Published 22 April 2020

We are in a situation quite unlike anything that we are used to. We are asked to and required to make decisions in circumstances for which we are relatively unprepared. The essence of the TJTO&C is that it is close to being live. The submissions may look polished, but a moments consideration of the content will make it apparent that the time from conception to publication is brief. This means that of necessity there may be a greater need for subsequent reflection than in a more sedate journal. There is therefore always going to be space for that response, debate and reflection. Last week’s submission from Swansea on SHiFT clearly prompted much thought and discussion, some of which is aired in the pieces that follow. The editorial is not here to judge, the opinions in the submissions are those of the authors not the editors’ or BOA. However, we do have our own opinions and will express them to entertain, pontificate, promote debate and occasionally inform.

As we all look at plots on a daily basis we try to discern whether we have passed a peak nationally or locally. We guess when lock down will be lifted and in what order, and when it happens what the response on those daily plot lines will be. There is increasing talk of the ‘recovery’, with some people seemingly fantasising that this will be a stepwise return to normal, but most are accepting that the term post-COVID-19 will come to have the same watershed significance as post-war. Things will not be the same, nor should they be. Our circumstances may be very different; if COVID-19 progresses from being pandemic to endemic then organisational and physical structures for delivering safe healthcare will have to accommodate this. We may have COVID +ve and COVID -ve hospitals. Surgical interventions in that new world may have different risks, real or perceived, which may change patients’ and surgeons’ attitudes. As in the post-war period, the post-COVID-19 era will be different not wholly by necessity but also as a result of the opportunity for change. In the natural world evolution seems to hit the accelerator after a natural disaster. For a brief period, the normal inertia of procrastination and foot dragging accompanying every innovation in the NHS may be suspended for long enough for the good ones to become established and persist. Who knows, it may extend to the BOA and the TJTO&C, with perhaps a different title, this may be one of those changes that persists after the age of the dinosaurs.

Bob Handley