How the Law Finally Caught Up with the ODP
Operating Department Practice has always been a slightly peculiar profession.
For decades, Operating Department Practitioners and their predecessors worked at the sharp end of anaesthesia and surgery, handling equipment, managing airways, assisting with anaesthetic drugs and dealing with some of the most potent medicines found anywhere in a hospital.
Yet for a surprisingly long time, the law did not entirely seem to know what to do with us.
The history of the ODP is therefore not simply a story of changing job titles.
It is also a story of a profession gradually moving from the margins of the operating theatre to statutory regulation, higher education and formal recognition as an autonomous healthcare profession.
And perhaps nowhere is that transformation more obvious than in the history of controlled drugs.
Before there were ODPs
Operating theatres existed long before the modern profession supporting them.
In the earliest theatres, assistants were often little more than attendants. Their responsibilities could include preparing the room, carrying equipment, cleaning instruments and physically restraining the patient during procedures performed before reliable anaesthesia existed.
The arrival of ether and chloroform during the nineteenth century changed surgery completely.
Anaesthesia allowed increasingly complicated operations to be attempted, but it also created an entirely new problem.
Someone had to understand the equipment.
Someone had to prepare it.
Someone had to assist the person giving the anaesthetic.
As anaesthetic machines became more sophisticated during the twentieth century, that role required increasing technical knowledge.
The theatre attendant gradually became the theatre technician.
And from those technicians eventually emerged the profession we now recognise as Operating Department Practice.
The Operating Theatre Technician
By the middle of the twentieth century, specialist theatre staff were becoming increasingly important.
In 1945, the professional organisation that would ultimately develop into today’s College of Operating Department Practitioners was founded.
At the time, practitioners were generally regarded as Operating Theatre Technicians.
The title was appropriate to the period.
Much of the work was viewed as technical support rather than independent clinical practice.
The technician prepared equipment.
The technician assisted the surgeon.
The technician assisted the anaesthetist.
The implication was that clinical responsibility belonged elsewhere.
But operating theatres were becoming more complicated.
Anaesthetic machines were developing rapidly.
Muscle relaxants transformed anaesthesia.
Endotracheal intubation became increasingly routine.
Mechanical ventilation became commonplace.
Cardiac surgery, vascular surgery, neurosurgery and major trauma surgery demanded levels of technical and clinical expertise that would have been unimaginable only a generation earlier.
The theatre technician was already becoming something considerably more sophisticated than the title suggested.
The Lewin Report and the birth of the ODA
One of the most significant milestones came with the 1970 report The Organisation and Staffing of Operating Departments, generally known as the Lewin Report.
The report helped formalise theatre staffing and career structures and contributed to the development of the title:
Operating Department Assistant — ODA.
Training became increasingly structured and nationally recognised.
The City & Guilds 752 qualification became closely associated with the profession.
The role was also becoming broader.
Rather than simply maintaining equipment, ODAs increasingly worked across what would eventually become the three core areas of Operating Department Practice:
Anaesthetics.
Surgery.
Post-anaesthetic care.
The profession was changing from technical assistance into clinical practice.
The terminology, however, had not quite caught up.
The word assistant remained.
The uncomfortable word: assistant
The title Operating Department Assistant created a problem because it increasingly failed to describe what these practitioners actually did.
In anaesthetics, an experienced ODA could be responsible for preparing and checking the anaesthetic machine, airway equipment, intravenous equipment, emergency equipment and drugs.
They might assist with difficult airway management.
They might participate in major haemorrhage.
They might help manage cardiac arrest.
They might prepare arterial and central venous monitoring equipment.
They might work in cardiac, neuro, vascular, trauma or transplant theatres.
They were clearly no longer simply carrying out technical tasks at somebody else’s direction.
By the late twentieth century, the profession had evolved beyond its name.
From assistant to practitioner
The next major transition occurred around the beginning of the twenty-first century.
Operating Department Assistants became Operating Department Practitioners.
That single word — practitioner — represented an enormous change in professional identity.
The profession was increasingly educated through higher education rather than purely vocational training.
Diploma programmes became established, followed increasingly by degree education.
Then came perhaps the most important milestone of all.
In 2004, Operating Department Practitioners became statutorily regulated healthcare professionals through what was then the Health Professions Council, now the Health and Care Professions Council.
