President’s Update

President's Blog - March 2026

The term “corridor care” has been picked up as a public and media friendly way of describing ED overcrowding. In this regard it has proved extremely useful as a hook. But has it become a victim of its own success or is it still a powerful way to focus attention on a problem which continues to claim lives, and which negatively impacts on everyone who experiences or works within emergency care.  

“Corridor care” is not a recognised scientific or operational term. From an ED perspective: ED overcrowding (or more correctly, crowding) is the issue. Long waits are one effect of crowding and have a hard association with mortality. Corridor care  describes a visible symptom of crowding, and will almost invariably be associated with long waits.  

The notion of providing patient care in unsuitable spaces is intrinsically problematical, given the reality of trying to do it and the risk of normalisation of the unacceptable. This was well demonstrated in 2024 when NHS England produced guidance with the oxymoronic title “Principles for Providing Safe and Good Quality Care in Temporary Escalation Spaces”. Whilst acknowledging this guidance was well intentioned, RCEM got noisy about the obvious flaw. The guidance has now been renamed “Principles for providing care in corridors.” I did feel a familiar sense of despair, however, when I noted that contained within is the bizarre statement “Corridor care areas must uphold the same high standards of care for patients as those in planned clinical non-corridor settings.” We can’t provide decent care in corridors, and it is likely, although not yet proven, that trying to look after patients in corridors actively harms patients. We need to see the back of it. 

This said: it may be that the term “escalation space” better describes all the places patients end up when our departments are full. We don’t just put our patients in corridors when we run out of space. We put them in spaces designed for assessment and rapid turnaround of patients, in converted cupboards and store-rooms, on chairs in waiting rooms, or in ambulances. It may be that by making the focus on patients in corridors, other patients who are also coming to harm will be forgotten. 

Recently the RCEM Trainee Emergency Research Network published their superb UNCORKED study: which managed to count the number of patients experiencing care in escalation spaces across the UK. It wasn’t easy to do, and probably underestimated the problem because of the difficulties associated with definitions. But they did show that 17.7% of our patients were in escalation spaces at any one time. The team are currently undertaking a secondary analysis and we look forward to seeing the results of that. 

However, although the term escalation space may be more correct, the movement to end “corridor care” seems to have gathered a life of its own. For example, in England the unimpressive 2025 Urgent and Emergency Care Plan talked about progress on eliminating corridor care. The Secretary of State for Health and Social Care doubled down and promised to eliminate corridor care by the end of the next parliament. That was a bold, and welcome, step. So far it hasn’t been backed up by bold action. But assuming that it’s best to take the opportunity presented and get behind efforts to make a dent in the crowding, what next? 

If a political promise is made to fix a problem, then the problem will need to be measured. That means a definition, and the method should be amenable to automatic data extraction from existing computer systems.  But then we know what happens: if something is counted, and there’s pressure on organisations to meet a target, there will be “gaming.” It seems that this is a tolerated part of NHS management culture, without accountability or consequences. And finally: how will counting patients in corridors translate into an improvement in the key outcomes associated with ED crowding, those of patient safety and staff wellbeing?  

Fixing crowding would eliminate corridor care. Fixing long waits would also eliminate corridor care in most departments. Fixing either would improve outcomes. 

There is currently no evidence that any measure of corridor care will act as a reliable proxy for long waits or ED crowding. That may come. It will be complicated to do. We can expect debates on thresholds and “when is a corridor not a corridor."  It could be argued that if we need an existing validated metric for crowding, with evidence behind it, we already have at least one. Consider the 4-hour standard. We already measure it, everywhere, and it is linked directly to occupancy measures, and outcomes. If we were to go back to hitting the 4-hour standard, particularly for admitted patients, we would fix crowding. Our corridors, along with all the other hiding places for patients, would be empty.  

The politics means that we are about to see the introduction of an unvalidated metric, to act as a proxy to drive progress towards fixing a problem that has been suffering from a lack of consistent commitment and focus from our politicians and health service leaders across all four nations. We will, I am sure, adapt and overcome the inevitable problems, because the goal is improved patient care and staff experience. It’s great that the term “Corridor Care” has provided a way of describing a problem, and a target to focus minds. But it is frustrating to see the unintended consequence of another new wheel being invented, to count what we can already measure by other means, and just need to fix. Watch this space. The debate is just getting started.  

Higgi

President's Blog - February 2026

Mostly harmless …

This newsletter was written in anticipation of the publication of an NHSE document called “The Model Emergency Department.” Although an English publication, this is likely to influence health policy across the four nations.

This document has had a stormy time in utero. RCEM were not involved in its initial conception or embryogenesis, and were invited to comment and “sign it off” towards the end of the last trimester.  We raised concerns about its content, and after some discussion a more consultative approach was adopted, although it was a something of a case of “If I were you, I wouldn’t have started from here” and we were left commenting rather than co-developing. However, it is a better product as a result of this intervention. At birth, it remains an NHSE document, and not something that RCEM have agreed to co-badge or “sign off.” That said, it has been useful for us to explore, more recently, some of the issues it covers with a group of wise colleagues brought in during the latter stages of its development.

