The President’s Blog – January 2021

Maintaining staff wellbeing in the face of adversity

One advantage of a blog (over an article in a news magazine, for example) is the ability to publish almost simultaneously as writing the content. In one way that makes this blog easier, as I can reflect on the current pandemic surge, but in another it is no help at all – as we all know either by direct experience, or through contacts, colleagues, friends, about the tremendous pressure the health services in the United Kingdom and in Ireland are under this week. It is not necessary to expand further, except to say that although we are an association of anaesthetists, many members also have a commitment to critical care, and for those who don’t – many are offering help and support to their critical care colleagues.

At this year’s virtual Winter Scientific Meeting the wellbeing session was the most highly rated part of the event. 

It has never been more important for us to focus on our own wellbeing and that of the wider team. We know that many NHS staff (including anaesthetists and intensivists) have been traumatised by the first wave of the virus and are now going through even more difficult times. The Association has prioritised supporting the wellbeing of members for many years and has multiple resources available on our website including the ‘Vital Signs in Anaesthesia (a guide for anaesthetists seeking help and advice during the COVID crisis)’ document. At this year’s virtual Winter Scientific Meeting the wellbeing session was the most highly rated part of the event. The speakers were Professor Neil Greenberg, Dr Anna Baverstock and Dr Fiona Kelly. They spoke about the threats to our wellbeing, how to prepare effectively, how to sustain ourselves and support each other, and what will aid our recovery afterwards. To aid all our members, and also other healthcare workers, we have made this session freely available to all; there is no pay wall. Please do use this resource and share with others in your teams, departments and hospitals.

There is much understandable anxiety about the decision to split the two parts of the vaccination. We published, with others, a statement on this on January 11. We have seen since the continuing disquiet in the general and medical media and also heard from our members. There is no answer that will satisfy everyone. I have heard the disappointment, frustration, anger and – yes – fear resulting from this decision. I have also heard from colleagues who accept the need to vaccinate as many of the population as possible, as quickly as possible. There is a lack of scientific evidence to support the delay to the second part of the Pfizer/BioNTech product; there is also credible actuarial analysis to support the delay. I am in no doubt that the strength of feeling on this matter has been heard across Whitehall, by the CMOs, and by the JCVI.

We are disappointed that the reality of working during this crisis and the professional risks (in addition to the personal risks we take every day) are not being acknowledged.

The Association made a number of representations last year about protecting healthcare workers from coronial, regulatory, civil or criminal action or criticism as a result of the actions and decisions they are taking. Others have continued to campaign on this issue, with a letter to the Secretary of State in England highlighted last week. We support that campaign and are disappointed that the reality of working during this crisis and the professional risks (in addition to the personal risks we take every day) are not being acknowledged.

It may seem a distraction to write on other matters this week. But, the success of our recent Winter Scientific Meeting does suggest to me that members do still want educational material, and perhaps also the sense of belonging or camaraderie that comes from attending a meeting (even if online). I wrote a few weeks ago to members about our decision to continue with the meeting, despite the surge. The recordings of all the sessions (in addition to the one I mentioned above on wellbeing, which is free) are now available to all registered delegates via the meeting platform, and will remain there for the next six months. I confess that we just don’t know when face-to-face conferences will restart. We very much hope that both the Trainee Conference in July and the Annual Congress in September will have a significant physical element. But who can say?

The Association’s work for its members is continuing. The Board will be undertaking strategy work over the next 3-6 months on workforce, Anaesthesia Associates, and new educational activities. We are celebrating the 75th anniversary of the first issue of Anaesthesia, important work on the environment continues in preparation for the IPCC COP26 meeting hosted by the UK government at the end of this year, the ‘Fight Fatigue’ campaign is gaining more and more supporters, and our trainee members are preparing for a change in the curriculum. I would say this, wouldn’t I, but it has never been more important than now to be a member of an organisation that can represent and advocate on your behalf.

Finally, let me just say: “please look after yourself and your colleagues” and “stay safe”.

