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January 2019
Nobody likes a bully
How can the NHS contribute to
upskilling the global anaesthetic
workforce?
Refreshing our ambition to deliver a
stronger College
20–22 May | etc.venues St Paul’s, London
www.rcoa.ac.uk/anaesthesia
SAVE 10%
LIMITED EARLY BIRD
PLACES AVAILABLE –
QUOTE EARLY10
WHEN BOOKING
world class speakers | interactive workshops | networking opportunities
www.rcoa.ac.uk
@RCoANews
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
Anaesthetists as Educators: An
MAY SEPTEMBER
EVENTS CALENDAR Introduction
%
11 June 2019
Introduction to Leadership and Updates in Anaesthesia, Critical
RCoA, London
Further information about all Management: The Essentials Care and Pain Management
%
%
of our events can be found on 2–3 May 2019 UK Training in Emergency Airway 24–26 September 2019
our website. RCoA, London Management (TEAM) RCoA, London
20–21 June 2019
www.rcoa.ac.uk/events Anaesthetists as Educators:
events@rcoa.ac.uk Anaesthetists’ Non-Technical
Royal United Hospital, Bath OCTOBER
%
@RCoANews Skills (ANTS) Primary FRCA Revision Course
Anaesthetists as Educators:
7 May 2019 24–27 June 2019
An Introduction
%
RCoA, London RCoA, London
1 October 2019
Leadership and Management: Global Anaesthesia: Engaging the
JANUARY Leading and Managing Change collective
ANAESTHESIA 2019 Airway Workshop RCoA, London
%
%
20–22 May 2019 25 June 2019
%
%
5 February 2019 22 March 2019 Anaesthetists as Educators:
Tracheostomy Masterclass etc.venues St Paul’s, London RCoA, London
RCoA, London RCoA, London Simulation Unplugged
%
11 January 2019
%
GASagain (Giving Anaesthesia 2 October 2019
RCoA, London Final FRCA Revision Course RCoA, London
Safely Again)
Airway Workshop
11–15 February 2019 APRIL JUNE 26 June 2019
RCoA, London Ultrasound Workshop
15 January 2019 Royal Bournemouth Hospital
%
Introduction to Leadership and Airway Management: Training 8 October 2019
%
RCoA, London Updates in Anaesthesia, Critical Management: The Essentials the Trainer
%
RCoA, London
%
Care and Pain Management JULY
%
2–3 April 2019 6 June 2019
Primary FRCA Revision Course A Career in Anaesthesia:
25–27 February 2019 Sheffield RCoA, London
15–18 January 2019
RCoA, London Final FRCA Revision Course Foundation Year Doctors
%
RCoA, London Cardiac Disease and UK Training in Emergency Airway 1–5 July 2019 9 October 2019
Anaesthetists as Educators: Anaesthesia Symposium Management (TEAM) RCoA, London
%
GASagain (Giving Anaesthesia RCoA, London
Teaching and Training in the
%
3–4 April 2019 10–11 June 2019
Safely Again)
Workplace RCoA, London Solihull Hospital
16 January 2019
27–28 February 2019
Bradford Royal Infirmary GASagain (Giving Anaesthesia
RCoA, London
Anaesthetists as Educators: Safely Again)
Advanced Educational Supervision 25 April 2019
MARCH
%
29 January 2019 RCoA, London
#Anaesthesia2019
RCoA, London After the Final FRCA: Making the Developing World Anaesthesia SAVE 10%
Patient Safety in Perioperative Most of Training Years 5–7 29 April 2019 LIMITED EARLY BIRD
Practice 6 March 2019 RCoA, London PLACES AVAILABLE –
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31 January 2019 RCoA, London QUOTE EARLY10
UK Training in Emergency Airway
RCoA, London WHEN BOOKING
Management (TEAM)
Ethics and Law 29–30 April 2019
13 March 2019
%
FEBRUARY RCoA, London
Salford Royal Hospital
Anaesthetists as Educators:
Faculty of Pain Medicine Study
Teaching and Training in the
%
Days: Hot Topics and Case Studies
%
Ultrasound Workshop Workplace
in Acute Pain 19 March 2019
%
30 April – 1 May 2019
4–5 February 2019 RCoA, London RCoA, London
RCoA, London 20–22 May | etc.venues St Paul’s, London
CPD Study Days www.rcoa.ac.uk/anaesthesia
20–21 March 2019
%
RCoA, London
Discounts available for RCoA-registered Senior Fellows and Members, Anaesthetists in Training, Foundation Year Doctors Discounts available for RCoA-registered Senior Fellows and Members, Anaesthetists in Training, Foundation Year Doctors
and Medical Students. See our website for details. and Medical Students. See our website for details.
%
%
Book your place at www.rcoa.ac.uk/events Book your place at www.rcoa.ac.uk/events | 1
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
Contents
The President’s View4
News in brief8
Guest Editorial12
Faculty of Pain Medicine (FPM)14
Faculty of Intensive Care
Medicine (FICM)15
From the editor
SAS and Specialty Doctors16
Revalidation for anaesthetists18
Dr David Bogod
Patient perspective19
Technology Strategy Programme 20
Welcome to the January Bulletin.
Anaesthesia Clinical Services
Accreditation (ACSA)22
We seem to have been mourning the passing of great men in recent issues, and I was very sad to learn of the death in
Teamwork and anaesthesia24 October of Bill Mapleson, a name known to all of us who have ever marvelled at the elegant simplicity of his classification for
breathing systems. I was lucky enough to be a researcher in the Cardiff Department in the office next to Bill and, along with
Out of the frying pan, into the fire28
Paul Clyburn, whose affectionate and touching obituary can be found within, found him a great source of wisdom, comfort
Keeping up with kids – and humour. I still recall his ability to make an overhead projector presentation of the three-compartment pharmacokinetic
clear fluid fasting30 model look like a continuously moving image, while explaining the concept in a way that even we dullards could comprehend.
