There has been an increasing realisation that the majority of complications from high risk surgeries are not due to technical failings in either the operating theatre or anaesthetic room, but from medical complications occurring out on the wards. 'Failure to rescue' has become part of critical care lexicon and with it, an awareness of the financial burden associated with treating morbidity associated with high risk surgeries. Over the last three years there has been an explosion of interest in perioperative medicine both as a solution to this problem and as a means to improving the quality of surgical care experienced by all patients. Accompanying the article on the multi-disciplinary team approach to the high risk surgical patient published in this month's BJA, Dr David Walker, director of the Masters programme in perioperative medicine at UCL, addresses some of our hopes, fears and maps out a possible future for this exciting new speciality.