The journey was becoming clear:
Theatre Attendant
↓
Operating Theatre Technician
↓
Operating Department Assistant
↓
Operating Department Practitioner
↓
Statutorily regulated Allied Health Professional
But one area still demonstrated how slowly legislation sometimes catches up with clinical reality.
Controlled drugs.
Enter the Misuse of Drugs Act
The principal legislation governing controlled drugs in the United Kingdom is the Misuse of Drugs Act 1971.
The Act established the overall framework for controlling drugs considered capable of misuse and created powers allowing detailed regulations to govern their possession, supply and storage.
Two particularly important pieces of secondary legislation eventually emerged from this framework.
The first was the:
Misuse of Drugs (Safe Custody) Regulations 1973.
The second was the:
Misuse of Drugs Regulations 2001.
Although they are often discussed together, they perform different functions.
The Safe Custody Regulations concern the physical security of controlled drugs.
The Misuse of Drugs Regulations deal with matters including lawful possession, administration and supply.
That distinction is important.
The controlled drug cupboard
Anyone who has worked in an operating department will recognise the ritual.
Two people approach the controlled drug cupboard.
The cupboard is unlocked.
The controlled drug register is opened.
The quantity recorded in the register is checked against the physical stock.
The drug is removed.
The ampoule is checked.
The dose is entered.
The administration is recorded.
Remaining quantities are accounted for.
Any discarded controlled drug is witnessed and documented according to local policy.
The cupboard is locked.
The key is secured.
It is an extraordinarily familiar process.
And precisely because it is so familiar, it is easy to forget why it exists.
Controlled drugs are particularly vulnerable to theft, misuse and diversion.
The Safe Custody Regulations therefore established requirements for certain controlled drugs to be stored securely in appropriate locked receptacles.
Hospitals subsequently built extensive governance systems around those legal requirements.
Controlled drug registers.
Witnessed checks.
Stock reconciliation.
Key management.
Investigation of discrepancies.
Destruction procedures.
Audit trails.
Local policy may be considerably more restrictive than the minimum statutory requirement.
That is entirely deliberate.
And this is where ODP history becomes rather interesting
For decades, theatre practitioners routinely worked with controlled drugs.
Consider a traditional anaesthetic list.
The anaesthetist may require opioids such as fentanyl or morphine.
Depending on the procedure, other controlled medicines might also be present.
The anaesthetic practitioner may participate in checking them.
They may handle the ampoule.
They may prepare equipment for administration.
They may participate in documentation.
They may check stock.
They may deal with unused medication.
In practical clinical terms, controlled drugs were part of everyday anaesthetic practice.
But historically the legislation had developed around professions such as medicine, dentistry, pharmacy and nursing.
The Operating Department profession had evolved somewhat separately.
That produced a curious situation.
An experienced ODA might spend every working day assisting with potent anaesthetic and controlled drugs while their precise legal status in relation to possession and supply was considerably less obvious than the clinical reality suggested.
The profession had evolved faster than the legislation describing it.
The law versus the operating theatre
This is not particularly unusual in healthcare.
Clinical practice changes.
Professional roles develop.
Technology advances.
Legislation tends to arrive afterwards.
Operating Department Practice is a particularly good example.
The anaesthetic practitioner standing beside an anaesthetist might possess extensive knowledge of pharmacology, airway management and emergency medicine.
They could help manage a catastrophic airway obstruction.
They could assist during major haemorrhage.
They could prepare vasopressors.
They could help with arterial cannulation.
They could participate in resuscitation.
They could work during cardiac surgery where changes in a patient’s physiological condition occurred second by second.
Yet legislation governing medicines had largely been written around an older model of healthcare professional roles.
Eventually that anomaly had to be addressed.
2007: a significant year
The important change came with amendments introduced in 2007 to the Misuse of Drugs legislation.
The changes explicitly recognised Operating Department Practitioners within the controlled-drug framework.
The legislation allowed appropriately regulated ODPs to possess and supply relevant controlled drugs for administration to patients within specified clinical circumstances and according to the directions of an authorised prescriber.
That might appear to be a fairly obscure legislative amendment.
For the profession, however, it was significant.
Because the law was finally acknowledging what clinical practice had already demonstrated.
The individual standing beside the anaesthetist was not simply a technician.
They were not simply an assistant.
They were a registered healthcare practitioner.