Guest Editorial Your professional learning and
As a passionate nature-lover, Bill would have been fascinated to learn of the impact of volatile agents upon global warming,
Nobody likes a bully
development, just how you like it32
a subject barely considered in his day. Tom Pierce and Lucy Williams have contributed an article in which they consider
The Climate Change Act 200834 anaesthesia’s contribution to reducing the UK’s output of greenhouse gases to that mandated by the Kyoto protocol. I never like
Change will only come through long-term sustained interventions to support desflurane much, to be honest (nasty smelly stuff which made patients cough and needing a large vaporiser which took up one
Anaesthetic soapbox 40
all workers in the NHS of my precious power sockets). It has now fallen even lower in my esteem, as Tom and Lucy report that, while it hangs around
Page 12 Managing your operating list; in the patient’s body for less time than isoflurane, it stays in the atmosphere over four times longer, making it by far our biggest
managing theatres – what is source of CO2 equivalent emissions since nitrous oxide started to fall by the wayside. The good news is that, by losing the Bain
‘efficiency’?42 system (a modified Mapleson D, of course) and switching almost universally to the circle, UK anaesthetists have reduced their
Success for anaesthesia patient CO2e by 75%, a trend likely to continue with the increasing use of end-tidal controlled volatile injectors and TIVA.
How can the NHS 2016 contract for doctors in feedback team46
contribute to upskilling training – where are we now? My hospital has, at the time of writing, just undergone an ACSA visit, and I know that our leads – and I really do recommend
College examining – you have more than one – will empathise with Michael McGovern, who reports in this issue of his experience as the sole lead
the global anaesthetic The green shoots are starting to a novice’s experience 48 at Aintree University Hospitals NHS Foundation Trust. It is an exhausting role which seems to require the leadership skills of a
workforce? appear after what has been a
An exciting new initiative: CEO, the diplomacy of a politician, the enthusiasm of a school PE teacher and the patience of a saint. Michael has obviously
challenging period in medical training SALG Safety Scholars50 now learnt the lesson that I was taught early on in my career – never say ‘yes’ to any position, however attractive it might
The MTI scheme aims to equip
doctors with clinical and non-clinical Page 38 sound, in your first year as a consultant – but is to be congratulated of having led his team to accreditation, a feather in the
Anaesthesia in an austere
skills that they would find difficult to cap for all concerned. He rightly points out that ACSA can and should be a tool for driving quality in the department, and
environment: an Out-of-Programme
‘Calm and steady’: the Experience with Médecins Sans can even be used as a potent stimulus to unlock funding for service development. I was only sorry that my role in the College
obtain in their own country
Page 26 perioperative care of Frontières52 meant that I was unable to take a more active role in our own ACSA process for fear of a conflict of interests – honestly!
people with learning An (almost) A–Z of College roles54
Refreshing our ambition to disability and autism Perioperative Journal Watch55
deliver a stronger College The needs of this group are not
As We Were56
Our revised strategy continues the ‘special’ but common to all patients,
ambition we set out with, and we to be treated with respect dignity My memories of a great man:
Professor William (‘Bill’) Mapleson58
believe will deliver an even stronger and competence
College in the future Page 44 Letters to the Editor60
Page 36 New to the College64
Notices and adverts65
2 | College events70 | 3
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
Professor Ravi Mahajan
President
Anyone who has ever set an ambitious package of New
Year’s resolutions will know that the success of a resolution
– whether reaching February with the carbs curtailed or
with the treadmill still turning – depends very much on the
planning and personal commitment.
The failure of our resolutions often results from in emergency departments, with manifest
the lack of a plan – ‘fail to plan, plan to fail’ as implications for all of us in the hospital.
the saying goes. ‘I will swim three times a week’ However, I believe we have more reason for
is quite different from clearing the diary on optimism than this headline might suggest, and
Monday, Wednesday and Friday; booking the would even say that ‘NHS 71’ in 2019 might just
sessions at the pool; keeping the fridge stocked be more significant than ‘NHS 70’ last year.
with ingredients for a quick post-swim meal;
and packing the shorts and towel before work. In 2018, the NHS in England received a
commitment to an annualised 3.4% increase
Just as this is the case for our individual goals, in funding for five years, and the mandate to
this is also true for our institutions, and the develop a plan to outline how services could
health service is no exception. put the money to good use.
(All being well) at the close of 2018 a long- Is this 3.4% uplift all that we wanted? No, it was
term plan (LTP) for the NHS in England was not, and we have been clear that tough ‘either/
published, and we now enter 2019 with a or’ choices will still need to be made. However,
plan for how the NHS will adapt over the next the funding is a significant commitment that
decade to respond to changing demographics, compares extraordinarily well in the context
population health and increased demand on of cuts across a number of areas of public
health and care services. services, from transport to defence.
The need to prepare this article before the However large the cheque might have been,
publication of the final plan means that I we know there are challenges that will not be
cannot provide a full analysis of the document. solved by money and certainly not by money
However, at the close of September, the alone. That insight was central to our long-
College and the Faculty of Pain Medicine term vision for the NHS when we prepared
submitted a joint response to help shape the our submission to NHS England last year. With
The President’s View LTP, and I wanted to use this article to reflect on funding settled, ‘NHS 71’ will be the year in
the solutions that I hope will emerge from the which the focus moves from the accountants
A NEW YEAR’S RESOLUTION
recommendations that we put forward. and strategists to the front-line NHS workforce
as the implementation of a plan begins.
Could ‘NHS 71’ be more significant
than ‘NHS 70’? Our plan for the long-term
FOR THE NEXT DECADE I am writing this article the day after a new
report from the British Medical Association
concluded that ’Winter pressures’ are now
experienced year-round for staff working
Our submission detailed a number of
recommendations for how, over the next
decade, the NHS can transform the way it
delivers care and treatment for patients.
4 | | 5
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
Delivering patient care along a
comprehensive perioperative pathway
improving rota design in departments across Scotland.
