5 days ago
Flagship British project to boost global surgical standards under threat of closure
A flagship British project created to improve the safety of medical surgery around the world could shut down next year because of the government's aid cuts.
The Global Surgery Unit (GSU), launched in 2017 by the Royal College of Surgeons, conducts large-scale studies across a network of 120 countries to find ways of making surgical care both more effective and accessible, particularly in developing countries.
Every year more than four million people die from conditions that could be treated with surgical procedures – a greater number of deaths than HIV/Aids, malaria, and TB combined – yet it remains one of the most neglected components of global health.
In recent years the GSU has conducted some of the biggest surgical research studies in history, and claims to be the largest global research network in science. In 2021 it set a Guinness World Record with a landmark study on the impact of Covid-19 on surgical patients that involved collaboration from over 15,000 scientists and researchers.
But it could now be forced to close in June next year when its current funding runs out, said Professor Dion Morton, GSU co-lead and the Barling Chair of Surgery at the University of Birmingham, which co-created the unit.
'They've already funded us through to June 2026, they can't take that back – [but] if they could, they would,' he told The Telegraph.
Prof Morton said the GSU 'has been run on a shoestring' since its launch, costing only around £20 million and focusing on a public health intervention that plays a vital role in nearly every area of medicine.
Some 28 per cent of the global disease burden stems from conditions that are treatable with surgery – from infections and trauma wounds, to blindness and maternal health.
Improving surgery is also a key component of the fight against antimicrobial resistance (AMR), which kills more than 1.1 million people around the world every year, including 35,000 in the UK alone. By preventing and managing infections, it helps to reduce unnecessary antibiotic use.
The GSU, which involves 40,000 surgeons across 120 countries, conducts large-scale trials to tackle major global surgical challenges across many countries at the same time.
The initiative has driven advancements in low-cost and practical interventions to improve surgical care in low-resource settings - innovations that are also feeding back into surgical practices in the UK.
One of the GSU's landmark studies, known as the CHEETAH trial, conducted across three continents, found that simply changing gloves and instruments before wound closure prevents one in seven wound infections. This practice has now been adopted into routine practice in Britain and around the world.
Another major initiative, the EAGLE trial, tested in 70 countries, introduced a standardised medical checklist to improve outcomes in bowel surgery.
'Global surgical care is probably the greatest world health challenge today and the one that we are currently failing to meet,' said Prof Morton.
'It is a fundamental part of the health system and if we're going to provide effective global health care and we must strengthen the whole system, it's not enough to just treat single conditions.'
A 'bottom up approach' to transforming care
Experts have warned that Labour's decision to slash its overseas aid budget by around £6 billion, including a 46 per cent drop in health related spending, could reverse vital progress in some of the world's most vulnerable regions.
Shrinking development budgets means politicians are focusing on threats like single disease interventions, pandemics, and conflict.
'There's a tendency in global health to look backwards…but it's not actually treating the whole health system. It's not addressing the real need in the world. And I think that this is a mistake,' said Prof Morton.
Last month, The Telegraph reported that the Fleming Fund, a major £265 million British programme designed to tackle AMR in the developing world, is being closed by Labour's aid cuts.
Sir Jeremy Hunt, the former health secretary, told The Telegraph that the move 'directly puts our national security at risk'.
Prof Morton also challenged a common misconception that surgery is 'only a crisis treatment of last resort', adding that it 'is not simply something that's carried out in an operating theatre.'
Some global health and development institutions have come under increasing scrutiny for perpetuating so called 'colonial power dynamics'. But Prof Morton said the GSU takes 'a bottom up approach to transforming care.'
Instead of allowing Western high-income countries to dictate the agenda, the GSU prioritises collaboration with local surgeons and healthcare providers in poorer countries to co-create interventions tailored to their specific needs.
'In some respects, it bypasses the policy makers and allows the clinicians to improve the care for their patients, and that's the key element in the global surgery network that makes it different from anything else,' he added.
The consequences of not having access to surgery are profound.
It means that every year millions of people die from treatable conditions, such as hernia repair and obstructed labour, which is treated with basic procedures like caesarian sections.
The burden falls heaviest on the world's poorest. Some 93 per cent of people in sub-Saharan Africa don't have access to basic surgical care. One survey suggests that 40 per cent of donated surgical equipment in poor countries is out of service.
Yet, some surgeries can rank among the most cost-effective of all health interventions, such as cataract removal, which reverses blindness at a remarkably low cost.
Research suggests expanding access to surgical care in poorer countries would boost the global economy by $80 billion annually.
Training enough surgeons, anaesthetists and obstetricians remains a key challenge to widening access, with over 160 million patients unable to receive surgery each year.
In higher income countries such as the UK, there are around 35 surgical specialists per 100,000 people, whereas in Bangladesh there are 1.7 per 100,000 people.
Only 26 per cent of countries have met the Global Surgery 2030 goal to ensure everyone has access to essential surgery within two hours.
Yet basic training can make a huge difference. Research shows that trained junior staff, such as clinical officers with around three years of experience, can perform caesarean sections just as safely as doctors.
Prof Morton, who has an Officer of the Order of the British Empire (OBE) for services to innovation in the NHS, warned that the UK's aid cuts will have profound global consequences.
'It will likely result in the suspension of national surgical obstetric and anaesthetic plans in most countries around the world,' he said.
