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In Scotland there stands a national gap in clinical governance which results in blind spots and potential risk to patients. This article explores why Scotland is missing out and what needs to be done next.

Our nation is ideally placed to perform and contribute to UK-wide audit. The population size, the uniform governance structure, and the infrastructure and expertise should lend themselves to a world-leading approach to clinical audit and outcomes.

Despite this, Scotland doesn’t participate in an important programme for ensuring standards and safety in anaesthesia in the UK. The Safe Anaesthesia Liaison Group (SALG) is a long-standing collaborative project between the Royal College of Anaesthestists (RCoA) and the Association of Anaesthetists. Established in 2008, it aims to provide a central repository for anaesthesia-related patient-safety incidents. SALG then analyses, prioritises and takes appropriate action on reported incidents.

Healthcare systems account for up to 4.4% of the world’s carbon footprint, and it is well established within hospitals that operating theatres are some of the most energy-intensive spaces. 

The NHS has recognised the impact it makes towards climate change by setting an ambitious target to reach net-zero of carbon emissions by 2045. This means a reduction in current levels of carbon emissions by at least 80% by 2036.

Within North Bristol Trust, we organised a Green Operating Day to implement carbon-saving measures rooted in the Intercollegiate Green Surgical Checklist and the Green Surgery Report to test the feasibility of implementing these measures across three neurosurgical theatres and 10 operative cases.

It’s only the start of meteorological winter, but the recent rhetoric of the newish government does seem to chime for the multidisciplinary team working in critical care services. It is becoming more difficult each day to keep safe services afloat, with bed occupancy well above recommended levels throughout the four nations.

While there’s a definite wish in critical care to accommodate the long list of elective surgical patients and for emergency patients to be located in the best place, be that enhanced or critical care, it will be most welcome to see details forthcoming from government. We hope they lead to the better flow of patients through our ICUs in 2025 and beyond.

Two years ago, the clinical leads census revealed that 50% of responding ICUs have at least one gap on their consultant rota. We continue to seek triangulating information on recruitment challenges, which appear to be in less urban areas and specialist ICUs. FICM continues to engage with relevant stakeholders, including NHS England and the Academy, to make the case for more intensivists in the future.

Returning to work following a prolonged period out of training is daunting, whether that be due to parental leave, sick leave, carer’s leave or for Out-of-Programme time. 

Anaesthetists in training know all too well the stresses that come with frequently rotating between different hospitals and departments, with three- and six-monthly rotations being quite the norm in some deaneries.

Having a child is a life changing experience, and many would hope that their place of work remained constant throughout the beginnings of parenthood. Frequent job rotations with a diverse curriculum to work through means trainees are potentially carrying out their return to work in a new environment while juggling the stresses of childcare and pressures of getting back up-to-speed at work.

Dr Jon Chambers picks up the reins as Editor of the Bulletin and welcomes you to the year's first issue.

As I pick up the reins as Editor of the Bulletin, I do so with an appropriate degree of trepidation. The Bulletin has been a constant throughout my anaesthetic career, and it remains a window into our specialty that combines a mix of news, developments within the specialty, personal stories and guidance. In my short time in the role, I’ve already been humbled by the quality of contributions from the anaesthetic community willing to share their stories and their work with colleagues.

The start of a new year is often a time to look to the future and the new challenges ahead. In the midst of this newness I have always believed that we should also take the time to look back, and to learn from and reflect on the lessons of our past. In the run up to LGBT+ History Month (February) Professor Andrew Hartle does just that, and he writes openly and honestly on the challenges he has faced as an out gay anaesthetist throughout his career in the NHS and the military. His reflections take us through his journey of exclusion and stigmatisation, and then ultimately of acceptance, recognition and celebration. It is an incredible journey and ends with him rightly encouraging us all to feel prouder in 2025.

Dr Claire Shannon, President outlines what's coming up in 2025 and why it's important to support each other and work as part of a great team.

Happy New Year to you all. I know many of you will have been working over the festive period, but I hope you also had some time to catch up with friends and family and take a well-earned break. 

Winter is never an easy time in the NHS. During the more challenging times of the year, I’m always particularly grateful for the support of my colleagues and the benefits of working as part of a great team. I hope that’s true for you too as we look to the year ahead.  

Winter can be hard for many of us, with the combination of longer nights, shorter days and the rounds of respiratory infections that come our way.

It can help to think of wellbeing as a balance between restorative and protective activities and those activities that are draining or reinvigorating. These are, of course, different for each of us and so the best person to advise you on what works for you is yourself. That said, there are some simple steps that are likely to pay real dividends and help you thrive through the long dark winter months.

Approximately two million people attend the Hajj pilgrimage in Saudi Arabia every year. The journey is obligatory for those who have the physical and financial means, once in a lifetime. The pilgrimage lasts five days and is based in and around the city of Makkah.

The climate is one of a hot desert with day temperatures regularly exceeding 45ºC (113ºF) during the summer. This is made all the tougher with average relative humidity reaching 33%. Pilgrims travel from around the world. They include all ages and backgrounds, and individuals with complex medical conditions.

I was lucky enough to be given the opportunity to attend this year. My journey began like any other pilgrim’s, initially solely focusing on the religious events ahead. The first few days went as planned, with challenging walks, but nothing more than I had physically and mentally prepared for. Things however changed as the days went on and as the weather deteriorated. I cannot emphasise enough the combined effects of extreme heat and huge crowds. Despite an umbrella to keep one out of direct sunlight and copious amounts of water consumption, heat exhaustion is relatively common. I was also soon to learn that heat stroke was becoming dangerously frequent during my time there. As anaesthetists, our challenge is often to keep patients undergoing major surgery warm. As I entered my hotel lobby, my job was to do the opposite and help cool my fellow pilgrims down!