Under the direction of Scottish Clinical Leadership Fellow,
Bulletin
NHS 71’ in 2019 might just be
is about providing more personalised Dr Kate Arrow, I know there are ambitions for this model
of the Royal College of Anaesthetists
and coordinated patient care, from to be used across the UK, and the College’s Welfare Churchill House, 35 Red Lion Square, London WC1R 4SG
more significant than ‘NHS 70’
the moment surgery is contemplated and Morale report noted PCAT as an example of best 020 7092 1500
through to a full recovery and beyond. practice. Word count restricts me from noting all of the www.rcoa.ac.uk/bulletin | bulletin@rcoa.ac.uk
By utilising the opportunities offered by excellent initiatives across the UK – and indeed, across
last year
@RCoANews
integration of services and embracing the globe – but one of the privileges of being President
/RoyalCollegeofAnaesthetists
shared-decision-making, there is of this College is hearing about exciting developments
evidence that a perioperative approach week in, week out. Registered Charity No 1013887
leads to better outcomes and, by doing Registered Charity in Scotland No SC037737
so, enables patients to get home from In conclusion VAT Registration No GB 927 2364 18
hospital sooner. The recommendation the multidisciplinary teams that provide continued to call for a comprehensive I believe that our submission offers an ambitious vision for
that all surgical patients are managed patient care. However pioneering or morale and welfare strategy for all NHS the NHS with achievable recommendations grounded in President Sudhansu Pattnaik
on a perioperative care pathway was simple the design of the service, the staff. Through our membership survey, the experiences that each of you would recognise. I am Ravi Mahajan Lead College Tutor
a central pillar of our submission, healthcare professionals are relied on to our report on the SAS workforce and hopeful that when the NHS plan arrives we will see our Vice-Presidents Emma Stiby
and I have been encouraged by the deliver. our separate report into the wellbeing viewpoint reflected within it. Janice Fazackerley and SAS Member
growing interest in the philosophy of anaesthetists in training, we have a Simon Fletcher
We took the opportunity to restate However, if this is not the case, I am very clear that our Katie Samuel
and methodology that informs the catalogue of experiences that should act
our call for the regulation of Medical recommendations will not be our New Year’s resolutions Editorial Board Trainee Committee
perioperative approach. as a call to action for national decision
Associate Professions (MAPs) and I was – without a long-term commitment and the planning to David Bogod, Editor Carol Pellowe
makers. We know this is not just an issue
The influential Health Service Journal very pleased that in late-October the achieve them. I am absolutely committed to this College Monty Mythen Lay Committee
for the membership of this College – it
(1 November 2018) wrote about our Secretary of State for Health and Social delivering improvements over the long-term that will Council Member
is an issue indiscriminate of specialty or Gavin Dallas
vision for patient-focused decision- Care, Matt Hancock, used the new Talk make a tangible impact in every single hospital, and to
seniority, but as the largest single specialty Jaideep Pandit Head of Communications
making, which looks at the outcomes Health and Care Platform to announce beginning this year as we plan to continue.
of hospital doctors your experiences Council Member
patients want, rather than the outcomes Mandie Kelly
that Physicians’ Assistants (Anaesthesia) provide a bellwether for the experience of As ever, please contact me via presidentnews@rcoa.ac.uk
doctors want. I was also pleased to speak Krish Ramachandran Website & Publications Officer
(PA(A)s) will become a regulated role, doctors throughout the NHS. with comments, ideas and thoughts about how the College
with The Times (27 October 2018) about Council Member Anamika Trivedi
alongside Physicians Associates. can help support you.
the benefits that improved preparation Website & Publications Officer
This is a plan for England – Joanna Budd
– or ‘prehabilitation’ – could have for The delivery of any plan will rely on Lead Regional
patients ahead of a surgical procedure. an NHS workforce, incorporating new
what about the rest of the UK?
Anaesthesia Advisor
Prehabilitation is a vital component While the NHS LTP is for England only,
roles such as PA(A)s – with appropriate
of comprehensive perioperative care, and despite the devolution of the UK’s Articles for submission, together with any declaration
supervision and governance, to be
and I was heartened by some of the health systems, the issues that we raised of interest, should be sent to the Editor via email to
equipped with the skills, resources
comments in response to the article from in our submission are largely applicable bulletin@rcoa.ac.uk
and support structures to provide the
individuals who had enjoyed the benefits across all the UK.
standard of care patients deserve. All contributions will receive an acknowledgement, and the
of what we would recognise as high-
It is clear from feedback many of you Editor reserves the right to edit articles for reasons of space
quality perioperative care. Another tenet However, staff cannot provide the very
have provided to a number of College or clarity.
of our submission focused on support best care for patients if they are not
surveys over the past few years that the
for all of you and for your colleagues in themselves cared for. That is why we have The views and opinions expressed in the Bulletin are solely
pressures experienced in Caithness are
those of the individual authors. Adverts imply no form of
not so different from those in Cornwall.
endorsement and neither do they represent the view of
I believe that the variation between the
the Royal College of Anaesthetists.
…[T]here are challenges that will
design and delivery of health and care
across the four nations can be a major © 2019 Bulletin of the Royal College of Anaesthetists
opportunity if we can look to and learn All Rights Reserved. No part of this publication may be reproduced,
not be solved by money and from different approaches. stored in a retrieval system, or transmitted in any form or by any other
means, electronic, mechanical, photocopying, recording, or otherwise,
certainly not by money alone
To take just one example, I have been without prior permission, in writing, of the Royal College of Anaesthetists.
encouraged by the emerging evidence
that shows how the Professional ISSN (print): 2040-8846
Compliance Analysis Tool (PCAT) is ISSN (online): 2040-8854
6 | | 7
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
NEWS IN BRIEF
News and information from around the College
New to the NHS Meeting 2019 Have you received or provided return
to work support?
The College is conducting a survey to understand what resources are already in place
for those returning to training after a long period of leave. Extended periods of leave
can be anything from maternity leave, sick leave or periods out of programme. We
would like to collect examples of best practice from across the UK from return to work
20–22 May 2019 | etc.venues St Paul’s, London
training courses as well as any other support given. Our aim is to make the best examples of
return to work support available via the College website. Our goal is to ensure that our trainees,
alongside any other members who might need this information, get the right help at the right time.
This project will also form part of a supported return to training (SuppoRTT) project run by Health Education
England. It will help inform the creation of generic resources which will be used across specialities.
The College recognises the important contribution that
overseas doctors make to the specialty and to the NHS in The survey takes no more than 10 minutes to complete and we welcome your views.
general, and we will continue to support them in adapting to After a sell-out 2018 event, our flagship conference
The survey can be found bit.ly/WorkSupportSurvey
UK life and the NHS. We are delighted to announce that the returns with an extra day in May 2019, for what
College is planning two 2019 meetings for all doctors new to promises to be a must-attend event for the specialty.
the UK. The first of these is scheduled for Monday 11 March Learn more about the programme on our website at:
2019 at the College and the second is planned to take place in bit.ly/2019Programme and book your place here: FACULTY OF
Manchester at the GMC on 16 September. If you would like to
find out more details please email: global@rcoa.ac.uk.
bit.ly/2019BookYourPlace
PAIN MEDICINE
Anaesthesia 2019 will bring together national and world- of the Royal College of Anaesthetists
renowned experts to present the latest advances in
perioperative medicine, critical care and pain medicine.
The College is proud to be sponsoring the Board of the Faculty of Pain
Updated examiner regulations Hear from the key players shaping the future of the
Anaesthesia and Perioperative Medicine Team of
The application window for new examiners has now closed
specialty in the UK and beyond.
the Year category at the 2019 BMJ Awards. The Medicine Election Results 2018
With a packed programme, covering a diverse range of College strongly encourages as many teams as
but please remember you can apply again in July 2019. The The Faculty of Pain Medicine of the Royal College of Anaesthetists is
subjects, this conference is suitable for anaesthetists at possible to take part.