Mike Nathanson

Email: president@anaesthetists.org

Twitter: @mikenathanson61

The President's Blog - December 2020

I am sure it seems strange to everyone that we are coming up to the holiday season in such circumstances. While the information about current numbers of admissions to hospitals, and specifically the number of patients in critical care beds, shows a rather heterogenous spread of the second wave of Covid-19, we are all feeling the pressure one way or another. We heard recently of the death from Covid-19 of our colleague Krishnan Subramanian in Derby. Every death is a huge loss to family, friend and colleagues. Losing someone from the ‘family’ that is anaesthesia and intensive care has been felt in every department. It seems Dr Subramanian’s death is the first in the UK and Ireland of an anaesthetist. A publication in Anaesthesia will be examining this, and suggesting possible reasons why, so far, we have been mostly spared. However, as we all recognise, this is not a time to be complacent, even with a vaccine now being delivered.

At times, it seems so obvious that we need to train more anaesthetists , and it is disappointing that the number of training posts has not been increased.

The recently published College census shows, again, the number of unfilled vacancies for consultant and SAS posts. This number will inevitably grow. We all want to see that change. At times, it seems so obvious that we need to train more anaesthetists, and it is disappointing that the number of training posts has not been increased. It was good, however, to see the announcement of more training posts in critical care. Of course, many other specialties also need their training posts to increase, so we are – to some extent – competing with them. We will continue to lobby, work with others and highlight this issue.

Our ability to work on behalf of our members has increased hugely.

This links to my next item – our new Policy and Advocacy Committee. Following the appointment of our Advocacy and Campaigns Manager in April 2018, our ability to work on behalf of our members has increased hugely. In the last three year we have responded to 45 consultations on behalf of members. Another major success has been the Fight Fatigue campaign, with interest from many parts of the profession and beyond (for example, Highways England), and the project group won the 2020 BMJ Workforce and Wellbeing Team of the Year Award. Many congratulations to all of the team. Other advocacy work that the committee is overseeing includes workforce, future service design, environment, wellbeing and Anaesthesia Associates.

As I have said previously, our work around the changes to Anaesthesia Associates (the archetypal ‘Marmite’ topic) is very important to members. Their regulation, planned for the end of 2021, offers some opportunities, as well as concerns – particularly on how post-qualification changes to the practice will be managed. To those who believe their introduction should be resisted at all costs, I say ‘that boat has sailed’. As the details of how regulation will work evolve, we will continue to represent anaesthetists and their patients. We plan to consult widely next year on the line we should adopt, but in the meantime, I’d be very happy to hear from members about their experiences and views. There is much to consider, including education, standards, and Fitness to Practice proceedings.

Our Trainee Committee’s survey on recruitment and examinations is about to close and we will be analysing the data in the next few weeks. There is no doubt that recent changes continue to cause anxiety. Thinking of my comments above about workforce shortages, it is even more perplexing to know that we have great candidates who can’t get into specialty training.

We have been made aware of a trend for some private providers to directly employ senior anaesthetists. The use of private providers to deliver some NHS care was a political decision taken some years ago. But one recent change is the use of these employed colleagues to provide care to ‘private patients’, i.e. those with health insurance or self-funding their care. We are not a trade union (consequently we are unable to offer advice on individual contracts) and this development is quite ‘above board’ and legal, but members may wish to read carefully any contract they are offered to ensure it allows them to work, like their NHS colleagues, with professional independence and with access to SPA time, study leave, wellbeing resources, appraisal, etc.

Finally, I was privileged to speak last week to the Tri-Service Anaesthetic Society (on my favourite topic - sustainable anaesthesia). One the other speakers was Dr Richard ‘Harry’ Harris who spoke on his experiences as an anaesthetist and cave diver. Harry was instrumental in the safe recovery of the Thai boys football team stuck underground in 2018. It was a truly inspirational lecture highlighting his huge skill, ingenuity and astonishing personal bravery. I was reminded again of the bravery of anaesthetists when I watched Dr Ian Roberts rescue Romain Grosjean from the burning remains of his F1 car at the Bahrain GP. As we all know, our work is not always recognised by the public but is crucial in so many areas.

