The Right Thing to Do
2 April 2020
I apologise for the lateness of this latest of President’s blogs.
There has been much going on and many teleconferences, video conferences, telephone calls and emails which have continued late into the night. As I write this today, I am still waiting to hear the announcement of the publication of the latest guidance from Public Health England on Personal Protection Equipment.
Many of you will be aware that the real concerns of The Royal College of Surgeons of Edinburgh along with our sister colleges, felt compelled to issue guidance to our Members and Fellows in the front line treating patients with acute general surgical emergencies who felt unclear and unsafe with the guidance that had been recommended to the health boards and trusts based on that from Public Health England.
There were examples of significant omissions and a lack of fullness in the list of aerosol generating procedures. The clear example was that of Upper GI endoscopy. Until last Friday there were many diagnostic endoscopy lists occurring throughout the United Kingdom despite the fact that Upper GI endoscopy was one of the most high risk of the Aerosol Generating Procedures (AGPs). A COVID-19 positive but asymptomatic patient at the start of an upper GI diagnostic endoscopy list could potentially transmit COVID-19 widely by infecting health workers in the room and then the subsequent patients on the list. The potential risk of transmission is up to 66,000 members of the public. It was information like this that we considered to be so important that we felt compelled to give guidance to our Members and Fellows not just to protect them, but importantly to protect patients, and the general public.
In the aftermath of feedback on our guidance from PHE, the colleges re-drafted and updated the guidance 48 hours later based on further evidence from a number of scientific sources. The response from Public Health England was to initiate a full review of the guidance that had previously been issued. This we welcomed. The surgical colleges were intimately involved in reviewing that guidance but have waited longer than expected to deliver that national guidance to all Members and Fellows. This is an issue of morale and professionalism. The workforce is working flat out across the country administering care to not just seriously ill COVID-19 patients but also those patients presenting as emergencies within surgical disciplines. Those front line workers need to know they are adequately protected and adequately supplied with the protection that they need.
The delay in issuing this guidance further reduces confidence in the systems, the hospitals, and the national bodies and destroys morale at a critical time. I trust and hope that by the time you read this that guidance will be up on their site. (PHE published its guidance today, 2nd April at 3pm).
Guidance is of no use at all unless it can be backed up with the equipment that is so important in the protection of staff and the prevention of ongoing transmission to other healthcare workers and the general public. There have been many reports of a failure of supply and distribution of PPE. Whilst in Scotland regular bulletins of supply levels have been provided to the Royal College it is unclear exactly what the level of supply is in England and Wales. There have been reassuring messages from the Chief Medical Officer and the Deputy Chief Medical Officer about huge numbers of Personal Protection Equipment that have been issued across the United Kingdom. There are nevertheless reports of inadequate personal protection and woefully low levels of equipment. To add to this the level of testing of healthcare professionals (crucial to the maintenance of our expert teams remaining in the workplace) remains one of the lowest of all the countries affected by this distressing disease. There have been repeated reports that “massive” ramping up of the numbers of tests would occur in this last two weeks. Sadly, this has not to date happened to the extent expected. Is this once again a failure of supply of reagents or a failure of distribution? There are many questions that remain unanswered and honesty and clarity needs to be evident from the National Bodies and from Government. The general public deserve that as do our hugely stressed healthcare workers.
On Monday we hosted the second of our COVID-19 series of webinars which seemed to receive significant support and interest. The aim of these webinars going forward is to improve communication with all of our membership and fellowship and also to provide information to help them deal with the complex situations in which they find themselves. A question and answer session that I chaired together with my Vice President, Rowan Parks and Mr Simon Paterson Brown dealt with difficult questions regarding personal protection, appropriateness of strategies to treat emergency general surgery by open or laparoscopic methods and the difficulties of protection during aerosol generated procedures such as upper GI endoscopy. I was particularly reassured by many from our fellowship that fed back, having logged in, who described feeling closer to the College that they had for many years! We have taken the decision to run many more of these COVID-19 related webinars to cover all of the specialties within Surgery as well as in Perioperative Care and of course Dental Surgery.
We hope to look at strategies to reduce burnout and stress during the period of this epidemic and also to address issues of training and assessment. We have an outstanding group of professionals who are at the front line and in senior positions in national bodies that can inform our membership and fellowship. We will deliver for you. Please contribute your questions and your suggestions about how we can help during this difficult time to: Covid19comms@rcsed.ac.uk
I have been hugely impressed with the commitment of our college staff during this time of difficulty but above all I have been overwhelmed by the commitment of our members and fellows and the entire NHS workforce in facing up to the challenges of dealing with the outcomes of the viral epidemic.
Professor S Michael Griffin OBE PRCSEd MD FFSTEd FRCS(Eng)FRCP&SGlas Hon) FRCSI(Hon)FCSHK FCSSL(Hon)