.

Looking ahead

Perioperative care aligns naturally with the three shifts of the NHS 10-Year Plan. It is digital by necessity, community-focused by design and preventive by nature. CPOC’s ambition is that every surgical patient, regardless of where they live or what operation they need, experiences coordinated, patient-centred perioperative care that reflects the expectations set out in the Patient Charter.

By focusing on implementation, collaboration and prevention, perioperative care can deliver safer surgery, better outcomes and long-term value for patients and the NHS. This is a collective endeavour, and I look forward to working with colleagues across the system to make perioperative care everyday practice.