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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.

It all started conventionally enough – A-levels, a medical degree, house officer jobs. Nobody in my family was medical, so I had no preconceived ideas about postgraduate career pathways.

During my interview for the regional Obstetrics and Gynaecology training scheme, I was asked how I would combine this career with getting married and having a family. As I wasn’t in a relationship at the time, I didn’t feel this was a major consideration, and fortunately neither did the other members of the interview panel!

However, having completed the training scheme and obtained my MRCOG, my career then took a different path…

In my last update, I mentioned that the College has been addressing some financial challenges.  

We are committed through our current five-year plan to manage the College’s resources with care, and to ‘ensure the College is resourced and equipped to carry out its strategy: now and in the future’. One of our core values is being open and responsive, and in that spirit I am keen to share with you our current financial position, and what we are doing to improve it.

The College’s Quality Network (QN) was formed to share learning, develop quality improvement (QI) knowledge, and encourage local improvement work. It is comprised of regional leads, who are aligned with the schools of anaesthesia, and local leads who are based within the hospitals of each region.

The College’s Quality Improvement Working Group wanted to make a fresh assessment of the QN to take stock of our progress and plan future work. A short national survey, to understand implementation of an important safety initiative, was felt to be an effective way to re-invigorate members and generate learning for future projects.

Prep Stop Block¹ (PSB) was created in 2021 to enhance the message of ‘Stop Before You Block’ (SBYB) and standardise national regional anaesthetic practice, aiming to reduce the incidence of inadvertent wrong-side block. It was launched with a training package and supporting resources. This new standardised operating procedure applies to all departments undertaking regional anaesthesia.

The first six months have been extremely busy in the world of CPD at the College. At the end of May, the Lifelong Learning Platform featured more than 156,000 individual CPD activities which had been added and reflected upon.

Good Medical Practice talks about the importance of regular reflection on the standards of practice and care which are provided, and this will help a doctor assess whether their learning is adding value to the care of their patients and improving the services in which they work.

Being an anaesthetist in training has always had its challenges, alongside the many opportunities and benefits offered by our specialty. However, I think that those of you currently in training are facing a particularly tough time. And without wanting to be too downbeat, I think it’s important for the College to recognise that, to reiterate our commitment to supporting you and to update you on what we are doing to try and improve your working lives.  

There could be no stronger reminder of these challenges than the fact that, as I write this, junior doctors are about to begin the first day of a 72-hour strike. Although unsurprising, the overwhelming support for industrial action among junior doctors is further evidence of just how frustrated and undervalued they are feeling. Our job is to ensure the voices of our members are heard and understood. We do value you, and while we do not have a role in negotiations about terms and conditions of employment, we have made it clear that we believe the exclusion of doctors in training and SAS doctors on the reformed contract from the government’s pay deal is likely to exacerbate the NHS staffing crisis. We will continue to make that point to the government as we advocate action to address workforce shortages and pressures.