The document aims to set out key components of the Emergency Department and related areas, with some detail about expected processes and patient pathways. The discussions around the document have revealed areas where a lack of clarity, or variation, might be problematical. Having a blueprint to shoot at will be useful in some settings.

There is welcome, explicit, recognition of the issues around overcrowding, that the Emergency Department doesn’t function in isolation, that wider engagement and leadership is needed, and that wider systems need to operate over extended hours and across the week. There is a promise to publish similar guidance relating to the rest of the system. We were, and are, concerned that EDs have once again come first in thinking about improving system issues, and that in isolation this document will reinforce the ongoing tendency to focus on the front door without ensuring that there is more focus on where it matters at the back. This is where there is greater opportunity for change. EDs have been the subject of improvement efforts, external advice, and bright ideas from the centre for over 20 years now.  We’ve been done to death. The results speak for themselves and perhaps it’s time to look further afield. We appreciate that we that we need to keep our side of the street clean, that we can’t externalise everything, but we also know how to run Emergency Departments and don’t need to be repeatedly told how to do it.

Other good things:

• The commitment to reviewing coding and counting practice, since we know there is a lot of variation and suspect there is a lot of gaming.
• The commitment to look at leadership development within relevant specialities: we have felt the loss of cental funding for the well-received RCEM EM Leaders program.

Of concern:

• We are unconvinced that this document will move the dial on overcrowding, Ultimately that will only come when there’s finally some commitment around improving flow.
• We can’t be in two or three places at once. The blueprint specifies a number of distinct physical areas where senior emergency physicians will be required. This therefore needs a workforce which doesn’t currently exist, and we are not sure how this joins up with workforce planning currently being undertaken.
• Co-location of key facilities is key and the practicalities of achieving that are uncertain .
• The section on funding is vague and there is a risk that we remain systematically underfunded or that unproven models are adopted without appropriate evaluation. There is also a risk that we are going to be asked to undertake additional activity without appropriate resourcing. Whenever I’ve raised this, and I have done a lot, there has been avoidance of eye contact.

Areas of uncertainty:

• The section on Mental Health points to the emerging concept of mental health emergency departments, which is as yet poorly defined. Their effect on the appallingly long waits faced by our patients with mental health problems, both adults and children, remains unclear.

What’s else? We have argued that:

• Minor injury remains within the Emergency Medicine skill set and interest, but that minor illness services are not a core part of our speciality and need to be separately and effectively commissioned.
• UTCs will need to open longer hours, and have the appropriate capability: likely in the form of experienced primary care clinicians alongside clinicians skilled in minor injury care. Note the definition of a “co-located UTC” is rather woolly: we predict issues around this
• Initial assessment, streaming and redirection are difficult skills and are again a core EM skillset: initial ideas about using UTCs as the front door for EDs were not the right way forward and it's great that they no longer appear.
• The document was originally focused on adults, with children an add-on. This isn’t how it works in most EDs. The final version recognises the importance of paediatric practice within EM and interweaves the specific needs of this population.

And finally: what’s new and where does this document point?

• Look out for telemedicine. We need to get good at this. It fits with the government agendas around hospital to community and optimising digital opportunities. And it fits with what is happening in some parts of the country, and in other parts of the world. If UK-based emergency doctors can run resuscitations in Australasian EDs, we can certainly provide remote support to ambulance clinicians and UTCs in the UK. But this will need a whole infrastructure behind it, as well as appropriate training, governance and leadership. You can’t just stick a computer with a camera at the EPIC desk and call that a telemedical service. RCEM are starting work on this area of practice and we will be happy to work collaboratively to develop the ideas.
• And what on earth, you might ask, is Extended Care Emergency Medicine? This is an opportunity for EM, but carries risks. RCEM is supportive of those departments who wish to operate CDUs, but we don’t see it as mandatory. We do however expect to see an increase in the number of EDs taking on Extended Emergency Medicine Ambulatory Care (EEMAC) in the future. This is the name we have come up with to replace the term “EM-SDEC” - which made no sense since all EM is “same day”.  Done well, this has the potential to enable us to stop having to send patients who we could sort out perfectly well, and much more efficiently, to other services … simply to improve performance metrics. It also offers an opportunity to develop decent environments for patients to wait for advanced investigations, or in which to be observed. We are however worried about the risk of a return to off-the-clock units being used to cheat performance figures, or to “dump” patients on the ED who other specialities try to walk away from. We are also worried that there is no formal plan around funding (whether than be for estate, workforce, and other service costs). As mentioned we have been pressing for that. NHSE have released specific guidance on EEMAC, but RCEM have also prepared more extensive advice which aims to address some of the concerns whilst exploiting the opportunities for our patients, and speciality.  We will be dropping that imminently.