Safe custody does not mean prescribing
This is where terminology becomes particularly important.
There is sometimes a tendency to talk about controlled drugs as though every aspect of their management is governed by one piece of legislation.
It is not.
Several different concepts have to be separated.
There is:
possession.
There is:
supply.
There is:
administration.
There is:
prescribing.
And there is:
safe custody.
They are not interchangeable.
The Misuse of Drugs Act establishes the overall legal framework.
The Misuse of Drugs Regulations provide lawful authorities concerning possession, supply and administration.
The Safe Custody Regulations concern storage and security.
Professional regulation determines scope and accountability.
Employer policy adds another level of governance.
An ODP therefore cannot simply say:
“I am registered, therefore I can do whatever I like with controlled drugs.”
Nor can any other regulated healthcare professional.
The authority depends upon the medicine, the circumstances, the relevant legislation, professional scope of practice and organisational medicines policy.
The controlled drug cupboard is only part of the story
It is also worth remembering that not every drug legally classified as controlled is necessarily subject to identical safe custody requirements.
Drug scheduling under the Misuse of Drugs Regulations and the physical security requirements of the Safe Custody Regulations are related but separate systems.
This occasionally creates confusion.
Healthcare staff sometimes assume:
controlled drug = must be kept in the controlled drug cupboard.
Legally, it is more complicated.
Some controlled drugs are exempt from particular statutory safe custody provisions, although healthcare organisations may still choose to impose stricter storage requirements through local policy.
Again, local policy may deliberately exceed the legal minimum.
Why theatres developed such strict systems
The operating theatre presents an unusual medicines environment.
Large quantities of potent drugs may be used rapidly.
Multiple patients may pass through the department during a single day.
Anaesthetic drugs may be drawn into syringes rather than remaining in their original packaging.
Emergency situations can develop within seconds.
Several members of staff may participate in medicines preparation and administration.
Drugs may need to travel with patients between theatre, recovery, critical care and other clinical areas.
And many of the medicines used in anaesthesia have substantial potential for both harm and abuse.
Theatre controlled-drug systems therefore have to achieve two things simultaneously.
They have to provide security.
But they must not obstruct emergency clinical care.
That balance explains why theatre medicines management developed into such a disciplined system of checking, recording and accountability.
From equipment assistant to medicines professional
The history of controlled drugs illustrates the wider evolution of Operating Department Practice remarkably well.
The early theatre technician was primarily associated with equipment.
The ODA became increasingly involved in clinical care.
The ODP became a regulated practitioner.
And eventually medicines legislation began explicitly recognising that professional reality.
Modern Operating Department Practitioners now work far beyond the narrow image of somebody who simply hands an anaesthetist equipment.
They may work in:
operating theatres,
post-anaesthetic care,
critical care,
emergency departments,
resuscitation teams,
interventional radiology,
cardiac catheter laboratories,
endoscopy,
pre-operative assessment,
simulation,
education,
research,
management
and increasingly advanced clinical practice.
Many now undertake postgraduate education and extended roles that would have been virtually unimaginable to the original theatre technicians.
Yet the profession retains something distinctive from its origins.
It sits at the intersection of technology and clinical medicine.
An ODP needs to understand both the machine and the patient connected to it.
They need to understand both the syringe and the pharmacology inside it.
They need to understand both the procedure and the physiology being disrupted by it.
That combination is what makes Operating Department Practice unusual.
The law eventually caught up
The evolution of the profession can therefore be viewed as a gradual process of recognition.
First operating theatres recognised the need for specialist staff.
Then education recognised the need for formal training.
Then healthcare recognised that these individuals were practitioners rather than assistants.
Then professional regulation recognised them.
And finally medicines legislation increasingly recognised what they were already doing in clinical practice.
There is something wonderfully British about the fact that somebody could spend years standing beside an anaesthetist handling some of the most powerful medicines available to medicine before the legislative machinery eventually caught up with the professional reality.
But eventually it did.
The Operating Theatre Technician became the Operating Department Assistant.
The assistant became the practitioner.
The practitioner became a regulated Allied Health Professional.
And somewhere during that journey, the person holding the controlled-drug cupboard key stopped being regarded merely as the person who looked after the anaesthetist’s equipment.
They became recognised for what they had increasingly been for decades.
A healthcare professional responsible for the safe care of the patient.