College recently made changes to the appointment process pleased to announce the results of the Faculty Board election held on
and will now consider flexible and less than fulltime training all stages of their careers. Anaesthesia 2019 will offer the The Anaesthesia and Perioperative Medicine 31 October 2018. There were two seats open on the Faculty Board
working. We are also in the process of reviewing the essential chance to learn from, and network with, your peers from Team of the Year award will recognise an and four candidates stood for election.
requirements for examiner commitment so keep a look out all areas of the profession. innovative project in the field of anaesthesia
Candidate Votes Outcome
for the updated examiner regulations What you can expect: which has measurably improved care for patients.
Hughes, John 136 Elected
which can be found here:
■■ stay informed with lectures on best practice and future The BMJ Awards provide perioperative teams with Sharma, Manohar 130 Elected
bit.ly/examinerregulations
developments the platform to showcase their innovative patient-
or get in touch with the Roques, Clare 97 Not elected
■■ get up-to-date via quick-fire talks focused research and quality improvement activities.
exams department at Mendis, Victor 89 Not elected
exams@rcoa.ac.uk. ■■ tailor your day with breakout sessions The College looks forward to this being an TOTAL 226
■■ have your say during audience interaction and incredibly competitive category.
thought provoking debate. The Faculty is grateful to all candidates for their participation in the
More information can be found at:
election and to all fellows and members who voted.
bit.ly/BMJAwards19
For more information and to book your place
please go to: www.rcoa.ac.uk/anaesthesia
8 | | 9
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
NEWS IN BRIEF
News and information from around the College
Its now quicker A collaborative Clinical Quality
and easier to book alliance to tackle 2018 was another successful year
College events bullying for the Anaesthesia Clinical Services
Accreditation (ACSA) scheme, and
online with now over 40 visits completed, the
POMCTN recruiting new board scheme has come a long way since
launching in 2013. Following the GPAS
members and chief investigators publication, ACSA standards are currently
being reviewed.
The UK Perioperative Medicine Clinical Trials Network, part of the National
Institute of Academic Anaesthesia, is recruiting for vacancies to both the If you are interested to find out how ACSA can
The College has joined the National
POMCTN Board and the POMCTN Chief Investigator Scheme. be of benefit to your anaesthetic department – the
Guardian for the NHS and other
College is holding an information day at its offices in
Applicants to the POMCTN Board should be active researchers in the field healthcare organisations to support the
London on 28 January 2019 – please find more details here: bit.ly/
of clinical perioperative medicine. Clinical POMCTN Board members must formation of an alliance to address the
ACSAInformationDay.
be current and eligible members of either the POMCTN Local or Principal unacceptably high levels of undermining
Over the past few months we have been
Investigator scheme. and bullying behaviour throughout The information day is an opportunity for anyone wanting to learn more about
working behind the scenes to bring you a
the NHS. The alliance will coordinate the accreditation process, as well as departments already accredited to meet,
The term of office for POMCTN Board members is three years, renewable much quicker and easier way to register
activity, share best practice and develop share experiences and hear about the benefits accreditation offers.
for a further term to a maximum of six years. There is no remuneration or for College events online. Now all you
resources to tackle undermining and
backfill for Board members, though meeting expenses are reimbursed. need to do is go to the College website
bullying, while also scrutinising the If you are unable to make the trip to London there will also be ACSA information
(www.rcoa.ac.uk) and select the event
complex cultural, behavioural and days held throughout the UK in early 2019. To stay fully updated on where these
The POMCTN Chief Investigator Scheme is intended to provide training that you wish to attend and you will be
systematic issues underpinning it. will be taking place – go to www.rcoa.ac.uk/acsa for more details.
and mentorship for a small number of talented individuals who wish to lead taken to the new registration system.
their own clinical trials in perioperative medicine. They will also ideally have The improved user interface delivers a The 2017 NHS staff survey reported 2019 is set to be one of our busiest years to date for ACSA and we look
the experience of a complete research cycle as a grant co-applicant, from smoother, more intuitive process, as the a quarter of employees in trusts and forward to working with you to maintain the high standards of our specialty. Any
outline application through to publication and dissemination of results. page is easier to navigate, allowing for foundation trusts in England were subject questions please contact ACSA@rcoa.ac.uk or visit www.rcoa.ac.uk/acsa.
faster event booking. to undermining and bullying behaviour
Further information on both recruitment opportunities are available at:
last year, with devastating consequences
bit.ly/POMCTN18. The closing date for both recruitment rounds is Monday We hope you find the new system easy to
for both staff morale and patient care.
21 January 2019, with interviews to be held in London on Wednesday 27
February 2019. For any enquiries, please contact pomctn@niaa.org.uk.
use and we welcome hearing about your
experience or suggestions about how we
This is also borne out by recent data News from the Twittersphere
from the National Guardian which shows
might do things differently. Please share
that 45 per cent of cases dealt with by
your thoughts at events@rcoa.ac.uk
Freedom to Speak Up Guardians involve
bullying and harassment.
The College firmly believes that
Call for rest facilities for NHS staff undermining and bullying behaviour
is unacceptable and we support the
The College and the British Medical Association (BMA) are calling on the Secretary of State for Health and Social Care to
need to foster an honest and open
deliver on his priority of 'valuing, fighting for and championing NHS staff', by ensuring all healthcare staff have access to
culture within the NHS. The College is
high-quality rest facilities.
committed to helping anaesthetists raise
A recent survey conducted by the College found nearly half of hospital doctors (49%) do not have access to a dedicated and handle concerns to ensure positive
place to rest during or at the end of their shift. More details can be found on our website: bit.ly/RestFacilities. outcomes that improve patient safety.
Read our guest editorial on page 12.
10 | | 11
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
Guest Editorial
Dr Janice Fazackerley Dr Lucy Powell
NOBODY LIKES A BULLY RCoA Vice-President,
Warrington and Halton
NHS Trust
Association of Anaesthetists
Trainee Committee Member,
Royal Victoria Infirmary,
Newcastle upon Tyne
the bullying practices of surgeon, Ian between disruptive behaviour and poorer come through long-term and sustained
Paterson.8 It offers tools and resources patient outcomes. interventions to support all workers in
via its website to inform and tackle the NHS. This meeting was a positive
undermining, and is keen to promote The positive effect of early intervention start, with all healthcare organisations
cultural change across professions. The against incivility must encourage us encouraged to join. By working together,
symposium gathered representatives to speak up when witnessing poor we can have an impact in improving
of organisations (see Table 1) and was behaviours. Hickson et al describe professional behaviour, workforce morale
followed by a round-table discussion. a pyramid of disruptive behaviour.11 and, crucially, patient outcomes.