So that’s a romp through this latest development. There is more to say around purpose, ambition, metrics, implementation, evaluation and about the surrounding strategies, but I think that’s enough for now. It’s in a place where it is mostly harmless, where it will help promote some standardisation, and where it can stimulate some interesting discussions about the development of our speciality over the next few years.

Higgi

President’s blog – January Newsletter 2026

Hello,

Nobody knows more about prioritisation than Emergency Physicians. So, it should have been easy to work out my priorities for my term as President. But, of course, it wasn’t.

My first priority is to (perhaps obviously) make a positive difference for our speciality. I am not alone in this.  The thing about our College is that is that there are loads of wise, talented, people involved. And together, we make a powerful team to advocate on your behalf and improve the specialty we work in.

Which brings us to my second hope: to make it less ‘Presidenty’.

The role of President has grown, and although I was well prepared for the role, having worked with both Katherine and Adrian as their VP, nothing prepared me for the sheer variety and volume of stuff that comes my way.

I am also aware that I was the only applicant for the job, and I want to make sure that next time elections roll around, you have a diverse field of brilliant people to choose from. So we are working on how we can best deploy those who want to engage with our national work, to their maximum potential, whilst offering them satisfying professional development, and spreading the load. I am so grateful to my VP colleagues and the wider team for what they have already done, although much is invisible to our members. However, you will see a difference in the way we present ourselves and are represented both internally, and externally. I am hopeful that you will also see a variety of people taking part in our advocacy efforts. We will continue to be very loud, and promise we will not be afraid to say it how we see it.

OK so that done, what about the nitty gritty? Well there are a number of other priorities, because there is a lot to do, and times are turbulent. Everything, it seems, is changing. But if it isn’t broken, don’t fix it …

Our College already does a lot of things well, and many things really well. What we don’t need is every new President to come in and try to change everything. So we’ve agreed that we will aim to keep things as stable as possible within the organisation where they are working well, and continue to build on our strengths where we have them. The focus here will be on member value, our academic and training activities, our work around quality, and our policy and advocacy efforts across the four nations. The latter needs to continue to focus on crowding, but also increasingly on where we fit in to the wider picture, and on the workforce required. We are also looking at how we can consolidate – and grow – our international presence.

At the same time, I have asked our colleagues within College to ensure that our organisation reflects our speciality, and that it is a positive experience to volunteer with us. I hope this will help encourage more members to bring their expertise to bear for our speciality. We are aiming to be modern, forward thinking, responsive, agile, effective, and fun. Because that’s who we are as a speciality. Which brings me to culture.

Workplace culture is something that we can all, as individuals and as leaders within our teams, contribute to. RCEM should not be afraid to lead the way in this, and support efforts to improve it. We know that, for instance, racism, misogyny, sexual harassment, and bullying are more common in our EDs than we would like to think, and we have placed this high on our agenda. This will also make our working lives more sustainable … which ties into the next area of focus: our workforce.

Governments and NHS managers do not inherently comprehend the workforce planning needs of individual specialties, so it is our job to make sure they understand. (although whether they take our advice is up to them). We need to develop and deepen our expertise in this field  to better represent our current and future workforce needs. And we intend to. We are also a broad church and need to think about a lot of groups of people, and how to retain us in EM. Part of this is getting the basics right and also recognising what is important for different groups, and workplace culture is critical. We also feel that violence and aggression against staff is becoming more prevalent. Our job has to be sustainable. We have led the way on this within the specialities, and we want to continue to do so.

But what will that job be? Emergency Medicine is changing. We will look for the opportunities, and work out where we might be headed. We know what we do, and we are prepared to be more assertive about what we shouldn’t be doing. But that’s only half the story. What about the digital shift and the drive to work more in the community?  Where are we with the Virtual ED and telemedicine? Is Community Emergency Medicine a thing? Should Geriatric EM be a thing? And where is PEM going? We will need your help in defining the future of our speciality.

Nearly there: the penultimate priority is to Meerkat up and look at what’s coming down the road. You’ll be hearing from us on the ongoing climate crisis, the threat of conflict in Europe, potential future pandemics, and the challenges brought on by generational diversity, and new technologies including AI.  We will also be asking for your help to face these challenges.

And finally, at the end of a long strategy day where we tested these ideas we had one final priority. Our advocacy work is often about the difficult side of our job, but there’s more to us than being at the mercy of crowding. It’s time to start bigging up our speciality, and we will be looking at ways to do that. At its best, Emergency Medicine is bloody awesome. Let’s allow ourselves to be confident that we have a lot to offer our patients and society, that we are worth investing in, and that we not pushovers. We’ve earned that.

Higgi

President’s blog – December Newsletter 2025

Hello,

This is the first blog I’ve written since taking over from Adrian. It’s been a really busy time on many fronts, and there’s plenty to update you on – especially when it comes to our ongoing policy work.

