|The President writes - March 2013|
|Tuesday, 19 February 2013|
In the first period of a new year, there is a tendency to a feeling of anticlimax as the weather remains cold, wet and rather depressing. However, the pace of life in the NHS and the world of surgical politics remains hectic. There have been a number of reports published by the government, the Academy of Medical Royal Colleges, and other colleges which make for interesting reading.
The topics include sevenday consultant-present care, reshaping the NHS, and contributions to Professor Greenaway’s anticipated report on training the workforce to meet the future needs of the NHS. Finally, the Francis Report on the events at Mid Staffs will occupy our thoughts for years to come.
Overall, the message coming through is of change and those of us working in the Health Service are only too conscious of the effect of these changes on our working lives. Speaking to my colleagues who are physicians and reading the Royal College of Physicians of London report Hospitals on the Edge, there is no doubt that the systems we are accustomed to are groaning under the strain of many pressures. These start with changes to GP contracts, which have added to the pressure on our A&E departments. The consequent changes in medical admissions combined with the pressure to reduce bed numbers produce inevitable concerns about capacity.
New treatments and ways of working mean that patients with both medical and surgical conditions are kept in hospital for much shorter periods. In turn, this places strain on community services, resulting in both a higher turnover in hospital and an increased tendency for patients with ongoing problems to bounce back into the hospital soon after discharge. For the surgical specialties, the targets on waiting lists are placing an added strain on both management and clinicians.
These pressures are not eased by reduced numbers of trainees and consequent changes in work practises as a result of the New Deal and the EWTR. The icing on this cake is the time and effort involved in revalidation.
I am not really surprised that the outcome of all these changes is to induce a feeling of frustration and impotence in almost all surgeons, from those who are in Core Surgical Training all the way to senior consultants who are looking forward to retirement with increasing longing.
It is difficult for those of us who face our patients daily to ignore the effect that this is having on them. It is no surprise that the valued relationship between the doctor and the patient is under strain and I can’t be alone in believing that this bond of trust must be maintained and improved.
In my thinking about these issues, I have observed that the problem is not just in surgery but that the bunker mentality is affecting all hospital staff, even those most resilient and faithful servants of the patient, our nursing colleagues.
Clearly, there has to be a different approach to how we deliver care for our patients and, given the imperative stated in the GMC’s Good Doctor document, we all have responsibility for putting patient care at the centre of our actions. We also have an obligation to those who manage the health service to co-operate effectively to deliver that service.
In the difficult circumstances of today’s NHS, with the multiple challenges facing us, we often find that working harder doesn’t sort the problem and so we have to consider wider issues and confront the risky proposition that other methods of dealing with the problem are needed. These ideas have been defined by Aryris and Schon in the concept of single and double loop learning (Organizational Learning: A Theory of Action Perspective, 1978).
Most of us will react to a problem by applying well known remedies such as working harder or using traditional alternatives to deliver the solution. When that doesn’t work, the need for innovative new solutions is where the double loop learning concept comes into play and a search is made for a new way of working which will deliver a lasting solution.
Well-functioning units, departments and hospitals react to the pressures on them by working as a team to adapt to the changes with the common goal of improving patient care by changing the way that they work. This can be an uncomfortable process but ultimately leads to a position in which the patients are looked after well and the staff providing that care are happier in the job that they are doing. I know of many teams who have been through such processes and have emerged stronger and more effective in delivering good care for patients and excellent training for the next generation of consultants.
This is no easy task and it requires leadership, team work and a willingness to consider that change. I believe that this challenge is the biggest one facing us this year and it is my goal to ensure that the College provides the support that you need to make the necessary changes to continue delivering first-class patient care. We have already addressed some of these issues by establishing the Faculty of Surgical Trainers, providing support on the College website for revalidation, as well as ensuring that our Regional Surgical Advisers are prepared with information to help you engage in the process. We support the Faculty of Medical Leadership and Management, an organisation whose raison d’être is to provide support and guidance in these areas.
In the near future we will be re-establishing the New Consultant Induction course, which is aimed at supporting newly appointed surgeons so that they understand better the processes and pressures of change.
Finally, we look to continue co-operation with other colleges through the Academy of Medical Royal Colleges and with our sister Colleges and Specialty Associations through the Surgical Forum. I am delighted to report that the Forum will be chaired for the next year by Professor John MacFie, former President of the ASGBI and a Fellow ad hominem of this College. I look forward to supporting him in the goal of providing a unified voice for surgery in the British Isles.
The year ahead promises many challenges but that is the nature of surgical practice and we should not be surprised at that. The priority must always be the care of patients. That is at the centre of all we do. Surgical practice is all about meeting and overcoming challenges. Avoiding the challenges by not changing is unprofessional.
I look forward to an exciting year with many opportunities to turn a somewhat bleak winter outlook into good news about intercollegiate working and continuing support for our members worldwide.