Anaesthesia was represented by both the At the base are those who behave
RCoA and the Association. unprofessionally but respond well to an References
informal peer-to-peer chat. Moving up, 1 RCoA & AAGBI launch #KnockItOut
The symposium was addressed by Sir for those exhibiting repeated rudeness a (bit.ly/RCoA-KnockItOut).
Robert Francis, who, drawing on his more formal conversation is necessary, 2 Cut It Out / Hammer It Out
(bit.ly/2JLKHHB).
experience from the Mid-Staffordshire but, again, most respond positively.
3 RCM and the RCOG statement
Inquiry,9 related why bullying matters to For the few with a persistent pattern (bit.ly/2PODQ5I).
patients. He called on us to face up to of negative behaviour disciplinary 4 NHS Staff Survey 2017 (bit.ly/2QoRGZH).
widespread ‘oppressive conduct’ and proceedings are required, and at the 5 Speaking up in the NHS in England: A report
meet it with a prompt and fair response. pyramid peak remain a very few, resistant by the National Guardian’s Office
Professionally led campaigns, headed to all correction. This urges us to (bit.ly/2PKO6vN).
by role models, must focus on the challenge undermining, before a pattern 6 (https://webcache.gmc-uk.org/analyticsrep/
correction of negative cultures. saw.dll?Dashboard).
emerges and damage ensues.
7 Bullying and Undermining Campaign – Let’s
Nobody likes a bully, and the NHS expects everyone to maintain dignity at It is often said in defence of doctors’ The round-table participants agreed that
Remove it, RCSED
work. Yet the complex cultural and behavioural issues of bullying, harassment misdemeanours, that none of us goes to there is already much good work out there.
(bit.ly/NHSletter2018).
8 College Focuses on Support and Openness
work to harm patients. If so, we must rid
and undermining are widespread in healthcare, and can have devastating the workplace of incivility and unkindness.
We must build on this, share best practice in wake of Ian Paterson Conviction
and link resources across specialties, (bit.ly/2STrZC2).
consequences for workplace morale and patient care. Chris Turner, Consultant in Emergency professions and all nations in the UK. Each 9 Mid Staffordshire NHS Foundation Trust Public
Medicine, from the Civility Saves Lives attendee must be an ambassador to their
Inquiry (www.midstaffspublicinquiry.com/report).
In March 2017, the Trainee Committees of the RCoA and 2018 5 found that 45% of their workload involved these issues. Campaign, 10 pointed out that witnesses 10 Civility Saves Lives (www.civilitysaveslives.com).
specialty, keeping up momentum, with
the Association of Anaesthetists (the ‘Association’) produced The GMC national training survey in 2018 6 revealed that to rudeness display a 20 per cent 11 Hickson GB et al. A complementary
ambition to effect real change.
a joint statement – ‘#KnockItOut’,1 which shared the aims slightly more anaesthetists in training were satisfied with their approach to promoting professionalism:
reduction in cognitive performance and
identifying, measuring, and addressing
of the ‘#HammerItOut’ and ‘#CutItOut’ campaigns,2 led by supportive environment than the average for all specialties. a 50 per cent reduction in willingness No one initiative will be enough to stop unprofessional behaviors. Acad Med
orthopaedic trainees and surgical trainees respectively. They Anaesthetic trainers, conversely, had a slightly lower average to help others. Correlation can be seen oppressive conduct, and change will only 2007:82(11)1040–1048.
wanted to create a positive workplace culture, with individuals than for all specialties. Six per cent of CT1 anaesthetists felt
empowered to speak out against unacceptable behaviours that they were not always treated with respect, rising to thirteen
and promote exemplar behaviours. The fact that two surgical per cent for trainers. Anaesthesia has avoided being a red flag Table 1 Organisations represented in Edinburgh, September 2018
groups, and obstetricians, working jointly with the Royal outlier, but cannot be complacent.
■■ Academy of Medical Royal ■■ General Medical Council ■■ Royal College of Midwives
College of Midwives,3 initiated anti-bullying campaigns must
The ‘urgent need to redress the unacceptable levels of bullying Colleges ■■ National Guardian, Freedom to ■■ Royal College of Nursing
have relevance to anaesthetists, who work alongside these
and undermining’ was addressed in September 2018 by Dr ■■ Association of Anaesthetists Speak Up ■■ Royal College of Physicians of
professionals, in their teams and in their space.
Henrietta Hughes, National Guardian for the NHS, at the ■■ Association of Breast Surgery ■■ NHS Improvement London
Despite efforts to hammer, cut and knock it out, bullying, Second National Anti-Bullying and Harassment Symposium, ■■ British Medical Association ■■ Point of Care Foundation ■■ Royal College of Surgeons of
harassment and undermining persist at unacceptable levels. in partnership with the Royal College of Surgeons Edinburgh ■■ Civility Saves Lives ■■ Royal College of Anaesthetists Edinburgh
The NHS Staff Survey 20174 showed that one-quarter of staff (RCSEd) and Royal College of Obstetricians and Gynaecologists. Scottish government
■■ Department for Health and Social ■■ Royal College of Obstetricians ■■
had been subjected to bullying and harassment. The first The RCSEd developed their campaign, ‘#LetsRemoveIt’,7
Care and Gynaecologists
report of the National Guardian for Freedom to Speak Up in acknowledging the enormous patient harm resulting from
12 | | 13
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
Dr Clare Roques Dr Mike O’Connor
Chair, Essential Pain Lead, Essential Pain Management
Management Advisory Group Advisory Group
Dr Helen Makins
Deputy Lead, Essential Pain
Management Advisory Group
Faculty of Pain Medicine (FPM)
The Essential Pain Management
(EPM) Advisory Group Dr Daniele Bryden
Chair, Careers, Recruitment and Workforce Committee,
Faculty of Intensive Care Medicine
The Essential Pain Management (EPM) Advisory Group aims to improve the Faculty of Intensive Care Medicine (FICM)
Careers, Recruitment and
management of pain, both at home and abroad, through education and the
coordination and delivery of EPM workshops.