We all want to be able to do our jobs well, but it’s hard to do this against the backdrop of corridor care, understaffing, and with the systems around us long past breaking point.

That’s where our vital policy work comes in. Policy is important because it addresses key issues that are affecting our specialty now, and which will affect us over the next few years.

We mustn't fall into victimhood, and use our agency where we have control. But where we don’t have that control, we can influence. RCEM has a reputation for punching above its weight in the way we operate. We seek to leverage our place as the authoritative body on Emergency Medicine, and in the policy field we do that in a number of ways.

Whilst we are a forceful presence in the media, most of the action takes place less publicly, usually through building relationships with relevant people and organisations, keeping our ear to the ground, predicting the future, and getting to places where our voice can be heard. To support this work, we need to know what we want for our speciality, and what the evidence tells us about the actions we are proposing. Our team generates that evidence and analysis, and we are careful to offer solutions as well as critique.

We engage with and meet politicians, at all levels, both Westminster-based and across the four nations. We talk about issues their constituents face when they end up in ED. These meetings often result in MPs asking questions in parliament, but also in them applying pressure behind the scenes. They can also influence political awareness. For instance last month, along with our Vice President Salwa Malik, I met with the Secretary of State for Health and Social Care, Wes Streeting. We discussed the current state of UEC, along with specifics such as violence, aggression, and racism affecting our colleagues in EDs.  It’s always hard to know how much these interactions will translate into action, but we do know that Mr Streeting talked about racism in the NHS, and particularly in A&E, in a widely publicised interview the next day.

RCEM also has close relationships with a number of key organisations. This includes other Royal Colleges or professional societies, government and regulatory organisations, or those with an interest in emergency care.  We share ideas and information, and figure out how we can work together to support common agendas or to amplify messages.

If others say what we are saying, we know we are getting somewhere. Recently both Age UK and the Royal College of Physicians have published reports on “corridor care.”  In Wales BMA Cymru and RCN Wales launched a joint petition on this same subject. We have co-signed letters from RCPsych around the Crime and Policing Bill, RCP around air pollution, and a cross-organisational letter around including health as a category of impairment in GMC investigations. Hard won RCEM data is often donated to broaden our reach.

And of course, more publicly, we advocate for you in the media – whether it’s through broadcast interviews, supporting documentaries, or making statements on online platforms. We aren’t afraid to be loud, and we tell it how it is.

Our networks are well developed, and we nurture them. Every time we change Presidents or National VPs, we have to handover these relationships – which is one reason I am seeking to move us away from a Presidential focus, towards a more team-based focus within our Executive (which includes the national VPs, Dean, and devolved nation VPs). Many of our committee chairs also build lasting relationships within their fields, and this helps with continuity.

Adrian was careful to make sure we had quietly built up an evidence base for what we are saying, and to guide our recommendations. This “insight” series is now up for review but is still very useful.

We are careful to ensure that our activity is supported across the four nations, seeking commonality when we can. The devolved nation VPs work really hard for EM on their patches. But we are a UK College, and we are also trying to ensure that where we don’t need to be, we aren’t English-focused. I have also been encouraging us to make sure that our specialty’s culture and dynamism, along with our basic principles, runs through our work.

Since September there has been the usual activity around winter plans, a most intensely frustrating process across the four nations in terms of their reactive nature, and the apparent lack of meaningful impact. This year Scotland’s winter plan won the prize for timing, coming out just after the John Lewis Christmas advert was released. In England, NHSE dropped their annual winter letter to the system, while in Wales, their plans were just laid out in front of the Senned. And in Northern Ireland, the winter plan outlined some positive ambitions, but we remain unconvinced it will have a meaningful impact.

Meanwhile, ambulance offload implementation is ramping up in England, Wales and Northern Ireland. Anecdotal suggestions are that it helps free up ambulances, but  at the expense of worsening ED overcrowding. An RCEM survey raises concerns about implementation and of this being another example of all the risk being piled into ED. We are making noises about that.

The main thing bothering us across the four nations is the way that the most important issues around hospital capacity,  “sorting out” social care, and building a sustainable emergency medicine workforce, remain in the too-hard basket for our governments and are not being given the focus they deserve. You just need to look at the UEC recovery plan for England as an example. We are making loud noises about that.

We have undertaken extensive political engagement across the UK, and try to get to all the major party conferences. This year has also seen the launch of an All Party Parliamentary Group on Emergency Care, with RCEM selected to provide the secretariat function … giving us another route into parliament. Its first report, published last month, was focused on Corridor Care, complied with damning evidence by our policy team.

In Scotland we launched our political manifesto ahead of next year’s election, detailing what all parties should commit to, and just last week, we also published a manifesto in Wales. Both stated the number of deaths there were last year, associated to long waits, explaining this is why Emergency Departments need to be a political priority. Meanwhile, NHSE have just published their Medium Term Plan for the next three years. This was a big policy document, which, put bluntly, offered no meaningful roadmap to reduce crowding or improve care in EDs. For more on my thoughts on this, read my full response.

