Obituary: Brendan Devlin

HAD ALL the members of the medical profession, not just some surgeons, listened to and acted upon the principles of audit, quality assurance and evidence-based practice proposed by Brendan Devlin more than 15 years ago, many of our present difficulties and loss of public confidence would never have occurred. His approach to surgery was encapsulated some 35 years earlier by George Armitage of Leeds when he said "Surgery, like cricket, is only interesting if you keep the score."

Born in Lancashire in 1932 into an Irish medical family and having thus seen medical practice in England and Ireland before the creation of the National Health Service, Devlin became an ardent supporter of its ideals, wanted it to be of the highest quality and learnt much about how to achieve his aims through the political machinery of the newly created Health Service from his father. This background led him to read for and obtain a BA in Public Administration and Political Science, in Dublin, before reading for his medical degree, which he obtained with honours in 1957.

His surgical training followed the standard pattern of the day, five years as a Registrar, time off-service for research, followed by four years as a Senior Registrar, collecting an MD, an MCh, and Fellowships of the English and Irish Surgical Colleges on the way.

Such a training, moving from hospital to hospital at six-monthly or yearly intervals, leaves little time to think beyond the day-to-day problems of surgical practice but, whilst working with Sir Hugh Lockhart-Mummery at St Thomas', Devlin became increasingly disturbed by the distress suffered by many patients with ileostomies and colostomies (artificial openings of the bowel on the abdominal wall following removal of part or the whole of the colon) caused by poorly fitting rubber bags and adhesives that often caused a severe dermatitis around the stoma. He was concerned about the way in which these problems affected the patients' whole life and so went out of the hospital to see them in their homes, arranged for them to be visited by nurses and encouraged the development of better bags and adhesives.

This work, including a book, Stoma Care Today (1985), continued after his appointment to a Consultant post at North Tees General Hospital, and with the work of others helped the growth and development of the British Colostomy Society, of which he was elected Chairman in 1998.

This experience rekindled his concern for the surgical patient when not in hospital, the effect of hospitalisation and the paucity of our knowledge about the long-term physical and social effects of many surgical procedures. His response, which determined his whole career, was only to admit patients to hospital for as short a time as possible (or not at all) and to count all aspects of the cost of his clinical work - clinical audit.

As soon as he arrived in North Tees around 1970, he started performing day case surgery - 15 years before the Royal College of Surgeon's first publication on the topic. As hernia repair was one of the main operations performed as a day case, he naturally became especially interested in the methods of hernia repair and more importantly their results. Although this interest produced many publications on hernias including a major textbook, Management of Abdominal Hernias (1988), and took him on lecture tours to many parts of the world, its most significant effect was to emphasise to him, yet again, the poor quality of evidence advanced to justify the multitude of medical opinions concerning not only the best form of hernia repair but many other surgical procedures. Anecdotes, case series, experience yes - but where was the hard, scientifically acceptable evidence?

In the early Eighties, he began his most important work - a crusade - to make all doctors, not just surgeons, audit and constantly review their work. After many lectures and discussion groups conducted all over the UK, he persuaded the members of the Association of Surgeons and the Association of Anaesthetists, with the support of the Royal College of Surgeons of England, to establish a National Confidential Enquiry into Perioperative Morality (NCEPOD).

Its first report was published in 1986. It is now firmly established and is one of the national audits that is to be supported by the new National Institute for Clinical Effectiveness. As Director of CEPOD and later as Director of the Royal College of Surgeons Audit Unit - now the Department of Clinical Effectiveness - he championed the use of audit, guidelines, individual comparative audit, patient information brochures and quality assessment by patients. His biggest regret was that his profession has been so slow in adopting these methods of guaranteeing quality.

All this work was performed whilst conducting an active surgical practice and whilst being a member of the Council of the Royal College of Surgeons of England where as Chairman of the Examinations Board he lead the revision of the nature and contents of the FRCS examination, making it, under its new title MRCS, an assessment of basic surgical training.

His CV describes the multitude of committees he chaired, books and articles written and lectures given but does not capture the zeal, enthusiasm, sometimes frustration and anger, of an exceptional man, whose lifelong concern was the well-being of the whole of every patient, body and mind, whether they be in hospital at home, at work or at play, and his unswerving belief in "keeping the score", to which NCEPOD will be his lasting memorial.

Hugh Brendan Devlin, surgeon: born 17 December 1932; married 1958 Ann Heatley (four sons); died 26 December 1998.