From the President's Desk
22 December 2025
From the President’s Desk near Christmas
As Christmas and the New Year approaches, I want to begin by wishing you a very happy Christmas, and hopefully a chance to pause. This period allows us to step back, spend time with friends and family, and take the air. In demanding professional lives, these moments help our perspective and allow us to rejuvinate.
It has been an extremly busy year and I want to thank all the SCTS team for their efforts and support specially in our new projects.
Air, Lungs And The Responsibility To Act
I am writing this having just attended a wedding in India, where winter often brings heavy smog across the northern plains. London once suffered similar conditions. A notable case was the Great Smog of 1952, a public health catastrophe associated with widespread illness and thousands of excess cardiopulmonary deaths. The visibility was so bad that it was described as looking through “pea soup”. What followed was decisive action: the Clean Air Acts, which transformed population health, improved quality of life and were also associated with improved economic productivity. This is an example of how evidence-based policy can deliver lasting health and overall economic benefit.
Watching haze settle over a city makes the consequences of air pollution impossible to ignore. As thoracic surgeons, we see daily the damage caused by what people breathe. Poor air quality is a major driver of lung cancer, asthma and chronic obstructive pulmonary disease. It disproportionately affects the most vulnerable. By the time patients reach us, much of the harm has already been done.
From Reflection To Action: Transformation That Delivers
I keep saying that reflection should lead to action. Across SCTS, our transformation work sits in different phases: what we have already delivered and now learn from and build on; what we are currently advancing; and what we are developing for the future.
This work takes place against ever changing backgrounds. With NHS England now in the process of being dissolved into the Department of Health and Social Care (DHSC), routes for clinical influence have become less clear and, at times, harder to navigate. Periods of organisational transition can slow decision-making and blur accountability. In that context, sustained professional influence becomes even more important. It is for us, as clinicians, to “fill the gap”: to define the solutions, and for the administration to ensure proper resources under our guidance.
LVRS: A Model Of What We Achieved Together
The national commissioning of lung volume reduction surgery (LVRS) stands as a recent example of progress achieved. For many years, access to LVRS was inconsistent and often dependent on geography rather than clinical need. It was too frequently framed as high risk or discretionary.
Through sustained engagement, articulation of the evidence base, careful patient selection, multidisciplinary care, SCTS played a pivotal role in reshaping this policy and we are postively cited for that.
LVRS is now recognised nationally as a valuable intervention for selected patients with severe emphysema. The majority of procedures are minimally invasive, and improvements in case selection, surgical technique, technology and enhanced recovery pathways have led to safer surgery and better outcomes. This success should give us professional confidence. It shows what is possible when we work together, and it provides a good model for other areas of transformation.
Cardiac Transformation: Building Momentum
A similar approach underpins our cardiac transformation programme. Seventeen units applied in our first round! With a focus on teamwork, minimally invasive cardiac surgery and enhanced recovery, this has the potential to transform care achieving better patient outcomes with a reduced length of stay in ITU and hospital. A win-win-win.
We are aware of some departments exploring alternative avenues, and that is legitimate. At this stage, what matters, is that positive change is happening. If our SCTS programme shows a way acting as a catalyst for improvement, either in or outside our framework, patients will benefit. Momentum is building.
Transplantation: Resetting The Programme
We have also used this year to restart and reset our approach to cardiothoracic transplantation. This service line has major worforce challenges and overall numbers are low by international standards. We will address this.
The newly re-established SCTS Transplant Committee has already held robust and at times passionate meetings. In parallel, we are engaging with NHS England colleagues as a separate but aligned workstream.
The SCTS plan seeks firstly the the views of consultant surgeons who hold direct clinical responsibility for transplant patients. We must honestly and collectively understand why UK cardiothoracic transplantation is, in some ways, underperforming. This is in spite of sustained investment over many years. Are those resources actully getting to transplant care or are they being used for other purposes? These are uncomfortable but necessary conversations. There is already broad agreement that previous approaches have not delivered optimal performance.
Our first aim is to produce a consensus statement, developed by consultant surgeons, describing what an ideal transplant service should look like, unconstrained by past practice or perceived resource limitations. Why unconstrained? Because significant investment has already been made without delivering the expected outcomes. This suggests the issue is not input alone, but rather how services are structured, led and culturally supported.
By bringing transplant consultants from all units together, we are laying the foundations for a new vision and a better system.
Retraining/Reskilling
Following our recent statement on patient safety, teamwork and professional culture, we have developed proposals for Consultant Retraining/Reskilling. These are currently under review by the SCTS Executive. We are frequently approached by Trusts and members for advice in this area, and the questions are strikingly consistent. In response, we are developing a framework that we hope to share with you following this review period.
Time For A Presidential Board?
In parallel, Trustees and the Executive are considering proposals to evolve the presidential role into a Presidential Board model. Enoch Akowuah our president elect and I already run such a model, and it works well. Our proposal is an early stage of development, but the aim is clear: to increase leadership capacity, maintain momentum, improve transitions and enable more members to serve in senior leadership roles for SCTS.
These are not yet agreed policies, but I share this with you now, as they signal our progressive thinking and our desire to adapt. In due course, proposals will come to the membership. Your participation, challenge and support will shape the future direction of SCTS.
Clinical Work: Keeping The Skills
Despite the considerable time commitment required to lead and develop the Society, clinical work remains a privilege and a joy. My practice spans the range of thoracic practice, from patients discharged the same or next day to those requiring prolonged inpatient care.
Recently, a major chest wall resection and reconstruction for ulcerating recurrent breast cancer, undertaken with plastic surgery colleagues (including a pedicled flap, skin advancements and split-skin graft) and supported by many others, was a great example of teamwork in action. Seeing this patient walking on the ward with a healthy wound is so rewarding. It gives us confidence to push a little further next time to achieve an even better margin.
Looking Ahead: A Call To Join In
As we look 2026, please join us at the SCTS Annual Meeting in Belfast, 15–17 March 2026. Registration is open. Book early and take advantage of the early bird rate!
Early in the New Year, we will also launch registration for the second SCTS London to Brighton Bike Ride. Our first event was just great.
Make it your New Year’s resolution! Get fitter, build teamwork, bring your colleagues, trainees and patients together, and ride as teams. Raise funds and visibility for SCTS, and help make heart, chest and lung surgery better.
Warmest wishes for Christmas and the year ahead.
Aman S Coonar
SCTS President
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