There are also some major policy consultations that have been published, or are just getting started. Whenever the opportunity arises to submit feedback, and if it matters to our speciality, we do.  For instance, the College provided feedback on NHSE’s 10 Year Plan, 10 Year Workforce Plan, the Medical Training review through the Academy of Royal Colleges, and the Leng Review. We will also engage with the recently announced GMC review into regulatory reform.

So in summary there’s a lot going on. Our policy and advocacy work is vital for our speciality, but often hidden. We stop a lot of silly things ever seeing the light of day, because they won’t offer any meaningful change at all, and we try to influence what does make it out there, or what will make it out there. I am particularly grateful to my national VP / Dean team and to our College colleagues as we have been spread pretty thin but we have got our faces in the right places.

And finally … as we all buckle up for the winter ahead, it comes with the festive season attached. If you celebrate Christmas: have a good one. I hope you do manage to get some time with friends and family, away from work and the pressures that it brings. And for those working over the holidays, I hope at least some of it is fun.

I look forward to writing to you next month, where I will start to map out how we will be prioritising the work of RCEM in the short to medium term, and where we will need your help.

Hope this has been interesting, and take care.

Higgi

President’s Blog – August Newsletter 2025

And cut!

Council, Board and Executive Meetings 30

Diploma Ceremonies 4

Visits to Downing Street and Parliament 13

Hip operations 2

Mentions in the media Loads

Conferences 32

Nights away from home 85

Countries visited on College Business 8

This is my last blog as President and traditionally a chance to reflect over the last three years, I’ll try not to be too self indulgent. I have enjoyed this role enormously and would encourage anyone who is thinking about getting involved with the College to have a go. I have always found the College a place where stuff gets done. This is hugely refreshing for many of us in overly bureaucratic and constrained workplaces. I must thank my colleagues at Addenbrookes for their flexibility and willingness to cover me at short notice when I get called into urgent meetings.

I have been extremely fortunate to be surrounded and supported by a very able and aligned executive, most of whom have useful expertise in areas that I don’t. The leadership principle about surrounding yourself with  excellent people has been proven again and again. Gordon Miles, the CEO, has been a steadfast rock and quietly makes sure all the wheels keep turning with only occasional squeaks. The College has been confronted by numerous challenges over the last three years. My predecessor, Katherine Henderson, ably steered the College through the pandemic which can be likened to a single hurricane.  I was fortunate not to have to deal with a pandemic, but navigating the PA debate, industrial action, a change of government (and a lot of senior health managers and civil servants) and various government plans can be likened to sailing in a series of short, sharp gusts. I am proud of how our College Council can discuss contentious problems without rancour and agreeably disagree. We really play the ball, not the man.

We have been very evidence based and data driven in our external policy work. We were fortunate that the scientific evidence became increasingly robust about the harm and mortality related to long stays and crowding. I took every opportunity to explain this, both behind closed doors and in the media. I am sure our consistent, accurate messaging ensured that RCEM’s view was sought out by policy makers and parliamentarians.  Laura from the college comms team keeps reminding me to ‘stop being a human graph and remember you’re talking to Mrs Miggins.’

There have been some real highlights. It is quite something to sit in front of a Health and Care Social Select Committee and be asked to explain your comments to the media. Likewise, being sat in Downing Street and Rishi Sunak looks me in the eye and says ‘we’ve all heard rather a lot from the Royal College of Emergency Medicine recently, so if Dr Boyle could frame the problem for us, that would be an excellent start’ is pretty unforgettable (image below). Hearing Keir Starmer read out our analysis of mortality and long waits almost verbatim at the launch of the Darzi review in October 2024 was validation of the work of the policy team and exec.

27/06/2023. London, United Kingdom. The Prime Minister Rishi Sunak hosts an NHS roundtable in 10 Downing Street with senior representatives connected to the NHS discussing the new NHS Workforce Plan. Picture by Simon Walker / No 10 Downing Street.

I think we have managed to change the narrative about crowding from ‘you’re just busy’, and I am pleased that 12 hour stays are now routinely measured from arrival in England. There is little serious disagreement about the mortality harms of long stays. To use a medical analogy, everyone agrees about the diagnosis, but I’m not sure that everyone agrees on the treatment plan. NHS England have got better about evaluating their initiatives, and I am sure that is because we have constantly bent their ears (and occasionally twisted their arms.)

A huge benefit of the role is meeting other college presidents and all sorts of interesting people in leadership positions. I’ve been surprised by how much health policy is influenced by personal relationships, networking is vital.  I’m pleased that RCEM seems to be well respected externally. I think we punch above our weight in terms of influence, mainly because we have clear and unified policy priorities. A particular shout out should go to the leadership of the British Geriatrics Society, the Society of Acute Medicine, The Patient’s Association and the Association of Ambulance Chief Executives, who have amplified and supported our messaging.

