The structure of the NHS is currently undergoing radical reforms that will inevitably impact on the future delivery of surgical care in England. In light of these changes, The Royal College of Surgeons of England has set out to establish a greater understanding between surgeons and hospital managers. In October 2006, a meeting was held in the Lake District at Rheged, Europe's largest grass-covered building. It was attended by almost a hundred people and included both managers of NHS hospitals and those from the independent sector, chief executives, and consultant and trainee surgeons representing all of the surgical specialties. The meeting was hosted by the president of the College, Mr Bernard Ribeiro, and was facilitated by Professor Tony Mundy, medical director of University College Hospital and director of the Institute of Urology. The meeting took an interactive format and generated some lively debate.