Letter to the health secretary - Scotland
Mr Humza Yousaf MSP
8 June 2021
Dear Cabinet Secretary,
Re: Trainee Anaesthetists
Firstly, may we congratulate you on your appointment as Cabinet Secretary for Health and Social Care.
We are writing to you on behalf the Association of Anaesthetists which represents more than 10,000 anaesthetists (including approximately 3,500 trainees). We are seeking urgent action to increase the number of ST3 training posts in anaesthesia this summer. In light of the well-described workforce shortage in anaesthesia, it seems that time is of the essence to grow the number of trained anaesthetists in the UK.
This year, due to a combination of factors, there are many more applicants for specialist training in anaesthesia than in previous years. A recent estimate found there are around 350 jobs for approximately 1,050 candidates, leaving up to 700 trainee anaesthetists without a suitable training post. The increase in applicants this year results from a number of factors: a new curriculum which places an imperative to obtain a training post before the regulations change and the ‘goal posts’ move; the impact of the Covid pandemic on the number of trainees who might otherwise have sought a year abroad to consolidate their learning but who are now unable to travel and wish to remain in the UK; the difficulty in achieving educational targets while re-deployed during surges; and, a desire to complete training without any further interruptions after the unprecedented pressures and challenges of the last 14 months.
These trainee doctors have already spent at least two years gaining experience in anaesthesia and intensive care. During the pandemic surges most anaesthesia trainees were reallocated to intensive care units to provide the medical workforce and enable the provision of this resource to be massively increased. They have committed to a career in our speciality, and they are the workforce of the future. Providing them with training posts now will ensure we have a supply of trained senior staff in five years’ time, and during their five-year training they will provide significant service, staff many out-of-hours rotas, and ensure the resilience we need for further surges.
We know you are working with colleagues on the huge backlog of investigations and therapeutic surgical procedures that has grown over the last 14 months. The pressure on the NHS is extraordinary and unprecedented. Surgery and anaesthesia are, of course, intimately linked and there can be no increase in surgery without a concomitant increase in anaesthesia.
Last month, our journal – Anaesthesia – published the collated results of three surveys which highlight the extraordinary pressures faced by anaesthetic departments throughout the country during the surges. In addition, the most recent census published by the Royal College of Anaesthetists has confirmed the findings of previous censuses that there is a very significant shortage of anaesthetists in the UK (over 1,000, and almost certainly closer to 2,000). At a time of a very significant anaesthetic workforce shortage, it is disappointing and surprising that, to date, there has been no increase in the number of training posts. As a result, the workforce gap will continue to grow. The impact of fatigue and stress, leading to more retirements or move to part-time working, will only further increase the shortage.
We urge the UK and devolved governments to tackle the workforce shortage by funding a very significant increase in training posts. Not to do so will miss an opportunity to provide more anaesthetists right now, provide greater resilience immediately for further surges, and prevent these 700 doctors becoming the new ‘lost tribe’ in medicine. A recent survey of our own trainee members has shown a very significant degree of disillusionment in our trainee anaesthetists. If you do not act, we believe there is a very real risk that many of these doctors in whom we have already invested time and money in training will be lost to the profession forever as they will seek alternative careers or move to work abroad once travel restrictions are lifted.
We suggest that the number of training posts (ST3) is doubled this year from approximately 350 to 700, and remains at that level for the subsequent two years. We know that Trusts (and Boards) have money set aside for creating non-training ‘locally employed doctor’ (LED) posts this year as they recognise the need for more anaesthetists. We understand that Health Education England already has money set aside to support of education of trainee anaesthetists. LED posts will not lead to training of qualified specialists, but if the funds we have identified and some additional new money was used to create training posts then there will be a long-lasting improvement in the anaesthetic workforce and the capability to provide more surgical services.
We would be happy to meet with you and discuss our proposal further.
With best wishes,
Dr Roopa McCrossan
Chair, Trainee Committee
Dr Mike Nathanson