I’ve also had bits of luck. I was travelling back from Cardiff by train when a pair of gentlemen sat opposite me. One started reading a copy of the New Statesman. Two weeks earlier, I had written an opinion article about emergency care problems and he was now reading the article. I took the opportunity to introduce myself (he checked that I was the same person as the photo.) The two men were members of the House of Lords, and by Reading I had persuaded them both to table a handful of parliamentary questions.

It hasn’t all been glamorous dinners, medals, beautiful buildings and robes. The travel has generally been enjoyable, though I have developed slightly sour views about many of our railway companies and my personal plea to improve UK productivity is to fix Wi-Fi on trains. The policy team have been a great support, but I must admit feeling very old when Tamara, a millennial, provided a devastating critique of my Spotify playlist while we were stranded waiting for a plane in Edinburgh. I’ve learnt to ignore the social media anons, trolls and headbangers, though it is fascinating when you find out who is behind an anonymous account. No one ever stays really anonymous on social media.

Much of the College’s time has been responding to external events and demands, but I’m pleased we managed to get the Guidelines for the Provision of Emergency Medicine Services (GPEMS) published. This is a first attempt to standardise our services, manage expectations and build good fences with our neighbours. It’s separate from the curriculum and the various training guides. I hope this eventually will support departmental accreditation.

It’s difficult to anticipate what my successor, Dr Ian ‘Higgi’ Higginson, is going to be confronted with, but crowding, an increasingly disaffected workforce and governmental apathy towards urgent and emergency care will be likely staples.

I have no doubt that the College is in safe hands with Higgi. He’s been by my side throughout my Presidency, as Vice President of RCEM, steadying the purple-sailed ship and took the helm when I was recovering from my biking accident. Higgi knows the ropes well and I look forward to seeing what he will achieve for you and the specialty during his tenure.

The President-Elect will be supported by our Vice Presidents, and I am delighted so many of our existing VPs are continuing their roles, providing excellent organisational memory, alongside some newbies.

I have had a lot of ‘what are you going to do next?’ questions. I am planning a break from any external activity until at least the new year. I may have some remedial work to tend to my annualised rota and I owe my Cambridge colleagues. I have always enjoyed the basic currency of our job; seeing patients and supervising residents and will just spend some time reconnecting with this.

Last but not least – it has been an absolute honour and privilege to lead the College and be a voice on your behalf – all 14,500 of you. I have thoroughly enjoyed meeting our members at numerous events and within EDs around the country, and beyond. RCEM connects people, allows you to share experiences in your EDs. We are an incredible bunch working in the best specialty (I might be a little biased...)

Keep looking after yourselves and those around you. Emergency Medicine is one hell of a ride.

For the final time, signing off as your President,

Over and out,

Adrian.

President’s Blog – August Newsletter 2025 

Hello, 

With everything going on within the healthcare landscape, it’s fair to say that it has been a rollercoaster of a month for everyone. 

And yes, you are right when you think that I am alluding here to the recent industrial action in England.  

When it comes to industrial action, RCEM respects everyone’s right to join a union and strike if they chose too. As with previous strikes, I was struck by how much efficiently our services ran. An increase in bed capacity and senior decision making really benefited our patients.  

As a College, we don’t comment publicly about industrial action, but we all hope a resolution can be found soon and discussions keep happening around the table with all parties to achieve that shared aim.  

Amidst the uncertainty, pressures and challenges we all continue to face, it was nice to take a moment, pause and celebrate the people within the specialty as a College at our diploma ceremony in Edinburgh.  

It’s one of my favourite days on the calendar. We had 390 graduands crossing the stage across two ceremonies – FRCEM, MRCEM and ACP recipients - with more than1,500 attendees in total filling the room.  

It was an honour to present the Alison Gourdie Medal, recognising clinical distinction, to Dr Madhumita Subramony who was the top performer in the 2022 MRCEM exam, along with awarding several College medals to Sally-Anne Wilson, Tess Sangers and Chris Moulton who also received the Dr Clifford Mann President’s Medal. 

I, and everyone at the College, send our congratulations to everyone who has worked so hard to be there and celebrate with not only your family and friends, but your peers. 

During the ceremony, as I stood on stage, looking out at the sea of talent wearing their regalia – caps, gowns and taking in that unmistakable electric energy that only comes with diploma day, it suddenly hit me: This is it. My final time celebrating graduates as President, donning the cape and medal before I hand over the responsibility to Dr Ian ‘Higgi’ Higginson in September (more on this towards the end of this blog).  

There will be more of these final moments to come. And I am taking it all in, enjoying every opportunity before I sign off for the final time in the role.  

As the graduate’s step into their next chapter, so too will hundreds of new trainees who we will all be welcoming to our departments this month.   The College has some very useful induction  e-learning modules for new doctors here.  

Scrubs on, stethoscopes ready, nerves buzzing. 

I remember walking into emergency medicine for the first time nearly 31 years ago (it honestly just feels like yesterday….) and oh how times have changed.  

