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The need for a diverse workforce

It is understood that in healthcare having a diverse workforce that reflects the population they care for can have better outcomes for patients, improve staff retention, and can positively improve staff morale.

Traditionally, medicine has been a career dominated by those from socioeconomically advantaged backgrounds.¹ Despite this, there have been progressive changes in this stereotype in recent times – for the last 25 years more than 50% of medical students have been female, and in 2017 59% of those accepted into medical school were women.² In contrast to this, there is currently a disproportionately low number of doctors who come from lower socioeconomic backgrounds. Data from 2015 shows that only 14% of new medical students were from lower socioeconomic groups, yet these groups represent 56% of the population.^3,4 The RCoA has pledged to develop equality, diversity, and inclusion within the specialty of anaesthesia.

Critical staffing matters

Providing safe critical care services is core business for acute hospitals; this is ever more challenging when faced with burgeoning elective surgical pathways, an ageing and more co-morbid population, and new treatment modalities. Maintaining an appropriately trained, motivated workforce is key to this.

The FICM’s Careers, Recruitment and Workforce Committee (CRW) has been seeking as much data as possible regarding the staffing of ICUs in the UK. The FICM conducted its annual census, of clinical leads, in 2022. We publish some of the analysis in FICM’s Critical Eye publication. The 2023 census will look to strengthen our understanding of the issue all ICUs are faced with. The Scottish Critical Care Delivery Group’s detailed census resulted in the Scottish government supporting 16 newly funded intensive care medicine specialty training posts for 2023.

Welcome to the July 2023 edition of the Bulletin. As I write this, it is challenging to summarise the state of the UK NHS as anything other than the epitome of uncertainty. Yet many of us, myself included, continue to advocate for a healthcare service so close to our hearts, striving for solutions as we approach the 75^th anniversary of the NHS. 

As someone who comes from an immigrant background, I have personally witnessed sustained periods of uncertainty and instability – and, also, through creative thinking, steadfastness, and perseverance, outcomes beyond any that were imaginable. Observing generations of family, my parents included, undergo the process of building life anew including acculturation, instilled in me from a young age a strong foundation of hope that no situation is insurmountable. This hope is beyond naïve positivity, but rather is borne of a pragmatic optimism resulting from lived experience. As a specialty, we are intelligent, resourceful and innovative – we have ‘found a way’ countless times.

Read the latest letters submitted by members in July's Bulletin.

In a recent correspondence, I wrote: ‘So many ideas flying around in my head (ADHD). I need to pin them down, put them in order (ASD), and get started (ADHD inertia). I’m over the “I’m broken” phase and now feel that my mission before I finally retire is to help others realise they’re not broken either’.

Why? A Bulletin article entitled ‘Equality, diversity and inclusion (EDI): what it means to the College’¹ with no mention of neurodiversity! The College wants to ‘develop a dataset of the profile and diversity of their membership and workforce’, but without neurodiversity questions I feel excluded!

One in a hundred young people have an autism spectrum disorder (ASD); 10 per cent of these may become high-functioning adults.² Between three and six per cent of children have attention deficit hyperactive disorder (ADHD), and for one in seven of these ADHD will continue into adulthood.³ Also, adults with ASD are more likely to have ADHD!² Everyone has individual attributes and characteristics. Experience of autism is also unique; this is the power of neurodiversity. Some professions, for example aerospace, screen positively for autistic traits⁴ – methodical, attention to detail, ability to hyperfocus, pattern recognition, visual memory, and novel approaches to problem solving. 

Round one

Our path towards accreditation started back in 2014. We felt we were a good and forward-thinking department, but the challenge was (a) is it true? and if so (b) could we prove it? 

The ACSA process gave us the platform and the tools to provide assurance that we had the policies, and personnel in place, but also highlighted the gaps that had developed over the years. Our original involvement with ACSA and subsequent accreditation in 2018 was a positive experience. ACSA gave the department a common purpose and an opportunity to involve the whole theatre community in reviewing how we work and why we do what we do. We took pride in benchmarking ourselves against nationally agreed standards and opening the department up to external scrutiny. That said, our accreditation in 2018 was not the end of the story.

Authors:

• Alessandra Anzante, Employment Lead, RefuAid
• Dr Siân Jaggar, Cardiothoracic Anaesthestist, Royal Brompton Hospital
• Maria Burke, RCoA Global Partnerships Manager

World events have seen record numbers forcibly displaced from their homes – currently estimated at 103 million people.¹ According to the Refugee Council, in the 3^rd Quarter of 2022, 24,511 applications for asylum were made,² an increase of 58.1% on the previous quarter. Government statistics tell us that in 2022 74,751 asylum applications were made (relating to 89,398 people).³

A study by Deloitte in 2017 surveying Syrian refugees in Europe⁴ found that 38% of respondents were university educated, but that despite this 82% were unemployed. It highlighted language as being one of the biggest barriers to re-entering employment, despite 63% of those surveyed wanting to continue their careers in the professions for which they had trained in their home countries. In the case of anaesthetics (and medicine as a whole), there are significant challenges for them in entering UK practice.

Mrs Shivalkar was a 78-year-old patient with debilitating co-morbidities, scheduled for elective revision hip-surgery at a stand-alone surgical unit without level-2 or level-3 care facilities. Intraoperatively, significant hypotension was poorly recognised and treated. By the time care was escalated, she had developed severe metabolic acidosis and multi-organ failure leading to her death.

The coroner issued a ‘Report to Prevent Future Deaths’ to the RCoA and the Royal College of Surgeons for action. From our review of the available information, the lessons to be learnt by our specialty  were related broadly to risk assessment, remote-site working and team working. My previous article (Part 1) addressed the first two areas, while this follow-up article focuses on team working and the role of multidisciplinary team (MDT) training.