Overseas, we continue to run yearly
workshops with the Mercy Ships charity,
most recently in Guinea. We are towards
The numbers of Ugandan trainers and
local champions has steadily increased,
and through our evaluation programme
to appoint experienced EPM teachers
as regional leads to advise healthcare
workers wishing to run EPM – details
Workforce Committee
the end of our year-long partnership we have assessed both the impact of the will be on the website soon. Following
project with the World Federation of training and the locally perceived need the success of the Training the Trainers Over the summer, we’ve been running focus groups with ICM trainees across
Societies of Anaesthesiologists and for future expansion. course run by Sailesh Mishra and the UK. In these, conversation centred on the ICM curriculum, but inevitably
two institutions in Uganda – St Mary’s Sharon Tee at the National Acute Pain
Hospital, Lacor and Kumi Hospital.
Back in the UK, EPM is continuing to Symposium in September, we hope to
other themes emerged. Interviewees were very supportive of ICM training
Funded by the Tropical Health and
grow, and is now running in 18 of the 32 run similar events more widely through and its aims; the creation of the ICM CCT means that they now think of
medical schools. It is increasingly used our regional lead network.
Education Trust, the team has overcome
many challenges in 2018, running several
across trusts as a framework to teach themselves as future ‘intensivists’, as opposed to specialists ‘with an interest’.
all healthcare staff. We have started In support of our work, we were very
sets of workshops at both hospitals.
encouraged to see the recent British Pain One bugbear was recruitment to dual At a recent RCoA recruitment So, having started the conversation
Society’s document on undergraduate training, so called ‘stepped recruitment’, stakeholder event, anaesthetic trainers with our anaesthetic partners first, we
education identifying EPM as a ’uniquely whereby trainees can be interviewed indicated that it was better if possible to will be taking forward talks with the
simple approach to understanding and for two CCTs in the same recruitment know from the start which anaesthetic Royal College of Physicians and the
managing all types of pain’. round but can only accept one training trainees are in a dual programme, than Royal College of Emergency Medicine
to find out six months or two years later. in order to make a case to HEE. We
programme in that round. Trainees
Any new system will still not be able to need any new computer offers system
understand that the current system suits
fully deliver that, as some trainees only to allow for trainees who know they
If you are interested in getting neither ICM nor our partner specialties,
decide on dual training after ST3, but a want to dual train and are given offers
involved in any aspect of EPM and have found it wasteful of time and
significant number know they want to do for both CCT programmes in the
please contact us at the Faculty of effort. They gave us a very clear message both when they leave core training. same region and recruitment round,
Pain Medicine (cdriver@fpm.ac.uk) to go back to Health Education England to be able to accept both. There is
and see our web pages at (HEE) about this. It’s also very clear that no one wants a
considerable detail to be worked out in
bit.ly/FPMinitiatives system of ‘badging’ whereby ICM posts
the coming months, but we have started
Fortuitously, HEE will be reviewing their will be reserved for certain proportions of
the process of exploring that now.
Dr Odry Agbessi (Consultant Plastic Surgeon, Benin) teaching EPM on the Mercy software matching systems in 2019, and we trainees (for example, 60 per cent must train
Ships workshop, Guinea, September 2018 are putting the case for change to them. with anaesthesia), as that is manifestly unfair.
14 | | 15
Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
SAS and Specialty Doctors
INNOVATION IN SAS
RECRUITMENT AND RETENTION
Dr Kirstin May
RCoA SAS Member of Council,
Banbury
C oming together is a beginning; keeping together is progress; working together is success.
Edward Everett Hale
The last RCoA Census in 2015 indicated that 12% of departments had vacant SAS Boden confirmed to me that he has no This is achieved by converting locum that have difficulty with recruitment
difficulty in recruiting consultant mentors – spending into PAYE spending. The and retention of anaesthetists do not
and trust anaesthetist posts. In a recent survey conducted by NHS Employers, ‘consultants know that commitment from scheme is estimated to save £330,000 provide clinical services in the specialist
77% of respondents stated that they experienced difficulty recruiting to SAS posts them in the short term means better quality per six doctors in post. Retention rate areas that CESR applicants find most
care and more efficient departments in the stands at 92% compared to a national difficult to provide evidence of sufficient
and 30% stated that they had difficulty with retention of SAS doctors. The most long term once they are no longer dealing average of 62%. The impact on staff training for. These areas of difficulty
common reasons given for anaesthetists leaving were career progression (78%), with new staff all the time’. morale, safety and quality of patient are notably those of higher paediatrics,
pay (57%), morale (48%), career development (43%) and workload (26%).1 care has been described as significant. ITU, neurosurgery and cardiothoracics.
Work–life balance Sickness absence has reduced notably. A comprehensive educational
Gaps are having to be filled at high Recruitment in other specialties has at Derby provides structured training Central to the model is the ethos of model would therefore necessitate
cost by internal and external locums, been worse than in anaesthesia for alongside the emergency department’s respecting and valuing all staff. Sickness More information, and how collaboration and building of networks
sometimes risking short-notice surgical many years, resulting in other hard- service commitment. It allows postholders rates in Derby have gone down the model can be applied to between hospitals.
cancellations. A further result of the pressed specialties, notably emergency to go through three-month paid significantly. The scheme aims for a anaesthesia The most important change required is
employment of external locums is the medicine, leading innovation to improve secondments in relevant specialties timeframe of approximately four years, The ‘Derby’ model is that of mind set: There can be no such
demoralising effect on the permanent recruitment and retention. like anaesthetics, acute medicine and but can be applied flexibly to suit the described in detail in thing as a doctor working in a purely
staff working alongside them for a paediatrics, as required by the emergency applicant’s needs. The department has the form of a toolkit ‘service-providing job’. The days where
The ‘Derby’ model medicine training curriculum. It includes even successfully introduced electronic
lower rate of pay. Unpopular time- published by Health staff grades would provide the emergency
protected time for specific required self-rostering, giving staff control over their
slots like bank holidays or weekends The Derby Emergency Department Education England in service while the rest of the department
training, for example, simulation. Education timetable and allowing the creation of a
can be difficult to fill. Gaps lead to experienced all the problems described March 2018.2 Many of takes part in training, education or clinical
offered mirrors the formal training family-friendly flexible rota. Despite being
rotas being created with a high and above in 2013, and appointed consultant the principles can be governance meetings should have gone.
programme, and includes leadership and
unsustainable proportion of out-of-hours Dan Boden as workforce lead, tasking called a ‘CESR’ scheme it does also cater applied to our specialty.