I hope that every member has the opportunity for some rest and relaxation during the coming holiday season. I suspect we will need to recharge our batteries for more waves of the pandemic (despite the start of the vaccine program), the inevitable ‘other’ winter pressures, and the demand to catch up on all the elective work already lost this year. And, as the end of the year approaches, my thanks on behalf of all the Association’s members to all of our fantastic staff for their work and efforts in 2020.

Season’s Greetings!

Mike Nathanson

Email: president@anaesthetists.org

Twitter: @mikenathanson61

The President's Blog - November 2020

We are now, clearly, in another significant surge of the pandemic. The Association has heard of real pressures in various parts of the country: many patients with COVID-19 on wards and in critical care; episodes of likely nosocomial spread; large numbers of healthcare workers self-isolating; and, disruption of surgical activity, despite efforts locally and nationally to maintain an elective service.

Our trainees took a big hit in the first surge, and since then they have been affected by changes to the FRCA examination and to recruitment. The recruitment processes at CT1 and ST3 are changing again; some refinements were needed after the problems with the ST3 round a few months ago. We campaigned hard based on our belief that the self-assessment process could discriminate against certain groups. We received some reassurances from the statutory education bodies that the changes to the current round would reduce this risk. The Trainee Committee are now undertaking a survey of trainee experiences. If any of this has affected you, please do complete the survey so we can represent your views.

The Association Board is looking to balance our desire to maintain activities such as educational meetings, guidelines, grant awards, international work and our joint work with other organisations, and the need to prioritise clinical work as we are placed on emergency rotas. This affects our Board, speakers, faculty, volunteers and others we work with. At the beginning of the first surge we shut down many workstreams but maintained the main governance processes to ensure the Association (as an entity) got through the emergency. This time we have a little more time and certainly more experience to allow us finesse how we manage this surge. Most importantly, we recognise that our actions and experiences reflect what every member, their departments and their households up and the down the country are doing this week. We all know the wide impact of the surge and this current national lockdown on society, the economy, our patients and on our colleagues. We have updated the wellbeing guidance on our website, with new links and resources. As I have asked you before, please do check on your colleagues. A small act of kindness or support, or an expression of concern can make a huge difference.

As I mentioned above, there is much effort being expended on trying to maintain elective, cancer and other non-urgent services including surgery and diagnostics. Within London a plan has been developed to create a hub-and-spoke model, prioritising some services such as cataract surgery and joint replacement surgery. Similar projects in other parts of NHS England are underway. Of course, we broadly support such moves, but there is a need to ensure high-quality care and that patient safety is not compromised. Further, many clinical teams have not had time to fully recharge their batteries since the first surge. We have joined the groups created in the last few weeks to deliver this service, and will offer advice, encouragement and warnings as appropriate.

The first pandemic surge came with many surprises. The editors of our journals – Anaesthesia and Anaesthesia Reports – were worried that submissions would fall as colleagues concentrated on clinical work. In fact, they saw the reverse, with a large increase in submissions. We have increased the number of editors to ensure the workload is manageable. We are always hugely grateful to the Editor-in-Chief, Andy Klein, and his team of editors and production staff for publishing month in, month out, such successful journals. Next year marks the 75th anniversary of the first publication of Anaesthesia. There is an ambitious range of activities to mark this achievement – look out for the first of these in the New Year.

Last month I described how we were planning to deliver the Winter Scientific Meeting in a new format. The Chair of the Education Committee – Chris Mowatt, and our Events team led by Zack Puttock are working incredibly hard with our online conference provider – The Live Group, to produce a high-quality ‘product’ in January. Like many, I will miss the physical meeting and its opportunities to meet, socialise and learn with colleagues. In my opinion we cannot easily replace that, but we can offer something new and different and take advantage of the technology to do things differently. Providing we all get through the next two months and are not subsumed by work before then, I do hope we can come together online for a great event.

Finally, I’d like to finish this month’s blog by expressing my thanks to the Boards and Committees of the Association for all the work they do for you – the members. They could not do this without the support of our fantastic staff. We were very disappointed not to be able to reopen our headquarters at 21 Portland Place last month. For our staff, this was a heavy blow and I’d like to thank them publicly for their perseverance and continuing efforts for us. We remain open for business!

