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23 October 2020

RCSEd Communications Team

After a very busy week following our council meeting, I have had many video conferences with other colleges, specialist surgical associations as well as international groups regarding the state of the pandemic. It is clear in the United Kingdom that we are facing an extremely difficult winter. I as your president am in a privileged position having access to our Chief Medical Officers who provide up-to-date information about the state of our hospitals and the current situation with COVID-19.

Our Chief Medical Officers have been clear that the next few months will be challenging, with rising transmission rates not only in the community, but in hospitals as well. The balance between locking down communities and allowing the economy to recover is extremely difficult. All of us who came into this profession, whether we be physicians, surgeons or healthcare workers, did so in order to make a difference in caring and looking after patients. We all hoped to make life better for those in our charge and indeed, to try to cure their illnesses. There is little doubt that we do recognise that simply locking down our communities would definitely have reduced the transmission and the spread of COVID-19. Had we done this until a vaccine were to be available, it would without a doubt have saved many lives. However our view of the pandemic simply looked at lives saved from COVID-19. This failed to consider wide ranging other consequences.Whilst it would have achieved the aim in the short term of ensuring that patients and families were looked after, the longer term damage from economic collapse and the subsequent unemployment, poverty, and therefore social inequality would cost many lives in the longer term. The decisions that face our Chief Medical Officers and politicians are unenviable. How do we as members of the caring profession reconcile all of this?

The last few months has had the NHS trying to recover and encouraging patients to attend local hospitals for importantinvestigations as well as treatment. We all recognise that the NHS is still struggling with decreased capacity and we appreciate that there are many patients who have stayed at home with worrying symptoms that are yet to be diagnosed which could be caused by a serious disease. That backlog of diagnostic procedures as well as elective surgery represents an enormous challenge to all of us. We have to provide at least temporary solutions to mitigate against a further six months of delay in diagnosis and treatment. Urgent measures are required which will include the use of Nightingale hospitals, the independent sector, and indeed COVID low risk areas within established NHS hospitals in order to continue the absolutely crucial routine work of the national health service.

Nevertheless, I remain concerned that not enough attention has been taken to prevent unnecessary harm and potential mortality in our hospitals. We have an exhausted workforce from the first phase of this pandemic and now we face a potentially even more damaging six months over the winter. The balance between having sufficient resources to manage the increasing numbers of COVID-19 patients requiring hospitalisation, and keeping urgent elective services on track is almost impossible to deliver. If we take into account the well-being of our workforce after the rigours of the summer we are facing a near impossible task.

I am fearful that we are asking so much of our outstanding but overworked healthcare workers that the atmosphere is less supportive than during the first wave. Many surgeons are worried about patient safety, particularly at times of high levels of admissions. Hospital trusts and health boards are under huge pressure from top to bottom, but I make a plea that managers understand and listen to senior clinicians as well as health care workers so that they feel included, valued and listened to during this difficult time. If the workforce feel valued and supported we shall get through these potentially damaging months.

I, therefore, ask our senior managers, non-clinical leaders and the politicians to remember that the NHS is only as good as those that work within it and they need to be valued, supported and cared for just as they wish to value and care for the patients with whom they are entrusted. Make provisions for diagnostic services and elective surgical services to continue in COVID low-risk environments with the Nightingale hospitals, independent sector hospitals, or indeed COVID low risk areas within existing NHS hospitals. Provide safe, socially distanced areas where staff can meet at safe distances and without risking nosocomial infections. It is in the downtime in the hospitals that such infections and transmission can take place, and those safe areas must be identified and the work supported.

Finally, my plea to those under conditions of huge pressure. It is only too easy for us to see our own immediate problems and situations rather than seeing other peoples positions and issues. It is only by working together and avoiding division and silo working can we get through the difficult few months ahead in the safest possible manner. Thank you all for what you are doing day in and day out 24 hours a day, seven days a week. Please keep in touch with your college and let us know if we can help. Remember, talking together always helps working together and always makes a difference. We all need to make a difference.

Professor S Michael Griffin OBE PRCSEd

COVID-19

NHS

Patient Safety

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