management training. Expertise to guide We should all aim to develop ourselves
work, affecting morale, performance him with avoiding a major crisis. He for staff who wish to develop professionally Clinical directors have approached
postholders through the CESR process further. We should all aim higher and do
and health of staff adversely – risking introduced a workforce model based without CESR being the ultimate goal. us in engagement sessions to explore
is available within the department itself. better for patients.
a vicious circle of high sickness rates, on respecting and valuing SAS staff, and recruitment issues. Emergency medicine
Doctors are also allocated a consultant
disengagement, and difficulty retaining offering educational development. Financial benefit has the advantage that a large hospital References
to provide educational mentorship, which
staff. Rota pressures limit participation Despite a substantial financial investment like Derby Teaching Hospitals can cover 1 Doctors’ and Dentists’ Review Body report 2018.
is included in the consultant’s job plan,
in educational and developmental The educational offering and Dan Boden estimates a required in training, the savings for Derby Hospital all aspects of the curriculum in-house. 2 SAS development and retention programme
opportunities, and lack of training can The offered ‘CESR’ (Certificate of Eligibility commitment of one hour per doctor per have been sustained and substantial. Many departments of anaesthesia Toolkit for implementation, NHS, 2018.
lead to potential underperformance. for Specialist Regstration) programme week. In personal communication, Dan
16 | | 17Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
Chris Kennedy
RCoA CPD and Revalidation Carol Pellowe
Co-ordinator Chair, RCoA Lay Committee
Revalidation for anaesthetists
Extracts from the latest CPD Patient Perspective
quality assurance report Loneliness – another aspect of
holistic care?
Every year we publish a quality assurance report detailing the operation of the When you go to see a patient do you ever consider if they are lonely? And if they
Continuing Professional Development (CPD) approval scheme at the College. The are, what would you do? Well, results from a recent survey showed that lonely
latest report1, covering the period from 1 November 2017 to 31 October 2018, people do not trust others, and this negative correlation was found across all ages.
is produced to cover a number of terms of reference for the independent CPD Friends provide all sorts of different roles, but their key attributes are that they are
Board. It is available in the applications for event providers section of our website. trustworthy, understanding, supportive, sincere, and loyal. Lack of contact with
Focusing on some numbers, during
others can lead to self-pity, which in itself is linked with anxiety and depression.
the 12 months of the quality assurance Loneliness in this group could, of course, job, a country or a hospital, who might
In October 2018, the BBC reported on
reporting period, details of 1,213 events be due to feeling lonely for a first time, be feeling lonely? So what can we do?
their ‘Loneliness Experiment’ through
were submitted to the RCoA for CPD or not realising it won’t necessarily last The first thing to do is ask about it, and
a series of programmes on Radio 4
approval. This was very similar to the for ever. However, the feelings are the second is to listen to what they
called Anatomy of loneliness. The project
number received during the previous nevertheless intense and frightening. say. Listening is a key skill – something
involved completing an online survey,
12 months, when information on 1,199 A startling finding was the number of that we all too often think we do well,
which more than 55,000 people duly
events were submitted. young carers who, being their parents’ whereas in reality we hear but do not
did. They were aged 16–99 years old,
Of the applications reviewed for CPD and two-thirds of them were women. primary carers, were isolated from friends listen. So some things to think about
credits, 79.3% were unconditionally and contact with others. Caring was a today – make your social interactions
Although this was a self-selected group, significant burden which consumed all more meaningful by being kinder,
approved (a slight reduction when
the data is revealing. Only a third felt that their spare time and left little opportunity smiling, and saying hello. It may be the
compared with 84.9% during the
during the seven years operation of the The report also details some of the CPD loneliness meant being on their own; to be a normal teenager. only time the recipient interacts with
previous 12-month period) while 7.8%
CPD approval scheme, and we are very resources available, including the CPD the top four definitions were: not being someone today.
were declined for CPD, a noticeable Some older people are lonely due to
grateful for their help, although new Online Diary and online learning, as understood, feeling disconnected, feeling
increase when compared with the 4.1% of physical isolation and/or ill health.
applications are also very welcome. A well as the publication of a new suite left out, and sadness. So loneliness is a
declined applications during the previous Bereavement takes many forms, for
training pack is available to support new of revalidation guidance. By the time much more complex feeling than just
12 months. The reasons for this increase example, the loss of a loved one, of
CPD Assessors, and further information is of the publication of next year’s quality physical isolation. Many consider the
include a new ruling made by the CPD a driving licence or even of a pet.
available from cpd@rcoa.ac.uk. report, CPD functionality will have elderly to be the loneliest group, but in
Board that applications for approval Loneliness can be experienced in a
become an integral part of the RCoA this survey it was the 16–24-year olds.
cannot now be received less than An important section of our report relationship, for example, living with
lifelong learning platform; to get involved
two weeks before the event date, and focuses on an analysis of summary There might be a number of reasons for a partner with dementia, as the carer
in this exciting work, please contact
between 1 July and 31 October 2018 this delegate feedback from a sample of the this, including the transition from being has lost meaningful conversation
ckennedy@rcoa.ac.uk.
accounted for 16 declined applications. CPD-approved events, and we observed a teenager to adulthood, moving away within the home.
an interesting range of opinions on Reference from home, starting university, and use
The CPD event reviews were completed Loneliness makes one feel unsafe
the use of social media such as Twitter 1 Applications for CPD Approval, RCoA
of social media. Although social media
by 88 CPD Assessors, who include and alienated, and this does not
during events and lots of positive (bit.ly/RCoACPDApproval). are an effective way to keep in touch
nine members of the CPD Board. We just happen to our patients. How
comments about incorporating the with friends and feel connected, this can
currently have the highest number of about your colleagues? Is there
patient viewpoint into programmes. We also reinforce one’s sense of isolation
CPD Assessors that we have ever had anyone at work who is new to a
hope you will find this useful. and increase one’s exposure to bullying.
