P 38

Ymchwiliad i’r Adolygiad Blaenoriaethau ar gyfer y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon

Inquiry into the Priorities for the Health, Social Care and Sport Committee

Ymateb gan: Coleg Brenhinol Llawfeddygon Caeredin

Response from: Royal College of Surgeons of Edinburgh

The Royal College of Surgeons of Edinburgh is the oldest and largest of the UK surgical Royal Colleges, and one of the largest of all the UK medical Royal Colleges. First incorporated as the Barber Surgeons of Edinburgh in 1505, the College has been at the vanguard of surgical innovation and developments for over 500 years.

Today we are a modern, thriving, global network of medical professionals with a membership of well over 23,000 professionals who live and work in more than 100 countries around the world. 15,000 of these live and work in the UK with 625 in Wales. Our membership includes people at every stage of their career, from medical students through to trainees, consultants and those who have retired from practice.

With our interest in professional standards, the College’s primary role – and the main concern of our Fellows and Members - is to ensure the safety of our patients and provide them with the best possible care. We do this by championing the highest standards of surgical and dental practice; through our provision of courses and educational programmes, training, examinations and Continuous Professional Development; our liaison with external medical bodies; and by influencing healthcare policy across the UK.

Improving the Quality of Services

Given that common conditions account for the majority of the surgical workload, the development of general surgical skills and competencies are vital, especially as surgical care should always be consultant-led and delivered as close to the patient as possible.

However as rarer conditions are best dealt with by specialist surgeons who have the training and expertise to produce the best care, we believe patients needing specialist surgery are often best served when services are concentrated in regional or national centres of excellence.

Pooling expertise in this way allows for economies of scale, better knowledge sharing and a professional environment that helps attract and retain the very best consultants and trainees. All these are a vital prerequisites of better patient outcomes. As recommended in our Standards informing delivery of care in rural surgery[1], it is vital that these configurations are supported by more formal collaborations between urban and rural hospitals, an increase in the number of generally trained consultants and greater multi-disciplinary working.

Similarly as per our Trauma Care report[2], major trauma services continue to be consolidated into a smaller number of specialist centres as they provide the most effective way of reducing mortality and disability for patients with multiple injuries.

In terms of seven day services, many of our members are already providing round the clock emergency surgery when it is needed. However, we do not believe that seven day elective surgery can be delivered without a significant increase in the surgical workforce. Likewise those services related to surgery, such as pharmacy, radiology, physiotherapy and social care, will be need to be expanded and appropriately resourced.

This is just one example of the importance of an adequately funded health service. Whilst there are efficiencies that can be found, any sustainable model will depend on new sources of income. However, we believe that patients receive the best value service when funded through taxation and this principle should be the bedrock of any future model.

Therefore we feel it is important that:

· Every service meets the standards established in the Academy of Royal Medical College’s Report Guidance for Taking Responsibility[3].

· There is a guarantee that all patients will not suffer negative consequences as a result of longer distances to specialist centres. This can be realised by underpinning services with the ability to move all patients safely without depleting local services.

· Provision for general surgical trainees in Wales to have the opportunity to spend four months in a Rural General Hospital are made.

Improving Surgical Training

Good training leads to better patient care, but we are concerned that the perennial high dissatisfaction amongst trainees and trainers with the quality of surgical training remain stubbornly unresolved.

RCSEd therefore supports the Shape of Training review, particularly its emphasis on developing more generalist surgical skills, a more competency based approach and an enhanced training for members of the wider surgical team. The recommendations of this review should be support by a greater use of credentialing in order to support surgeons in developing specialist skills later in their careers.

We also believe that workforce planning needs to be focussed on producing more consultants. Not only do we believe that all services should be consultant led, but are concerned that staff shortages have created an undue reliance on trainees delivering services that have little educational value.

Therefore both trainees and trainers need to have guaranteed time for training enshrined in their job plans. Further, surgical training should only be delivered by trainers using the Faculty of Surgical Trainers’ Standards for Surgical Trainers and where possible, effective surgical trainers are formally identified and appropriately rewarded.

Surveys conducted by the College and the GMC consistently report that bullying, undermining and harassment is a frequent occurrence within the surgical profession. Not only is this harmful for the individuals affected, but these types of behaviours adversely affect patient outcomes. As such, non - technical skills training, such as around team working, leadership and patient safety should also be made mandatory.

Therefore we feel it is important that: