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President’s Blog – April 2024

Hello,

Welcome to April’s update. It finally feels like Spring might be here.

I hope all of you who celebrate had a lovely Easter. Perhaps you even defied the warning from one NHS medical director not to eat a whole chocolate egg in one go – I know I did! (everything in moderation Dr!)

Also, Ramadan Mubarak to all observing – those fasting while working have my utmost respect, and an early Eid Mubarak for next week.

Like many of you I spent my Bank Holiday working – unlike you I am still ‘legless’ as I continue my recovery from my cycling accident.

Despite not being fully mobile I am still able to keep up to date with my College work and advocating and influencing on behalf of our members.

Monday was spent doing multiple media interviews regarding the analysis the College has done examining the efficacy (or not) of NHSE and DHSC’s UCE Recovery plan launched in January 2023.

One of the key calculations – and which rightly attracted the media’s attention – was the analysis which showed that there were more than 250 deaths per week in England in 2023 associated ED waits of 12hrs prior to admission. Our explainer document is here.

Shocking stuff, but I doubt surprising to any of us who work in the ED.

The reason we engage with the media like this is to ensure that we keep the issues experienced in EDs across the country at the forefront of the minds of people – especially those of policy makers and politicians.

We saw good engagement from a number of MPs including the Shadow Health Secretary and other members of the shadow cabinet and we are planning meetings to discuss the challenges facing you every day in more detail and highlight our #ResuscitateEmergencyCare Manifesto which offers practical and pragmatic solutions.

Another piece of work which has seen us successfully influence for positive change is our Workforce Census. Last your we unashamedly badgered Clinical Leads across England to complete it – which dozens of you did, thank you.

The data we collected from similar pieces of work in Wales and Scotland has resulted in increased EM training places and we are in the process of meeting with the Health Minister in NI to try to secure the same there.

Our Policy team is currently finalising the results of the England census and I intend to share some of the key findings with you during my presentation at our Spring CPD Conference in Wales on the 16 to 18 April.

I am really looking forward to the conference and I hope as many as you as possible will be able to attend.

But you need to be quick – registration for in-person delegates closes at 11.59pm on Monday 8 April, and virtual registration closing at 7am on Tuesday 16 April.

There is a jam-packed informative and interesting programme, and it is CDP accredited – book here.

One issue which continues to dominate social media – often in a very unpleasant way – is the on-going discussion around Physician Associates.

The College’s Short Life Working Group continues its work and is seeking some additional members (see the update in the newsletter). The SLWG will also be analysing the data we collected via our Members’ Survey.

We had a good response with more than a quarter of the membership feeling they wanted to respond – my thanks to all who did. We will share the results of this survey in due course, but the working group and Council need to consider these results first.

While the weather may be improving the demands on ED clinicians continue. This week the UKHSA has issued a warning about the rising cases of Scarlet Fever.

The UHKSA page is kept updated with the latest advice and guidance and check out our own eLearning content about Scarlet Fever.

The College’s Quality Improvement team is busy at the moment publishing the annual reports for our current QIPs. The latest was the Year One report on our Mental Health Self Harm QIP.

The report itself is here – and its findings were picked up by The Independent.

This in turn led to the office for the Parliamentary and Health Service Ombudsman to contact us and ask for a meeting which is excellent news and shows the impact our work in this area has.

April is ‘Stress Awareness Month’ – and believe me we are aware of the stress you are under.

The recent British Social Attitudes Survey may have made for disheartening reading but when you look a bit more closely at the data you see it is the system which most people consider to be at fault – when it come to the care and compassion they have received, patients are full of praise and gratitude; which is often reflected on our own social media channels.

We will keep advocating for you to relieve the pressures so you can do what you do so well.

As ever, my inbox is open, if you want to ask me anything – president@rcem.ac.uk or come along to my Monthly Members’ Meeting and chat directly.

Now, where are those Easter Eggs….

Adrian

 

President’s Blog – March 2024

Hello, it certainly is good to be back after my ‘little’ cycling accident. I am on the mend, however the road to full recovery for me is going to be a long one – I am still not able to weight bear for a little while so I’m steering the Good Ship RCEM from my home office. I – and indeed my wife – are very much looking forward to the day when I am fully mobile again.

I must pay thanks here to all of you who have sent me messages and best wishes – it was so lovely to receive them. And I owe a huge debt of gratitude to the medics who looked after me when I was injured (a helpful reminder of our patients’ experience) and to my wonderfully capable team of VPs who stepped up while I was (literally and metaphorically) unable to.

While my hip may be not be fully functioning, I am still able to get stuck into College business, and it has already been a busy couple of weeks since I returned from my ‘break’.

The conversation about the role and scope of PAs in the healthcare workforce continues – as does our work as a College to examine the potential role and scope of PAs in EM. This includes our survey which has been sent to all members (there is also a link at the top of the RCEM website homepage and a QR code in the newsletter).

We really want to hear your opinions and experiences so please do complete it – it only takes a few minutes. The deadline for completion is 5pm on Friday 8 March 2024 so get your response in before then. The results of the survey will be fed into our Short Life Working Group as it continues its work towards establishing the College’s position on this matter.

I was very sad not to have been able to attend EMTA’s conference in Gateshead at the end of February. I was able to follow via social media and the feedback I have received from those who were able to be there has been very positive. It was such a varied and engaging programme – well done to the EMTA Committee, and to the EMTA and College Events teams. Another fantastic event, topped off by a visit and address from our Royal Patron HRH The Princess Royal.

The next major event in the calendar is our Spring CPD conference which is being held between 16 and 18 April at the ICC Wales. It looks great. And even if you can’t get there in person there is the option to join virtually too so make sure you book your study leave and place asap!

Our policy and influencing work continue. We have been closely monitoring and analysing the weekly ‘Winter Sitrep’ data published by NHSE. They really do show the pressures we are all facing at work with long waits, long stays, long delays in discharging people who are well enough to go home, as well as reminding us it has been a very long time since bed occupancy fell below 90%. The need to #ResuscitateEmergencyCare is clear for all to see when you look at the graphs and we will continue to use this and other data to campaign on your behalf as we head towards the General Election (whenever that may be!).

It seems the Government is also keen to focus on ED wating time data with the story breaking that unless EDs meet the 76% target for four-hour waits before April they will be financially penalised – less carrot more stick and very much in line with the ‘the beatings will continue until morale improves’ ethos.

But sarcasm aside – focusing on this one metric could have the serious consequence of focus shifting on to the less sick patients to hit the target, potentially resulting in the sicker or more complex patients being side-lined and facing even longer waits. Four-hour waits cannot and should not be considered in isolation – we must examine the 12-hour data alongside it to get a real sense of the issue.

One part of the Government which has recognised the extremely important role that ED staff can play is the Home Office. They approached us as leading experts and ask us to work with them to establish a new Standard Operating Procedure for the way EDs share information about violent incidents in our communities. Working with experts across the country we are relaunching the Information Sharing to Tackle Violence (ISTV) programme (there are more details in the newsletter and on our website).

I feel passionately about this as we know that around three-quarters of violent incidents are not reported to police. If we can help identify particular hotspots, we can help make our communities safer, and reduce the number of injuries caused by violence presenting in our EDs.

Data is at the heart of much of our work here at the College and another way we are utilising it is to lobby for tangible benefits for Members. As part of our #ResuscitateEmergencyMedicine manifesto one of our key priorities is an increase in the EM workforce. At the start of this month, we revealed the findings of our Northern Ireland Workforce Census at a launch event held at the Northern Ireland Parliament. The Census found that there are currently just half the number of EM consultants working in the country than there should be.

Similar pieces of work in Scotland and Wales resulted in an increase of EM training places and we will work hard to ensure the same in NI. We’ll keep you updated how that progresses.

Spring is also QIP Report publication season. We have already published the final report of our Infection Control and Prevention QIP – which was covered widely in the media – and which concluded that increasing pressures being experienced in EDs since the pandemic have contributed to a fall in the number of infection control measures abled to be implemented. Read more via the link in the newsletter. There will be two more QIP reports – one on Mental Health- Self Harm and one about the Care of Older People in the ED published in the coming months.

These are good examples of the depth and breadth of the work the College does. And if you are interested in getting more involved with our work – be that at a regional level or as a member of one of our committees or professional advisory groups – then please check out the current vacancies which are highlighted in the newsletter.

Lastly, I just wanted to remind you that I and all at the College know and understand how hard you are working and how difficult things are. We appreciate it, and we know from the feedback we get that patients and the public do too. We will keep working tirelessly to secure positive changes for you and your colleagues.

Adrian

Vice-President’s Update – February 2024

Whilst the cat’s away….

This is normally the President’s blog but I am stepping in for Adrian while he is incapacitated.

For those of you who are not aware, Adrian was due to be taking part in a cycling “holiday” which would have seen him undertake the Trans Andean cycle challenge – 1,100 miles over nine days and a daunting climb up to 3,800 metres on gravel.

He was planning to raise money for RCEM Fundraising. Unfortunately, he came off his bike whilst training, and fractured both his hip and collarbone. I am sure you will join me in wishing him best wishes and a speedy recovery.

I am also sure we will hear about his experiences as a patient in future blogs. In the meantime, although we can’t keep him off social media, the VP team are covering his (RCEM) shifts.

It won’t come as a surprise to anybody who works in EM that January has been … well … January. EDs in all four nations are overwhelmingly crowded. RCEM publishes Winter Situation Reports data.

It’s tough, and frustrating that the responses remain inadequate. It still seems that at many levels the need to spin, for political or preservation purposes, outweighs the requirement to acknowledge the reality of what is going on in our EDs.

The latter is a pre-requisite if we are to see the policy, funding and practical changes needed to tackle the problems we face. We work hard to advocate noisily for our members and patients, and to constructively engage with policy makers and health service leaders whenever we can.

In England, it is one year on from the much vaunted Urgent and Emergency Care Recovery plan. NHSE is claiming an increase in 5,000 beds, although there is some uncertainty about how much smoke and how many mirrors have been involved.

Last year we estimated that we needed at least 12,000 additional beds in England alone, so it is little surprise that things don’t feel much better in our departments. In a snap poll of clinical leads the majority felt that in terms of crowding and safety, things have got worse. There is no reason to think that this is anything other than a widespread sentiment.

Currently there seems to be a focus on driving ambulance offloads into our corridors, and on focusing on lower acuity patients. In England, the latter is likely so that NHSE can claim success against the unambitious goal of hitting 76% performance against the four-hour standard.

It is infuriating that we still see targets being chased by putting more pressure on our departments. The focus needs to be on the root causes, and on those patients waiting for beds in every available space. We continue to be vocal on this point.

If you haven’t seen the new crowding guidance it is now published.

We’ve been clear that we shouldn’t have to be publishing it, but we hope it proves useful. There’s a separate blog about it. All feedback gratefully received.

In other news Measles is on the up and is likely to continue to increase. We will be publishing some information but there is already good guidance on the management of measles available. Please see the link in the newsletter.

Importantly, as health care professionals we need to consider our own vaccination status. The advice we have had is that evidence of protection includes documentation of two doses of MMR vaccine or a positive antibody test for both measles and rubella.

This should be available in your occupational health department. Anyone born in the UK before 1970 is likely to have had measles as a child. You can check whether you had your childhood vaccines with your GP, and if not, you can receive MMR vaccination on the NHS.

If you are not sure, you can still be vaccinated. The rate of side effects is lower with second (and subsequent) doses and so it is not harmful to have an extra dose.

It’s soon time for the EMTA conference up in Newcastle (late Feb), and also for the CPD conference which will take place from the 16-18 April at the ICC Wales in Newport.  The programme has just been published. Time to book your tickets if you haven’t already. It should be a great event and I hope to see you there.

Our thanks also go to the team from Medics’ Money – Ed Cantelo (Doctor & accountant), Andy Pow (doctor & accountant) and Tommy Perkins (doctor) who last week hosted an extremely informative and practical online session about finances, tailored especially for RCEM members. There is a recording is available – link in the newsletter. And we are already planning the next one.

Finally for this brief blog, we’ve welcomed two new colleagues to the RCEM team. Dr James Gagg has just been appointed to the rebranded role of Vice President Treasurer, and Professor Matt Reed has taken over at the chair of our Research Committee.

There are profiles of both James and Matt on the website (links in the newsletter). They take over from Dr Scott Hepburn and Prof Jason Smith respectively, and we would like to thank both of them for their contribution to our College over the last few years.

If you would like to get more involved in the many different activities that RCEM undertakes for our speciality, there are many opportunities, wherever you are in your career.

They tend to be advertised on the College website, in the newsletter, and on social media. If you are interested but aren’t sure about where you might fit in, please feel free to contact us and we can point you in the right direction.

Please do look after yourselves and each other. There is a range of support options available through the College – details in the newsletter.

There is still joy to be found in EM, whether it’s in our clinical work, service development, training and education, research, or from the other opportunities that our extraordinary skills open up. I remain proud to be an Emergency Physician, and both to be part of, and to represent, our specialty.

Take care.

Higgi,

Ian Higginson,
Vice President

President’s Update – January 2024

Happy New Year everyone

I hope you managed to get some respite from our crazy world over the festive period.
Although there does seem to be a strange ‘medical’ phenomenon that when you take a break from working at 100 mph you get ill. I have heard it referred to as ‘relaxers’ sickness’ (not sure that’s an official ECDS recognised diagnosis!). But it appears I am a case in point.

I was very much looking forward to spending some time with my family over the New Year but found myself banished to another room after getting struck down with a bug – no one wants to hang out with someone with an infectious disease apparently!

And it’s obviously not just me. As you will all be more than aware we are fully into flu season and there has also been a spike in Covid again – so I hope you have managed to avoid the bugs as much as possible.

January is always an extremely busy time in the ED and I know how hard all of you will have been working. On top of the seasonal pressures this year we are navigating some of the added challenges resulting from a prolonged period of industrial action.

The College has previously commented on the strikes – and we recognise the disruption they can cause and the toll their impact can have which is why it is so important that while you are doing all you can to look after your patients, you are doing all you can to look after yourself too.

EM is, by its very nature, fast-paced and stressful. It would be like that if everything was running perfectly – but add in crowding, patients experiencing long waits, multiple competing demands and the moral injury which can be caused by having to practice in these situations, is it not surprising that many EM clinicians are exhausted, disillusioned and burnt-out.

How can you be expected to care for others if you yourself are in need of help and support?

That is one of the reasons I asked Dr Jo Daniels, PIPP Project Lead, Senior Lecturer and Clinical Psychologist, from the University of Bath and North Bristol NHS Trust to look into the issue of burnout and workforce retention in EM on behalf of the College. The findings of her research are published this month in the EMJ and her ‘Impact of staff burnout and how to improve retention’ report is here.

Unsurprisingly it shows across the board, participants reported feeling undervalued due to their basic demands not being met.

Examples cited included things such as ‘sharing toilets with patients’, poorly functioning IT systems, the absence of rest spaces and staff rooms and a lack of private space within hospitals which meant many found it hard to decompress.

The prevailing sense was of ‘just rearranging the deckchairs on the Titanic’ while working in under-resourced and high-pressure EDs. The report’s content is sobering, yet sadly unsurprising.

My thanks go to Jo, her team and all of the clinicians who gave their time and shared their experiences.

This important report makes a series of recommendations and we will be sharing it with parliamentarians and policy makers, and we will use it as part of our advocacy work to help improve things for you.

With the Prime Minister indicating he is planning for an autumn election we will be ramping up that work to influence those formulating the parties’ manifestos, and who will be in power this time next year.

We have already set out a very clear set of priorities that the next government should adopt in order to #ResuscitateEmergencyCare in our own General Election Manifesto and I and my team will be doing all we can to get them implemented.

Part of helping to look after your welfare is making sure you try to get a break from work. As I often tell people, it is important to ‘invest in rest’.

I know given our profession that it is not always possible however and that many of you will be – by nature –  ‘active relaxers’. I am.

I am most content on my bike – the combination of exercise and fresh air I find helps to clear the head and clear out the cobwebs. And because I may well be some sort of masochist, I have taken my hobby to the next level and signed up for a rather daunting bike-based challenge.

 

 

At the end of the month I – along with a group of similarly minded MAMILs (middle aged men in Lycra) and some (age unspecified) women – are heading off to South America to take part in the Trans Andean cycle challenge. This goes from the Chilean Pacific coast to the Argentinian Atlantic coast, covering 1,100 miles in nine days and a daunting climb up to 3,800 metres on gravel.

And, so that someone benefits from my cramps and creaking bones, I have decided to raise money for RCEM’s charity work at the same time. All money raised will be used by the College to support emergency care in low-income countries and advancing medical research programmes and well-being support for EM staff in the UK.

If anyone you would like to support my efforts, there is a just giving page here.

If I’m up to it I may pop some posts on X (Twitter) along the way so do follow me (@RCEMPresident) if you want to enjoy my suffering!

Right, I’m off to buy some more padded cycling shorts and an industrial sized tub of barrier cream.

Adrian

Adrian Boyle, President, Royal College of Emergency Medicine
@RCEMpresident

President’s Update – December 2023

Hello,

A busy weekend on call was a reminder of my core job, looking after my patients. I had one of those shifts where every patient had an additional level of complexity. The patient with ureteric colic was also pregnant, the person with the major pelvic fracture also had incidental septic emboli and the child with a benign sounding head injury was a haemophiliac.

We know winter has arrived when the Government starts publishing weekly ED performance ‘sit reps’ – these are statistical bulletins which show in rather stark numerical form the very human crisis we are each experiencing every day in our EDs.

We have made an effort to turn this data into meaningful information. Check it out here – Sitreps 2023/24 | Flourish. This tells me that this winter might still be tough, but maybe not as bad as last winter.

Last Sunday the new Health Secretary Victoria Atkins MP (who replaced Steve Barclay MP in the PM’s reshuffle last month) was doing the media rounds. Speaking on Sky News she promised that the winter crisis was her priority.

But she will have other things on her mind too as on Wednesday, the Junior Doctors Committee of the BMA announced that their talks had broken down and announced two continuous strikes over December and January.

Whatever your view is on the strikes, it is disappointing that the talks have broken down. My condolences go to the rota writers.

And we know the inevitable rise in flu cases is coming. If there is one thing you take away from my musings here – it is PLEASE do get vaccinated against flu.

For some counterintuitive reason healthcare professionals can often be reluctant to get immunised.

And while I respect it is a personal choice, please do give it some serious consideration if you haven’t taken it up so far.

Having the jab protects you, it protects your family, it protects your colleagues, and it protects your patients.

Whatever challenges we are facing here, I am sure you would all agree they are nothing when compared with the horrific situation in Gaza and Israel.

I, and other members of the College, have received numerous communications asking us to make a further statement on the conflict. We have also received many messages asking us not to say anything.

We were a signatory to a statement by the International Federation of Emergency Medicine but we have been urged by members with many different viewpoints to say more.

We had a lengthy discussion at Council last week where it was accepted that a statement from a small medical royal college would have little influence on the conflict itself.

However, it was striking that many members and fellows working in UK departments are carrying significant personal strain about this issue.

We have deliberately avoided any comment on issues which are beyond our remit. You can read it here. This statement will simultaneously be too much and not enough for many people.

November continued to be a busy month with the publication of our report Right Place, Right Care. It is a detailed piece of work published by RCEM but written in collaboration with 16 other leading health care organisations and Royal Medical Colleges. It attempts to capture the learning from last year’s ‘ground zero’ moment in EM and makes a series of practical recommendations aimed at preventing the same thing happening again.

We also saw important changes to CESR come into effect – find out more here and the publication of our latest position statement regarding Pharmacists and Pharmacy Services in the ED.

In last month’s blog I mentioned the College’s new Quality Improvement Programme on Time Critical Medications which had just been launched.

And which is being spearheaded by the amazing and inspirational Dr Jonny Acheson (check out his new video in the main newsletter).

Well, I am delighted that we have already had more than 100 EDs from across the country sign up. If you don’t know if yours is one of them – find out. And if it isn’t, get involved. Patients who need TCM will attend every one of your EDs and it is so important we get their care right.

At the next Monthly Members’ Meeting next week on 14 December, my Vice President Ian ‘Higgi’ Higginson will be hosting a short segment on an important guidance he has put together around ED Crowding. It’s free to join and I would welcome seeing you there if you have half an hour or so.

Now I’m off to see if I can still fit in my best suit after all the Quality Street and Mince Pies which appear in the staff room this time of year, as tomorrow (Thursday 7 December) we are holding one of my favourite events of the year – our winter Diploma Ceremony.

I am delighted to say that for the cohort of graduands who are attending the morning session there will be a very important guest in attendance – our wonderful Royal Patron HRH The Princess Royal which will make the event even more special.

I, and everyone here at RCEM give our wholehearted congratulations to everyone who has worked so hard to get to this special day. Enjoy it – you’ve earned it!

Now, while it is a little away just yet, this is the last newsletter from me for 2023, so it just leaves me to wish everyone a healthy and safe festive period, and a very Happy New Year. It has been an honour to represent you this year.

Adrian

PS – Next month’s newsletter will be sent on Wednesday 10 January 2024.

Adrian Boyle, President, Royal College of Emergency Medicine
@RCEMpresident

President’s Update – November 2023

Our thoughts have very much been on international matters and all those affected during the past few weeks as the tensions in the Middle East have once again escalated into horrific violence.

RCEM stands with the IFEM in its stance that medics and patients should be provided with safe havens where treatment and care can be administered and received, and its declaration that these should never, and must never, become a target.

We know many members have personal connections to people affected by this senseless and horrible violence and our thoughts are with all those impacted, and all our EM colleagues doing their best in unimaginably challenging situations to save and care for those who have been injured.

Emergency medicine and conflict have, by necessity, always been inextricably linked and that is as true today as it ever was, whether in the Middle East, Ukraine or elsewhere.

This coexistence is one of the reasons the College has chosen to show its support for the Royal British Legion Poppy Appeal this year by replacing the rosette on our shield with the poppy until Remembrance Sunday.

Elsewhere, as you will see from the newsletter content, we are unfortunately experiencing a Measles outbreak. For us this means making sure we isolate cases, and remembering that measles is a notifiable disease.

October saw a fantastic conference in Brighton for the South East region, with practical workshops as well as traditional conference content and it was a great way to connect, engage and support each other.

We also celebrated our fantastic Specialty and Specialist colleagues as we marked #SASWeek23 with a range of content much of which was made by members themselves. Catch up with it all in this round up.

EMSAS, our SAS doctors’ forum, is a vital part of the College. The forum is active and vocal in championing and advocating for SAS members.

This month is a key one for EMSAS. They are holding their annual conference in the Isle of Man; the current Chair Steve Black is stepping down and the election for his successor is underway. All SAS forum members should have received information and a voting link from our election partners Civica – if you haven’t get in touch with our membership team.

EMSAS Chair is a key position within the College and I encourage as many of you as possible who are eligible to vote to do so and have your voice counted. Steve has done a great job and my thanks and best wishes – and those of all of us at the College – go to him.

In my last update I told out our manifesto launch #ResuscitateEmergencyCare – and we continued to advocate on your behalf at the Labour Party Conference in Liverpool at the start of October.

We hosted a very well attended event with Parkinson’s UK and the British Geriatric Society highlighting the issue of older people in the ED in line with our manifesto ask around equity of care.

We also focused on the long waits which older people have to endure when attending EDs via data which showed that elderly people are twice as likely as other patients to face long A&E waits which was featured in the Telegraph and picked up by other news outlets.

We have also shone a light on the issue of our patients who come to the ED seeking help and support for Mental Health issues with data about the extreme length of waits this cohort face and the comparison to non-MH patients which we shared with Channel Four News with Maya doing a great job of getting our position across.

We have also been focusing on another of our key asks – transparent and meaningful data – which is so important so services have a true and accurate picture of the pressures and demand they are facing.

Our calls for a change in the way that Wales reports its ED performance data led to a bit of a spat with the Welsh Government – which insists there is nothing wrong with not accurately reflecting the length of time patients spend in EDs.

With data we obtained via an FOI request showing that from January to June this year more than 45,000 patients had their waits mis-categorised as being less than four hours when in reality they spent much longer there. This is possible because Wales has a policy called ‘breach exemptions’ which allow for patient clocks to be ‘stopped’ if they will complete their treatment within the ED.

As you will all know – even if the clock has stopped the need for care, attention, space and recourses does not – but none of that is being taken into account. RCEM has been calling ion this policy to be abolished for years and we feel positive progress has been made in raising awareness and support for its scrapping in recent week. So watch this space!

We also are campaigning for hospital-level performance data to be published and worked with the Guardian on this piece explaining why it is so important.

JP Loughrey has also been doing a fine job of advocating north of the border too – highlighting the issue facing Scottish EDs. We released data – again obtained via an FOI – which show that the number of people having to wait 24 hours in Scotland during the first half of this year was 250 times higher than it was in 2019. The piece was run by BBC Scotland and picked up by many other news outlets across the country.

And the team in NI is again working hard to raise awareness the issues facing EDs there as the latest quarterly performance figures are published.

Looking forward, November is shaping up to be another busy month.

As well as the anticipated rise in demand as temperatures fall, there is lots of College activity too.

Next week our collaboration with Parkinson’s UK continues as we kick of our latest QIP – which focuses on Time Critical Medication. Ed Consultant Dr Jonny Acheson – who himself has Parkinsons – has been instrumental in this project and please do check out his video.

And then there is just the small matter of the King’s Speech and Chancellor’s Autumn Statement this month too.

No rest for the wicked – or the EM clinician!

Adrian Boyle, President, Royal College of Emergency Medicine
@RCEMpresident

President’s Update October 2023

In my update last month I mentioned how I felt we were all getting back to school after the summer – well we’re well truly into the autumn term now and I’m getting stuck into my homework, course work as well as doing some legwork.

And I have to admit it felt a little bit like I was being summoned to the headmaster’s office at the start of the month when I was invited to the latest ‘Health Summit’ at Downing Street – especially after my ‘Iceberg warning’ in the summer.

I was, along with representatives from other leading health organisations, able to update the Prime Minister and the Health Secretary about our concerns about the winter ahead, as well as offering solutions to some of those issues. Our advocacy is getting us into the room.

On the same day the latest ED performance figures were also published which showed that almost 113,000 people waited 12 hours or more in an English ED in August.

So much for a winter crisis, it has become a perma-crisis.

The following week we marked World Patient Safety Day.

We know how dangerous crowding is for our patients, but we want to raise awareness about it to the public and policy makers.

So we asked for your help by sharing your experiences or crowding and other issues you have encountered at work – and you did not let us down.

I see crowding when I go to work in my ED.

But seeing so many of you from across the UK sharing similar horror stories of patients experiencing excessive waits; clinicians having to treat patients in the back of ambulances when there really is no room at the inn; having to play trolley Tetris and highlighting the emotional toll it takes on you having to work is such challenging situations was soul-destroying.

I can talk about the issues until the cows come home, but to have so many real-life testimonies to share with the public and politicians really gets the message across.

You can’t argue with lived experience, and we are very grateful to all of you who took the time to get in touch.

Having demonstrated the issues, we then moved on to focus on solutions.

Our General Election Manifesto: #ResuscitateEmergencyCare is what we think whoever forms the next government should commit to in order to improve the situation for clinicians and patients.

We have highlighted five areas where urgent action is needed.

You can find out much more on the #ResuscitateEmergencyCare pages of our website.

To launch the Manifesto we focused on the extremely long waits some patients have experienced.

24 hours in A+E? It’s no longer just a TV show – it’s the shameful reality of hundreds of thousands of people every year – almost 400,000 to be precise.

We also published an animation, specifically designed to raise public awareness, which has been widely shared. (If you haven’t already, please do so!)

The manifesto formed a large part of my President’s speech at our Annual Scientific Conference which was held in Glasgow last week.

The ASC was glorious, there were sessions on topics as diverse as REBOA, migrant health, frailty, consent, AI and smoking cessation.

Catching up with old friends and making new ones as well as being able to attend some exemplary presentations and sessions. Seeing the next generation presenting really did reassure me that the future of our specialty is in excellent hands.

Huge congratulations to all who took part and to the RCEM Events team for hosting such an enjoyable and successful event.

Now my focus moves on to the Political Party Conferences. Even more important this year as we move fully into the pre-election phase.

I have a packed schedule at both the Conservative and Labour conferences where I will be working hard to influence for positive change for the benefit RCEM’s members and patients.

I am particularly looking forward to a panel event next Sunday (8 October) which we are hosting with the British Geriatric Society and Parkinsons UK looking at the issue of older people in the ED.

Another cohort of people who make up a large percentage of ED attendees is those who are experiencing mental health crisis and we will be partnering with Mind the mental health charity later this month to highlight this issue.

Outside of work many of you know I enjoy keeping fit – but I have to say that I am not sure I am quite up to running a half marathon!

Which is one of the reasons I was so impressed to hear of Dr Luke Iddon who is running the Royal Parks half Marathon for RCEM this weekend – here are his sponsorship details if you are interested.

Also this month is SAS Week – which takes place from 9 – 16 October when we celebrate our fabulous Specialist and Speciality doctor colleagues – so keep an eye out for that.

It’s also World Mental Health Day on 10 October – so do check out the resources available, and make sure you are not sacrificing your own health while caring for others.

Bit of a mammoth update from me this month.

Does anyone know when it’s half term?

Adrian Boyle, President, Royal College of Emergency Medicine
@RCEMpresident

Dr Adrian Boyle

President’s Update September 2023

I can hardly believe it is September already. I felt a little sorry for all of the children going back to school just as the weather had improved.

Hopefully, the new starters in our specialty are beginning to find their feet a bit more.

Once upon a time, the summer months were considered to be a ‘quieter’ time when EDs could take stock, and a breath, after the stresses of the winter. But this year especially those days seem feel very long gone – consistently high attendances, coupled with the traditional holiday season – add in a period of industrial action to boot, there really has been no respite for busy EM clinicians.

Last month also saw the conviction of the neonatal nurse Lucy Letby which was met across the profession with a mix of disbelief and horror. Older clinicians will remember the parallels with the Beverly Allitt and Harold Shipman cases.
There has been a lot of discussion about how systems could change so that these rare, but important cases, are identified as quickly as possible.
There is going to be a Statutory Public Inquiry and it would be premature to second guess the findings.

However, previous public inquiries have led to substantial changes in the way the NHS is regulated. It is likely that the Letby inquiry will also lead to changes and the College will be watching this carefully.

The General Medical Council has published an update to Good Medical Practice, nearly 10 years after the last major revision.
There are a number of changes that we need to be aware of, but these standards do not come into force until January 2024.
There is a welcome recognition that promoting inclusivity and tackling discrimination is important.

I reflected on the specific standards around sexual harassment of colleagues in a short blog - Good medical practice – why we all deserve to be RespectED at work, and beyond  – Dispatches from RCEM

Autumn is party conference season and with Labour reshuffling this week it certainly feels like we are moving fully into the pre-election period.

RCEM’s Policy team does fantastic work helping to inform, educate and influence policy makers about the reality that our members and our patients are experiencing within EDs across the four nations, I really believe that our Policy team is the most effective of all the Royal Colleges. We continue to advocate for better care for the most seriously ill and injured, retention of workforce and emphasise tackling exit block and crowding

But September is certainly shaping up to be a busy month with two key elements related to this work – one of which we would very much like your help with.

RCEM will be launching our own ‘Manifesto’ based on our #ResuscitateEmergencyCare  campaign. This provides our key principles, which if adopted by the next Government, will help to ease the huge challenges we face in EM.

Before we launch, we are asking our members to share their experiences of crowding, extreme waits, or inequality of care that they have witnessed or dealt with working in the ED.

We would like you to share these with us – removing anything that would identify you, your Trust or any patients – via email directly to our Policy team.
We won’t use your name or any details which would identify you – but we want to be able show policy makers and the public the reality of what is happening in UEC.

We will be asking for these via X (formerly Twitter) in the run up to #WorldPatientSafetyDay on 17 September but you don’t have to wait until then – please do get in touch – nothing is stronger or has more impact than personal testimonies. Your experiences are vital.

I will be sharing more details about our Manifesto at our Annual Scientific Conference at the end of the month – make sure you book by the 18 September so you don’t miss out.

We also hold the RCEM AGM during conference – find out how you can attend that remotely or in-person here.

After that I will be heading to the Conservative and Labour Party Conferences to continue our policy influencing work.

We know that a huge cohort of our patients in the ED are older people and I am very glad to have been given the chance to take part in a panel event at the Labour Conference with Parkinsons UK and the British Geriatric Society looking at this very important issue.

We are also expecting another period of Industrial action at the end of the month and leading into October – with some days seeing both Post Graduate Doctors in Training and Consultant striking.

As a result, the next Monthly Members’ Meeting has been cancelled. The next one will be on Thursday 27 October, and I look forward to seeing as many of you there as possible – more details, and how to join can also be found on the link above.

Finally, many of you may have heard the unsolicited contributions of Tilly Boyle in various online meetings.
Though you may have heard her, few will have seen her. I thought I would put a face to the barks.

President, Royal College of Emergency Medicine
@RCEMpresident

Dr Adrian Boyle

President’s Update August 2023

I hope you all manage to get some holiday and downtime over the summer.

I enjoyed a family road trip across Western Canada and recharged myself for the coming turbulent months.
The spectacular scenery reminded me once again why it is so important we continue to do all we can to look after our amazing planet.

Which is why I am pleased to hear that our GreenED initiative, which launched at the start of July has been so well received with sign ups already coming in. If you don’t already – follow them on X (formerly Twitter) at @GreenED_uk

Clinical work continued to be busy, the persistent industrial action in England creates new ebbs and flow.
I must confess to a slight sense of bereavement as many of my post graduate doctors in training move on to other posts.
But this is tempered by being able to meet a whole new cohort who start this week. Welcome to the best specialty in medicine!

Good training depends on good relationships and these take time to cultivate. I was delighted to attend a couple of regional conferences, thanks to Sue Dorrian for inviting me up to the West Midlands, and Sally-Ann Wilson to the Yorkshire Wildlife Park.

Summer is traditionally a time where the College regroups and does some necessary behind the scenes maintenance.
We are gearing up for a busy Political Party Conference season.

The long-awaited Long-Term Workforce plan for England was finally published. We think it better to have a workforce plan than not, but many questions go unanswered, not least around the apparent silence on training numbers.>

Council will be considering the plan in detail and working with NHS England and the Department of Health and Social Care to make sure it helps us look after our patients better. We are increasingly concerned about progress against the Urgent and Emergency Care Recovery plan and little reassurance was provided by NHSE’s winter plan unveiled at the end of July.
We are consistent that the harms from long stays are mainly suffered by the horizontal not vertical patients, and that the solution is adequate capacity and staffing. We continue to keep a beady eye on both the number of beds and the length of hospital stay and express our concerns at Ministerial level.

See our campaign to improve care. Resuscitating Emergency Care

Dr Adrian Boyle
President, Royal College of Emergency Medicine
@RCEMpresident

Dr Adrian Boyle

President’s Update July 2023

Clinical work continued apace with the unexpected plot twist of thunderstorm asthma. I always feel that this time of year is busy with cyclists and motorcyclists, I have looked at a lot of damaged lycra recently.

