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‘You always own the option of having no opinion. Things you can't control are not asking to be judged by you. Leave them alone.’

Marcus Aurelius (121–180 CE)

For the record: I am a full-time NHS consultant in pain medicine and anaesthesia, and the sole provider of ‘interventional pain procedures’ to my local hospice, where I have a weekly session to see inpatients, outpatients and discuss complex pain problems in the end, and not-so-end, of life scenarios. I am also a former dean of the Faculty of Pain Medicine.

Discussions have started within the RCoA on whether the College, and its faculties, should take a stand on the issue of ‘assisted dying’.

They should not. Not pro, anti, or neutral (this last stance is multifaceted and arguably not ‘neutral’ at all).

Authors:

• Dr Samantha Black, RCoA Patient Information Lead
• Dr Lucy Connolly, Clinical Trust Fellow, Medway NHS Foundation Trust
• Elena Fabbrani, RCoA Patient and Public Involvement Manager

Over the past months, the patient information team has been busy creating new resources and collaborating with a wide range of partners to create innovative content to help you meet the challenges of preoperative assessment.

Helping you ‘make every contact count’

A child presenting for surgery provides an excellent occasion for health promotion, with the results of the PErioperAtive CHildhood obesitY (PEACHY) study showing that 24% of children presenting for surgery are overweight or obese. It has never been more important to address the physical health of children at every opportunity, ‘making every contact count’, especially in light of the surgical backlog and our ever-growing waiting lists that we are all too aware of.

At Newham University Hospital there were extensive refurbishments taking place in order to make the theatre complex compliant with current fire-safety regulations. As well as this, there have been a number of fires in intensive care units in the UK over the past decade requiring full-scale staff and patient evacuation.

We realised that we were unsure ourselves of how we would manage such a situation, and so we looked up whether there were fire-safety guidelines specifically for anaesthetists. We came across the recent Association of Anaesthetists fire-safety and emergency evacuation guidelines, published in May 2021. One of the key recommendations was that all healthcare workers should have ‘practical walk-through and/or simulated evacuation training’ at least every two years.

Authors:

• Dr Linda Nel, Consultant Anaesthetist, Perioperative Allergy Service, Southampton University Hospitals NHS Foundation Trust
  Email Dr Nel
• Dr Tomaz Garcez, Consultant Immunologist, Manchester University NHS Foundation Trust
• Dr Louise Savic, Consultant Anaesthetist, Leeds Teaching Hospitals NHS Trust
• Dr Lucy Gurr, Anaesthetic Registrar, Leeds Teaching Hospitals NHS Trust

The Perioperative Allergy Network (PAN) was set up under the joint auspices of the British Society of Allergy and Clinical Immunology (BSACI), the British Society for Immunology Clinical Immunology Professional Network (CIPN), and the Association of Anaesthetists. It represents a formal collaboration between UK anaesthetists, allergists and immunologists with an interest in perioperative hypersensitivity and is supported by the Royal Colleges of Anaesthetists, Pathologists and Physicians. It is affiliated with the International Suspected Perioperative Allergic Reactions Group (ISPAR).

Why now, and what need is being met?

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.