Anaesthesia fit for the future – one year on

Back in 2020 we knew that the pandemic had a huge impact on the specialty and we knew that our members played a critical role on the frontline of COVID-19, but something else also happened which we had never seen before – all of a sudden anaesthetists and intensive care doctors were thrown into the limelight and started to appear regularly on news programmes. It has always been difficult to raise the profile of the specialty, with the media and the public not fully understanding the role of anaesthesia in healthcare, making competing for space with other medical specialties quite tricky.

We wanted to take full advantage of this shift in public opinion and in February 2021 we launched  Anaesthesia -fit for the future, our UK wide campaign on the anaesthetic workforce – a 2-3 years programme of policy influencing activities aimed at setting out a vision for ‘team anaesthesia’ and define the support it needs to deliver the best possible patient care beyond COVID-19.

Even before the pandemic, we were well aware that the anaesthetic workforce was facing some considerable challenges around workforce gaps, poor retention and low morale and wellbeing across various grades. COVID-19 added a new level of complexity to these challenges and compounded the pressures already felt by our members. The question for us was to agree what our campaign priorities should be for the first year and which would have the most impact.

Prioritisation for a campaign can be a make-or-break issue, and the project risks failing if the right priorities are not picked. Policy professionals need to strike the right balance between listening to all stakeholders on what they feel we should campaign for and marrying these up with the priorities and interests of Government and Ministers, which, as we have seen in the past year, can change, along with their priorities, in the blink of an eye!

For this campaign the choice was not too difficult in the end. We knew that something needed to be done quickly to support our members and the specialty through the pandemic and beyond and we knew that the Government was desperate to start the recovery of the NHS and that it needed the staff to do this. Out of our prioritisation exercise, two priorities emerged which fitted the bill:

• Calling for increased investment in the anaesthetic workforce to fill the gaps
• Understanding and addressing the retention challenge in anaesthesia

Another critical component of effective campaigns is that any policy ask needs to be backed up by robust evidence, so our next task was to gather evidence to help us make the case for our two priorities.

On retention, we worked with the Evidence Centre to understand the factors affecting retention in anaesthesia and similar professions through a rapid evidence review. We also surveyed the RCoA Membership Engagement Panel to understand the career intentions of anaesthetists, how COVID-19 has affected them and what would help them to stay in work. All of this evidence was complied in our report Respected, valued, retained – working together to improve retention in anaesthesia. The key message to take away from the report is that the factors affecting retention are complex and multifactorial and this is why the report makes recommendations at individual, organisation and system level. One key recommendation was for staff and managers to have a continuous dialogue throughout their career about any adjustments and career intentions to support people to stay in work and to aid succession planning in departments.

In terms of workforce numbers, we were lucky to start with a strong evidence base in the form of the College workforce census carried out in 2020. But we also wanted to understand how the anaesthetic workforce was placed to cope with the predicted increase in demand over the next twenty years. For this we commissioned York Health Economics Consortium to carry out a demand and supply analysis of the anaesthetic workforce in the UK up to 2040 taking into consideration a growing and ageing population, the expansion of surgical interventions and the expansion of perioperative care services. The findings are stark – at the current growth rate the UK healthcare systems will have a shortfall of 11,000 anaesthetists in 2040, resulting in over 8 million missed operations. This analysis features in our latest publication The Anaesthetic workforce: UK State of the Nation Report, bringing together all of the evidence gathered during the first year of the campaign.

This report will form a solid evidence base to continue to make the case for anaesthesia and our members as the campaign progresses, but in fact we already have had considerable success at various stages of the campaign this year. Our retention report was well received by healthcare leaders, and we now have built a strong relationship with NHSEI retention team, who are willing to collaborate with us in finding ways to support anaesthetists to stay in work and to support anaesthetic departments with succession planning.   

In addition, building on the momentum created by a coalition of organisations calling for better long-term workforce planning, we are now productively engaging with relevant stakeholders, including Health Education England’s review of framework 15 on workforce planning, to look at ways not only to boost the anaesthetic workforce, but to also understand what ‘team anaesthesia’ might look like and the shape of anaesthetic services in the future.

The RCoA Policy and Public Affairs team will continue to work with key stakeholders on these issues through the Anaesthesia – fit for the future campaign and to advocate on behalf of our members, ensuring that our campaigns and policy influencing activities remain impactful and result in the best possible outcomes for the specialty.

For more information please contact advocacy@rcoa.ac.uk.

Elena Fabbrani

Policy Manager and Project Lead