You enter Emergency Medicine during a time of transition as the government lays the foundation for the next decade.  

Aptly titled the ‘Fit for the Future: 10 Year Health Plan for England’.

After months of comprehensive consultation, it was consolidated into a hefty 171-page PDF document.  

And then consolidated down even further into a one hour press conference which also canvassed other political curveballs featuring Sir Kier Starmer, West Streeting and a special guest appearance from Chancellor Rachel Reeves after her weeping in the Commons incident.  

Each taking to the mic for a ‘media moment’ in front of a room full of journalists at Sir Ludwig Guttmann Health Centre – the podium placed in front of a range of NHS staff.  

“Reform or die” proved to be the quote of the day from the Prime Minister. Journalists taking that and using it for their headlines across different platforms.  

Our Policy and Communications team tuned in, popcorn at the ready. Because we knew the plan would be bold, and would be broad. And indeed, it was.   

A lot of grand ambitions to fulfil the government’s three aims: hospital to community, analogue to digital, and sickness to prevention. 

It isn’t speciality specific and has no explicit mention of any diseases or professional groups. But we had been warned that it wouldn’t.  

What it is is ambitious, wide ranging and most of it admirable in its aims.  

What it lacks is more detail about delivery and we await more detail about this.  

I have summarised what the plan means for us. It’s not that long, you probably wouldn’t even finish a cup of coffee by the time you’ve read it.  

Just days after the plan was unveiled, the government also dropped the Leng Review – the independent review of PAs, who will now (again) be called Physician Assistants.  

There is a lot of work going on in the background at the College about this review. Our Short Life Working Group is currently examining the recommendations before it is debated at our Council. We will provide further updates on this work in due course.   

As I mentioned earlier, next month will be a time of change for the College as we welcome new and some more familiar faces to our leadership team.  

Alongside Higgi, Maya Naravi, Salwa Mailk and Jason Long have all been appointed for second three year terms as Vice Presidents.  

Meanwhile, two new VPs will also be joining them – Russel Duncan, currently the Chair of the Training Standards Committee, and Sally-Anne Wilson, the current Chair of the Yorkshire and Humber region, as well as the Chair of the Safer Care Committee.  

Congratulations to all – the purple HMS RCEM ship is in incredibly safe hands with this leadership team and I can’t wait to see the incredible advocacy work the College continues to do. 

I would also like to say a heartful goodbye to Russell McLaughlin, our Vice President in Northern Ireland, who is stepping down from this role.   

He has been an amazing asset – fiercely advocating to improve UEC since he came into the position in 2023. Most recently, he was standing next to the Health Minister following a collaboration which will see the recruitment of up to 26 new consultants by the end of the year. 

Thank you for everything you have done on behalf of not only members and colleagues Russell, but for the patients of Northern Ireland. I am sure you will all join me in wishing him well on his new endeavours.  

And I congratulate Michael Perry as he takes over the reins. A call for nominations for a new Vice Chair for the Northern Ireland Board will be made shortly so keep an eye on your inbox for that.  

As we now enter August, I hope you have had the time to get out of the department and enjoy the sun – whether it’s been around the UK or abroad.  

It’s important to take time out and breath the fresh air, especially as the pressure remains and wait times balloon.  

No matter what is happening in EM, and across the health care system, we are all in this together. Look out for one another.  

Adrian. 

President's Blog - July 2025

Hello, 

This Friday will mark one whole year since the Labour Party was elected into power and Sir Kier Starmer put his feet under the Prime Ministerial desk. The following day, Wes Streeting was handed the bulging ‘NHS’ briefcase aka a political hot potato.  

The first 365 days could be considered a honeymoon phase. Loaded with political ambition, fresh energy, dreams and aspirations.  

Also, numerous political catchphrases that have been used time and time again.  

The NHS “may be broken, but it’s not beaten”, anyone? 

Twelve months in and so far we’ve had words, reviews, and plans.  

It’s almost like Oprah walked into 10 Downing Street and said, “you get a plan, you get a plan, everyone gets a plan!” 

And among those PDF plans, was the recently released Urgent and Emergency Care Plan.  

There was no flashy press conference. Wes Streeting didn’t walk up to a podium with a motivational speech. Quite the opposite.  

Just unceremoniously landing in our emails.  

That being said, as I opened it and started to dissect the plan, one thing was clear.  

The government is under no illusion about how big the mountain is they have to climb to get Urgent and Emergency Care back on track to being a system that functions how it should.  

Under the title ‘the imperative for change’… was the following: 

The current state of “UEC services does not meet the standards our patients need or out frontline staff want to deliver” – correct.  

“The pubic continue to feel the impact of poor UEC delivery” – correct. Just look at the British Social Attitudes Survey.  

“We’ve normalised asking our staff to deliver sub-optimal care, and our patients have all but given up hope of expecting a reliable service in urgent care” – and sadly, correct.  

