Value-based surgical care: a view from the surgeon's knife.

NHS trusts across the country are facing unprecedented financial pressures, along with rising levels of demand and widespread variation in surgical quality and cost. There is a moral and financial imperative to provide the most efficient use of resources in order to ensure sustainability of a system that is free at the point of use, and provide consistently high-value care for patients across the country. Delivering 'value' does not mean any reduction in the quality of care - it means achieving the same or higher quality at the same or lower cost. Avoidable and costly incidents in surgery occur every day: patients do not receive the right care, procedures or tests are performed without real benefit, complications lead to prolonged hospital stays, to readmissions and re-interventions. Put simply: poor quality surgical care is expensive. The concept of value-based health care is well known in the UK, yet its principles are not yet fully embedded in the health-care system, surgical training or practice. The shift towards better value-based care with a focus on delivery system reform (Getting It Right First Time), outcomes-based commissioning and payment reform (accountable care systems and integrated care systems) provides an opportunity to make significant improvements in surgical care. Radical and immediate change is required, and everyone, from trainees at the frontline, to clinical leaders, trust chief executives, local commissioners and policy-makers, has vital roles to play. The health-care system needs to be designed, organized and paid for differently to deliver better surgical value for patients.