Mike Nathanson

Email: president@anaesthetists.org

Twitter: @mikenathanson61

The President's Blog - October 2020

The Association of Anaesthetists’ year starts at the Annual Members Meeting (AMM) each September. This year, of course, we were unable to conduct the AMM during an Annual Congress meeting; however, we held a very successful online Links/SAS Links/TNLs meeting combined with the AMM and a keynote lecture from Tim Cook. At that event we said goodbye to several Board members and thank you to several officers whose roles have changed. It was my duty and pleasure to pay thanks on behalf of the Association to Kathleen Ferguson as she completed her two-year term as President and handed over the reins to me. I thanked her, on your behalf, for her leadership, for her humility, for her attention to detail, for her commitment to equality and diversity, for her advice and for her friendship. 

I hope to use these President’s Blogs as a way of informing the membership about what the Board and staff have been doing on your behalf. 

One of my personal commitments as incoming President is to improve our communications with members. It's always difficult to get the balance right between timely messages and information overload. I hope to use these President’s Blogs as a way of informing the membership about what the Board and staff have been doing on your behalf. 

As I write this, we are entering the second surge of the Covid-19 pandemic. It is difficult to predict the impact on each of us, on healthcare systems and our patients, and on society in general. Tim Cook’s keynote lecture during the virtual event for our Links and AMM meeting on Sept 25th was a timely if somewhat scary reminder of risks associated with Covid-19. The Association has been working on your behalf throughout the pandemic and will continue to do so. We have another of our very successful free Covid-19 webinars on Saturday October 10th – this one is focused on getting back to normal. The impact of the current surge on elective activity is currently unknown. Not surprisingly, governments and healthcare systems want to try and preserve elective activity as much as they can. We met with Steve Powis Medical Director of NHS England last month focusing on new ways of working. Prof Powis emphasised the importance of maintaining non-urgent surgery, and we committed ourselves to several actions to assist with that.

There is no doubt that the new ways of working will include a much more multi-professional workforce. The issue of Anaesthesia Associates (AAs; previously known as PA(A)s) is one of the true Marmite issues in anaesthesia. It is my opinion, and I think that shared by many others, that the numbers of AAs in training will be increased and their role promoted by our governments.  We could put our collective heads in the sand, but these changes will still go ahead. Now that their regulation by the GMC has been announced we have opted to work with the GMC and will be represented on working groups looking at education, standards and fitness to practice processes. We think engaging and influencing from the inside will be much more effective, but I appreciate this will not suit everyone. Like it or not, the pandemic has highlighted the value of an expanded, multi-skilled and adaptable workforce; a rubicon has been crossed.

To ensure the best experience for our membership we’ve bought a new learning management system to deliver WSM as an online event. 

Our Events team and Education Committee are planning the Winter Scientific Meeting. I imagine the majority of members and delegates would prefer a real, physical meeting – with the extra richness of experience that comes from meeting face-to-face, the opportunity for chats over coffee or lunch, of visiting the industry exhibition, and of bumping into old friends. There are, of course, others who find the whole thing rather tiring, expensive and not particularly environmentally friendly. We’ve thought long and hard about what to do, and it does seem that our only option at present is a virtual meeting. While the Board asked the Events team to retain the possibility of adding in a physical element, that seems increasingly unlikely. To ensure the best experience for our membership we’ve bought a new learning management system to deliver WSM as an online event. As you might expect there are numerous companies competing to deliver these events. I think the one we have chosen will help us provide a new type of experience, with some possibilities that a physical event does not allow. We are not transforming the Association into an ‘online only’ organisation, but ‘needs must’ and being nimble and embracing new technology is part and parcel of the profession of anaesthesia. Bill Fawcett and Chris Mowatt, the outgoing and incoming Chairs of the Education Committee, have developed a great program. See you there!

I can’t write a blog without mentioning wellbeing. It is so integral to the Association and so vital during the extraordinary circumstances we currently live in. Do access the wellbeing pages on our website. We will continue to develop our own resources and signpost those from other organisations. And, just one request from me, please check those around you at work, as a quiet word of support or encouragement may make a huge difference to them.

Mike Nathanson

Email: president@anaesthetists.org

Twitter: @mikenathanson61