I had a meeting with both the Secretary of State, Steve Barclay and the Minister for secondary care and hospitals, Will Quince. They were genuinely interested to hear from the College, and have received a clear message that progress against the UEC recovery plan is fragile and uncertain. I hope this leads to better decisions.  Salwa Malik, VP membership, gave evidence at short notice to a House of Lords Select Committee about integration of primary and secondary care and how patients with mental health presentations are getting a very raw deal. Meanwhile, we held a face-to-face Council meeting with a packed agenda. We have moved many meetings online, partly to cut costs but also deliberately to increase participation from all around the UK. The occasional face to face meeting is still necessary for some of the stickier issues and the human connection.

In between all of the frenetic College activity, there was time to do some fun stuff. We celebrated the contribution of Council and the help of our friends at the Cliff Mann dinner. An important perk of College life is nice meals in beautiful buildings. I attended the International Congress in Emergency Medicine in Amsterdam. Meeting other EM College and Society Presidents was an interesting and useful experience, crowding, workforce burnout and poor staff morale are certainly not confined to the UK. We compared tactics and strategy.

This month a number of important reports came out. The GMC published a report into trainee well-being The state of medical education and practice in the UK – GMC (gmc-uk.org) , the Health Foundation on the length of emergency admissions NHS hospitals forced to cut admissions by over half a million due to lack of beds, new analysis shows (health.org.uk), and the National Audit Office on UEC performance Access to unplanned or urgent care – National Audit Office (NAO) report . All provide objective confirmation of what we have been saying for years. Our departments are crowded, usually because of exit block and this makes an unpleasant working environment.

Access to unplanned or urgent care – National Audit Office (NAO) report
A National Audit Office (NAO) report assessing the government’s approach to improving urgent and emergency care services in England.
www.nao.org.uk

NHS hospitals forced to cut admissions by over half a million due to lack of beds, new analysis shows
Health Foundation release analysis on length of stay of hospital admissions from 2019 to 2022
www.health.org.uk

The state of medical education and practice in the UK
The state of medical education and practice in the UK highlights what are the prominent issues in UK healthcare. You can find reports and data tables here.
www.gmc-uk.org

On a slightly gloomy note, I’m writing this as the BMA Junior Doctors Committee have announced a five day strike in July. This includes a weekend for the first time and feels as if Urgent and Emergency Care is targeted more specifically. The College is not a union, and can’t comment on terms and conditions, but I am sure everyone wants this resolved as soon as possible.

See our campaign to improve care. Resuscitating Emergency Care

Dr Adrian Boyle
President, Royal College of Emergency Medicine
@RCEMpresident

President’s Update June 2023

Summer has been late this year, but it is relief to hear mowers and more birdsong after a long winter. This month we celebrate Pride and the LGBTQIA+ community. We are marking it this year by launching the College’s first EDI calendar. We are committed to creating a compassionate and inclusive specialty in which everyone can be themselves – download the calendar below!

Industrial action grumbles on, but the anxieties about strikes causing unsafe emergency care do not seem to have been realised. Indeed, the reduction in elective capacity and increase in senior decision makers made for a better working environment in many places. It is reassuring that emergency care is better during strikes and that our problems are not insoluble. I’ve been on the road quite a lot since the last newsletter, meeting emergency clinicians all over the country is an enjoyable perk of the job, along with the nice meals in beautiful buildings.

We hosted an emergency care crisis summit in the House of Lords, along with friends from the College of Paramedics, British Geriatrics Society, Society for Acute Medicine and the Royal College of Paediatrics and Child Health. We started this by hearing from a patient who had spent over 24 hours waiting to be admitted. It was a well attended by MPs and Peers and I hope they are better informed and will make better decisions as a result.  We are watching progress against the English Urgent and Emergency Care recovery plan like a hawk, it is a reasonable plan but only if it is fully implemented.

See our campaign to improve care. Resuscitating Emergency Care

Dr Adrian Boyle
President, Royal College of Emergency Medicine
@RCEMpresident

President’s Update May 2023

The April 96 hour walkout by Junior Doctors in England was an interesting and disruptive time for many of us left behind to hold the fort. Largely, we coped and no department needed to close. Like many of us, I rolled up my sleeves, got stuck in and actually rather enjoyed myself. Performance figures were considerably better and departments seemed to run well. It isn’t clear whether this was because of reduced demand, increased capacity from less elective work or increased senior decision making. Regardless, it was good to know that our problems are fixable and emergency medicine can be enjoyable. The bill for this extra cover, either in money or PAs, is eye watering and I hope that both sides start the inevitable negotiation sooner rather than later.

The media frenzy around the strikes overshadowed the first monthly publication of 12 hour length of stay data by NHS England. This replaces the frankly misleading 12 hour Decision To Admit metric and is more meaningful. This is the result of a lot of lobbying over the last 10 years by the College.

I’m writing this on the way to the annual CPD Conference, which I’m really looking forward, not least because my own department, led by Virginia Newcombe is the organising committee. Conferences provide a valuable chance to reconnect and reflect.

See our campaign to improve care. Resuscitating Emergency Care

Dr Adrian Boyle
President, Royal College of Emergency Medicine
@RCEMpresident

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