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Dear Editor

With the start of 2024 we will each have set our own resolutions and goals for the year ahead, both personally and professionally. But to achieve these we will be relying on our healthcare system to do the same. The NHS Long Term Plan delivers many promising messages, but there appears to be an ever mounting number of constraints and challenges to overcome, too.

It goes without saying that a swift resolution to the pay dispute is essential to prevent any further distress for both staff and patients. With waiting lists spiralling out of control, the pressure on us to work harder and longer is very real. We need to collaborate effectively with non-clinicians and service users alike to come up with realistic solutions to curb the demand and supply imbalance. In the meantime everybody needs to remain proactive in taking simple measures to improve our daily working conditions and ensure we feel valued.

Have you missed a Bulletin issue or perhaps you’d like to re-read a past issue? Our full selection of back digital issues has you covered and will keep you up-to-date and informed on what’s happening in our specialty. We hope you continue enjoying your membership magazine.

Understandably, well-being means something different to all of us, but does it have more awareness and recognition than 20 years ago?

Dr Marie Nixon, Consultant Anaesthetist and Dr Thom O'Dell, ST7 Trainee discuss their experiences of wellbeing and what it means to them. 

Dr Richard Knight looks back at the turbulent 1970s – a decade well known as a time of crisis both economically and politically.

What comes to mind when you think of the 1970s? Flared Jeans, David Bowie, Dallas? Well, it wasn’t all Happy Days (forgive the pun) – this decade was also very much about skyrocketing inflation and unemployment, the Winter of Discontent, strikes, power cuts, and states of emergency.

Welcome to the Winter 2024 issue of the Bulletin. I am always filled with renewed enthusiasm at the start of a new calendar year, in part as the festive season in South Asian cultures starts in late October with the celebration of Diwali and then… well… continues! 

This is not to take away from the fact that winter within the UK National Health Service (NHS) is extremely challenging; some may say that this year, especially, is akin to walking a tight rope.

I’d like to wish you all a very happy New Year. I realise that January is a very challenging time in the NHS, with winter pressures compounded by ongoing staff shortages and sickness. And in looking ahead to some of the College’s priorities for 2024, I’d like to highlight some of the work we're doing to try to address these issues.  

The urgent need for more doctors to be able to train as anaesthetists is always the first thing I raise in conversations I have with the government, NHS England and other decision makers around the country. Last month I wrote to the new Secretary of State for Health and Social Care to set out the need to address the current shortage of anaesthestists and to outline the impact this is having on the elective care backlog, among other things. 

In the last year we have secured some incremental improvements on this front, but there is a long way to go, and we will do all we can to maintain momentum in the year ahead.

New Year is always a time of reflection, particularly as for me it is also the anniversary of my joining as CEO at the College. That is now four years ago, and I find myself looking back on the challenges the College has faced over that time, the changes that have been made and the achievements of our volunteers, elected leaders and staff team.

It has been a remarkable four years. Within a couple of months of my appointment COVID-19 hit. The challenges for our membership were enormous. The specialty was at the frontline, and anaesthetists and intensivists had to learn and adapt at pace to provide the best possible care for the patients who were most seriously ill under very challenging circumstances. The College too had to urgently adapt.

Exams, which had always been held in person, were rapidly moved to virtual platforms. It was a steep learning curve for so many of us and it didn’t all go as smoothly as we wanted, due in large part to the pressures put on so many by the pandemic. Nevertheless, I was proud of the College, its examiners and the exams team, who, along with candidates, contributed fully to the subsequent independent review of our assessment process. The review was published earlier this year. Lessons were learnt and changes have been made that have seen us continue to welcome almost 5,000 candidates per year to the College for their exams.

At Nottingham University Hospitals (NUH), it was felt that for our patients with cardiovascular disease, obtaining a preoperative cardiology assessment and perioperative management strategy was prolonging non-cardiac surgery waiting times. 

This was especially compounded by the surgical backlog and increased demand on preoperative services following the COVID-19 pandemic. In order to streamline the assessment process and facilitate safer surgery, a joint cardiology-anaesthesia multidisciplinary team (MDT) meeting was established.

The global problem

It is no surprise that underlying cardiovascular disease can contribute significantly to perioperative morbidity and mortality, with cardiac events being the leading cause of such.¹ Almost half of adults aged over 45 years undergoing major non-cardiac surgery have at least two cardiovascular risk factors, and conditions such as coronary heart disease, heart failure and arrhythmias put patients at increased risk of cardio- and cerebrovascular events in the immediate postoperative period.²

They're the fresh faces of anaesthesia and the future of our specialty.

We introduce you to some of our newest anaesthetists in training. We hope all of them and the rest of our trainees have very long, rewarding, and fulfilling careers as anaesthetists.