Written by the Perioperative care for older people having surgery team, Guys & St Thomas’ NHS Foundation Trust

At Guy’s and St Thomas’s, our POPS (Perioperative care for Older People having Surgery) team is dedicated to helping patients before, during, and after they have surgery. Perioperative care is the patient-centred approach that we use to support patients when they have an operation.

We work closely with the surgical and anaesthetic teams to plan for any risks and make surgery as safe as possible. This approach helps reduce complications and means patients get home quickly and safely after surgery. POPS services were first set up at Guy’s and St Thomas’ in 2003, and are proven to be beneficial to patients, clinicians, and health care services. We have been adapting and expanding this service with the help of patient involvement throughout.

We are very pleased to announce that the POPS team at Guy’s & St Thomas’ has won the Royal College of Anaesthetists 2025 Patient’s Voices Award, which celebrates care shaped by meaningful patient involvement. Over the past 20 years we have kept the patient and carer voice at the centre of everything we do. We did this through establishing a Patient and Public Involvement and Engagement (PPIE) group from the outset of POPS in 2003. This fantastic group of people have helped to shape the service and prompted POPS teams around the country to keep a holistic and personal approach, with the focus on the person rather than the condition and on addressing what matters most to the patient.

How patient voices have shaped our service

We appreciate how difficult it can be especially for some older people to be involved in this kind of work. It can seem daunting to work with healthcare professionals, to use computers or other technology, to attend in person or online meetings. It can be especially difficult if people have hearing, visual or memory problems.

We have worked hard to break down these barriers to participation. Patients and carers have been offered flexible dates, small group video calls or telephone consultations. Prior to the meetings, participants have been given written information in easy-to-understand language outlining the purpose of their involvement. This ensured everybody started on the same page with the same background information. We have worked with patient representatives from other organisations such as the Centre of Perioperative Care (CPOC) and the Patient Information Forum.

"The fact that you have a serious condition, you have various things that need to be taken into account and having the time to look into patient’s problems and taken seriously, for me it’s just brilliant,” PPIE participant.

Our PPIE groups around the country have directly shaped the development of POPS services. For example, they told us that being fully involved in decisions about surgery was very important, so we introduced shared decision-making tools such as the “BRAN” approach (Benefits, Risks, Alternatives, Do Nothing) to guide these conversations. This has helped some patients choose treatments that suit them better, including non-surgical options.

"When the POPS team got involved, the communication, co-ordination and the sense that there was actually a doctor looking after her was much better than the previous months. They looked at everything (not just the surgical things) and the continuity was much better (before you came in and you got one story and were then told a different story on the phone overnight),” PPIE participant.

Feedback has also helped us improve how we manage common issues such as postoperative delirium (confusion after surgery). Interviews with PPIE groups helped highlight delirium as an important factor in deciding to pursue surgery. Checking for the risk of delirium is now a routine part of preparing patients for surgery and planning their recovery afterwards. Now, during our PPIE interviews, patient say that delirium is better managed with POPS services. This is due to clearer communication and better support for patients and carers.

"I can’t believe my brother and I did not know anything about ‘delirium’ until it happened to my mum. I hadn’t even heard the word. The POPS team explained it to us in a way that we understood. I wish I had known about the chances of it happening before it did happen to my mum – I might not have been so worried or scared. I hope that its something that all doctors can pick up and explain," PPIE participant.

Building on 20 years of partnership

PPIE input has also helped shape our service through helping us come up with meaningful research questions. This has resulted in many publications, presentations and awards. The services are now being established across other countries in Europe, Asia and Australia. Our PPIE group has made us think harder about how we make sure all older people have access to services such as POPS. This has led to the award of a national grant (£1.6million) to look at how we can establish these services across the NHS and whether they continue to show we can improve outcomes for older people. This study is called POPS-ScaleUp or POPS-SUp.

We are very grateful to every member of our PPIE group who over the past 20 years has helped shape our services and our research so that we can improve care for all older people having surgery. We could not have done it without them! Now, looking to the future, we want to build on this work and if you would like to share your views and help us build a better health service for tomorrow, then do get in touch.