18 | | 19Bulletin | Issue 113 | January 2019
Bulletin | Issue 113 | January 2019
Michael King Aaron Woods
RCoA Digital Project RCoA Technology Strategy
Manager Programme Director
Technology Strategy Programme (TSP)
Technology Strategy Programme
update
Website Project
As part of the College’s on-going technology strategy programme, one work
stream that will benefit each and every member is the development of a Customer Relationship is historically very much a transaction- about giving an organisation a single
new College website. In addition to providing a new online presence for the Management (CRM) Project processing tool (subscriptions, event view of their members’ interactions with
bookings and the like), and we are them, be it the mailings you are sent,
College’s Faculty of Pain Medicine, the website will also provide a members’ The last major project within the
aiming to replace the current system with events you have attended, stage of
Technology Strategy Programme is the
portal to provide easy access to the College’s various systems, and an online task of replacing the College’s current
a modern, integrated CRM platform. training you are at, your areas of special
CRM stands for ‘contact relationship interest, and so on.
portal for the ACSA scheme. membership management system.
management’, and such systems are all
This is hidden in the back office and So if the College has all this information
Early in 2018, the College undertook a review of its website By the time you read this in January, work will have already in one place, what is in it for you? Well
and related system requirements. Crucially, this included started on creating the new systems. Throughout the project the more we understand about our
input from anaesthetists at different stages of their training or we intend to involve the College’s Membership Engagement members the better our engagement
career, and representatives from our lay groups and staff at the Panel and lay representatives in user review and testing. with them becomes, and the less we
College. A membership engagement survey carried out this have to keep asking for the same
year also generated additional feedback from a further 3,980 If you would like to volunteer your time to provide feedback on Exam Candidate Exam Assessor
BJA Reader information. Let’s say we know you have
College members. the website (and other College work), please email
more interest in research than difficult
engage@rcoa.ac.uk to join up to the engagement panel.
airways and have attended events up
In October the College appointed a digital agency, Manifesto,
Parts of the new website will be launched over a period of time to 50 miles away, a CRM helps ensure
to assist with the build and support of the new web systems. At
– with the full web offering planned to be live by the end of the that you get invited to the SNAP event
the time of writing in early November, we are currently working
with Manifesto to confirm requirement details and design
direction for the new system.
first quarter of 2019.
CRM up the road and not the airway one 100
miles from home. Or, if you tell us about
Event Attendee Webcast Viewer your contact preferences you only have
to tell us once.
A big aspect of CRM is how it integrates
If you would like to provide feedback on the with the website and member portal. The
more we understand about what content
website, please email: engage@rcoa.ac.uk
you like on our own site and the further
Research Lead sites you explore from the portal, the
Committee
Consultant Member better we can present you with personally
Revalidator
relevant information in the one place.
20 | | 21
| 21Bulletin | Issue 113 | January 2019 Bulletin | Issue 113 | January 2019
Dr Michael McGovern
ACSA Lead, Aintree University
Hospital NHS Foundation Trust
Anaesthesia Clinical Services Accreditation (ACSA)
ACSA at Aintree
When I took up my post as consultant anaesthetist, I fell into the trap of saying
‘yes’ when asked to become ACSA lead, without really understanding the
process or role in question.
What do I wish I’d known? can see the benefits, then they will be person to do unaided, and so work to
There have been a number of more willing to help (securing funds for close the gaps was spread more widely
challenges that were not fully training, for example). across the department. This encouraged (centre, left to right): Dr Russell Perkins, Royal College of Anaesthetists and Dr Michael McGovern,
appreciated by the department prior to greater cohesion across the department, Aintree University Hospital NHS Foundation Trust
I wish that I had used our College guide
starting the ACSA process. as we could demonstrate more clearly
more. They are an extremely useful
what we were working towards.
The workload arising from the ACSA resource with an in-depth understanding theatres. This, coupled with the relatively often hard to come by, and we sometimes the initial feedback at the end of the
of the process, and they can help to
process is significant and requires a How did we get the funding? low cost in comparison to other trust had repeated discussions about how visit. The visiting team very quickly make
substantial time commitment. I had solve problems very quickly and easily, as investment ideas, was seen as a positive policies and guidelines were worded, or the point that it is a quality improvement
The ability to make progress with the
agreed to take on the lead role without well as just being an ‘ear to bend’. way forward to ensure quality was how workstreams and processes were process, and I cannot thank them enough
ACSA standards prior to formally engaging
fully realising the commitment required maintained. It did help that our medical implemented. for their help during the visit or their
with the process is a huge positive, as it
and the workload involved. I know that How did we do the gap director (an anaesthetist) was on board ongoing encouragement since. The
enables trusts to assess themselves and
in other departments colleagues have analysis? from the start and was keen to use our How did we benefit? support offered by the College itself has
demonstrate progress towards meeting
For us, the process was started around 18 department as a model for the trust. On a personal level, as someone who been incredible, and the response to
shared the role and that this has worked the standards before having to make a
started this process as a new consultant, questions and queries for help has always
very well, and I would strongly suggest months before formal engagement. We financial commitment. This strengthened
that larger departments follow this model. were able to collate evidence and close our argument for funding.
What were the biggest it has very quickly enabled me to build been excellent. The use of the library of
good practice has been one of the strong
the gaps significantly before we made challenges? relationships with other specialties in
When a department is embarking on the As a trust, we had recently been the hospital. I have also gained a huge points of the process to help us close gaps.
any financial commitment. I led the gap Although we had initial difficulties with
accreditation process, I would encourage analysis myself, as well as commencing through a CQC inspection, and the amount of experience with many areas in
some of the larger areas which needed Using ACSA as a lever has enabled
the department’s senior management the closure of the gaps. Once we started ACSA process was seen as a method hospital and management that I would not
cross-specialty cooperation (diabetes me to provide evidence for funding
team to attend an ACSA event run in of ensuring quality was improved and necessarily have understood prior to this.
to make progress, it became clear that and haematology were two examples), in several areas, as well as the support
conjunction with ACSA accredited the level of work was too great for one maintained within anaesthesia and once discussions had been held, the As a department, we certainly feel that required to ensure that training
departments. This was extremely helpful
support from our colleagues was brilliant. we have benefited from the process. opportunities are provided to non-
for us in gaining the support required to medical staff. We will continue to use this
By demonstrating how changes and We have filled gaps in our knowledge,
make the necessary changes to meet the ACSA guidance, as well as information
cooperation can improve patient care as well as expanding the training
standards and ensuring that we had ‘buy-
in’ from the division as a whole. Having the The college guide has been and potentially reduce the workload of
those specialties, there was a very rapid
opportunities for our medical staff,
and also for our support staff – who
from our report, to ensure that we get
the appropriate resources required to
an invaluable resource
support of the rest of the multidisciplinary maintain our service and to ensure high
move to make positive changes. previously felt under-supported.
team enables much greater progress to quality anaesthesia is provided.
be made than if things are kept within the Where we struggled most as a department The accreditation visit itself was (relatively)
anaesthesia department alone; if everyone was in our own areas. Full agreement was painless and very constructive, even with
22 | | 23You can also read