Also, at point nine, mentioning the “burnout our frontline staff feel” – correct again.  

Aside from the grand sweeping statements, that were on par with the Darzi review, there was something we were pleased about.   

There has been a commitment to publish site-specific data.  

We have actively campaigned for this to become a reality, positioning it as one of our key policy priorities in our Roadmap to Recovery. 

The current process of bundling together Type 1 departments with minor injury units, eye units and UTCs make the figures look good…  

This will greatly improve transparency, enable comparisons of local health systems, and help to ensure that previous resources are distributed in the most efficient way. 

As you know, NHSE already has this data at their fingertips. It was just a matter of hitting the big green ‘transparency’ button.  

If you want to read more about the good, the bad and the ugly contained in the plan, I’ve put together a ‘one stop shop’ analysis of it here.  

But in essence…  

Will this plan improve the experience of an 82 year old grandmother on a trolley in a corridor who has been in our department for over 12 hours?  

I fear not.  

Mainly because there was an acceptance that 10 percent of patients who attend A&E will wait more than 12 hours.  

Using last year’s data for England, that would have been almost 1.7 million people.  

No one should.  

And from what I’ve been told about the 10 Year Plan… I fear that won’t help an 82 year old grandmother in our corridors either.  

So much so I raised these concerns with Laura Donnelly at The Telegraph.  

I now wait with bated breath to see if politicians hit the Ctrl+Alt+Delete button on aspects of the plan and start again…. Only time will tell.  

But one thing that has been a common occurrence across the UK, has been various government’s laser focus on the progress on reducing the wait times for electives.  

A classic example of ‘look here, don’t look here’.  

While directing huge wads of cash towards greater improvements.  

In Scotland – Health Secretary Neil Gray announced more than £106 million to tackle elective lists (all the while they’ve just announced they had a record number of delayed discharges last year).  

Meanwhile in Wales – Health Secretary Jeremy Miles MS revealed a new Planned Care Recovery Plan to reduce waiting lists by 200,000. Pumping in £120million to do so.  

While obviously cutting waiting lists is a good thing, Dr Rob Perry, our Vice President of Wales, appeared on BBC’s Sunday programme, Politics Wales, to reiterate our point – you can’t fix one without fixing the other. They go hand in hand. In case you missed his interview, alongside the Royal College of Surgeons, you can watch it here.  

But behind closed doors, our advocacy and policy work is continuing as always. Like a well-oiled machine. Holding the government to account, ensuring they understand exactly what you, your colleagues, and our patients are experiencing every single day. 

I recently met with Karin Smyth, Minister of State for Health (Secondary Care). We provided a briefing note beforehand and had a good conversation. She was interested and engaged.  

From one part of the government, to another – the Home Office has recognised the extremely important role that ED staff can play in sharing information about violent incidents in our communities. 

As I’ve mentioned in previous Blogs, they approached us and we worked with them to establish a new Standard Operating Procedure in a project called Information Sharing to Tackle Violence (ISTV).  

We know that around three-quarters of violent incidents are not reported to the police. 

While we can all play a part in making our communities safer, you can go one step further and become an ISTV Ambassador in the College’s mission to establish the programme in every ED.  

You can learn more about it here – along with a podcast that delves into the scale of the problem.  

While improving safety, you can also improve the care of our patients by getting involved with our Quality Improvement Programme competition.  

It’s that time again to submit your idea in our competition for the 2028-2033 cycle, with the winning concept developed into a fully realised national QIP.  

You have until 11:59pm on 25 July to submit your idea.  

While it permanently feels winter in our departments, with corridor care and lengthy waiting times, it’s apparently that time of year again when temperatures are rising.  

I’m sure in recent days you’ve already dealt with vulnerable patients experiencing heat stroke or heat exhaustion. And it’s not even peak summer.  

It’s a timely reminder to re-read our module on both conditions as we are surely in for more heat alerts (as I am typing this, I just got a breaking news alert to say the UKSHA has just released another amber warning for parts of England).  

NHS England’s own website saw a surge by nearly 200% in people visiting its heat exhaustion advice page.  

A symptom of the climate crisis, one the College takes very seriously and is why the GreenED programme has taken off across the UK and now, in other parts of the world, to ensure we play our part in tackling the ever-growing threat.  

A massive congratulations to the 10 Emergency Departments in England and Wales who have been accredited under the programme last week.  

Among the incredible achievements, Northumbria Specialist Emergency Care Hospital was awarded Gold – a GreenED first.  

It’s been fantastic to see the range of actions implemented, from reusable PPE and suture kits, to reducing nitrous oxide use.  

The next 12-month cycle starts in September and registration is already open for your department to express their interest in taking part.  

Compared to the start of this blog, it’s nice to be able to finish on a more positive note.  

Time and time again, I get to see and read about the incredible difference we are making for our patients – not only their care in our departments, but improving their overall health by improving the health of our planet.  

Adrian