Reflection is an important tool in our ability to conceptualise, sense-make and move forward, so for my final blog of 2022, I have revisited my monthly musings and noted that it’s been an unsettling and unpredictable year as a ‘new normal’ has evolved, with curveballs being thrown left, right and centre.
I started the year in a state of ‘cautious optimism’, looking forward to the ‘green shoots of spring’ and of course the RCP presidential election. How things have changed since then! The war in Ukraine, the growing cost of living crisis and ongoing workforce shortages. Through the summer into the autumn, the words pride, courage and compassion, along with ‘it’s okay not to be okay’ appeared in my blogs, a reflection on the conversations I was having with our members and fellows who constantly reminded me of how difficult the workplace has become, while continuing to adopt new ways of working to accommodate the backlog of outpatients and front door challenges. I salute your fortitude.
The ‘winter of discontent’ traditionally refers to the winter of 1978–79 when widespread strikes were driven by social, economic and political factors. There are some similarities with our current situation, and we can only hope that there is a prompt resolution.
Ultimately, I am an optimist – ‘yma o hyd’ – and so I would like to share with you some of our RCP Cymru Wales achievements over the past year that reflect the RCP’s strategic priorities:
- educating physicians and supporting them to fulfil their potential
- improving health and care and leading the prevention of ill health across communities
- influencing the way that healthcare is designed and delivered.
As life returned to a new normal after the initial chaos of COVID-19, we reduced our college tutor (CT) and associate college tutor (ACT) meetings back to three times a year, with an autumn meeting held face to face in Health Education and Improvement Wales’ (HEIW’s) building, Tŷ Dysgu. Everyone really appreciated being together to share experiences and build networks. We have also established more frequent CT/ACT virtual lunchtime meetings for each region (north Wales, south Wales west and south Wales central/east), which ensure we have our finger on the pulse regarding any educational training or service delivery issues that may arise. I’d like to thank all our tutors for their amazing contributions over the year and to head of school Dr Shaun Smale for his invaluable guidance.
In September, we held our annual RCP Cymru Wales poster competition. Alongside judges Dr Hilary Williams and Dr Shaun Smale, I took great pleasure in reading some excellent submissions. The winner was Dr Jenny Coventry (‘A multi-cycle quality improvement project to improve the proportion of DNAR forms discussed with the patients' next of kin’) and highly commended was Dr Anna Hesseling (‘Has the COVID-19 pandemic had an effect on the incidence and severity of anorexia nervosa referrals in young people?’).
The highlight of my year was our sell-out RCP Update in medicine in Cardiff. For obvious reasons, this was to be the first and only face-to-face Welsh conference during my tenure as vice president, so I had some fun and wore my ’yma o hyd’ bucket hat – sadly it didn’t help Cymru in the World Cup, but it brought a smile to everyone’s faces. The overwhelmingly positive feedback from delegates was uplifting – our conference committee certainly know how to put together an excellent programme.
Supporting our fellows and members
This year I am proud to say that we have developed and expanded our Cyswllt RCP Connect series of hospital visits. These provide us with a direct link to fellows, members, trainees and physician associates, and give physicians the opportunity to speak out in a safe space about their concerns, local issues and to highlight any key achievements. Following our visit to Swansea Bay (SBU) in late 2021, we published our follow-up report in March and met with the SBU leadership team about acute medicine service redesign plans. We have continued those conversations by meeting regularly with our college tutors and members on the ground who have kept us updated on progress.
In April, we published follow-up reviews to our Ysbyty Wrexham Maelor and Grange University Hospital (GUH) visits and contributed an article to Commentary on the outcomes from these. I hope that you find these visits valuable; our goal is to support fellows and members, especially our doctors-in-training who do so much to keep our patients safe, and I also hope we’ve shown that as a college, we take your concerns seriously.
Finally, we launched Positives from the pandemic, our report on innovation in north Wales, following our visit to Ysbyty Glan Clwyd earlier this year. We also ran two successful south-west Wales Cyswllt RCP Connect events on 7 September at Prince Philip Hospital and Glangwili Hospital and our follow-up report, Thinking outside the box was published earlier this month. Case studies from both reports have also been published as blogs on the RCP website.
We organised a successful inaugural Welsh SAS network event at the beginning of the year and published A positive career choice: supporting SAS doctors in Wales. After our second meeting in the autumn, we plan to publish an updated briefing with recommendations after Christmas. The next network meeting will take place in the spring.
In April, we were delighted to welcome Kate Straughton, immediate past Faculty of Physician Associates (FPA) president to Wales during her UK tour. She visited GUH and met with the executive medical director, Dr James Calvert, and local physician associates, and she also met with HEIW to discuss national policies. Kate said, ‘we learned about the success and great work being done across multiple health boards in Wales, as well as regional issues and concerns. I continue to be impressed by the level of engagement from everyone involved and look forward to the FPA continuing to support the devolved nations.’
Improving health and care
In 2022, we finally saw some progress on the implementation of the national clinical framework and the establishment of the NHS executive for Wales. With more than 20 organisations, we published Ending the postcode lottery: the case for an independent NHS Wales executive, then coordinated a joint letter from 34 organisations to Judith Paget CBE, director general for health and social services and the NHS Wales chief executive, asking for an update. After the Welsh government announced that they would establish a hybrid model, we were invited by the Senedd health committee to submit a collective view which was signed by over 30 organisations. We also responded to a new consultation on establishing the NHS executive for Wales, met with the deputy chief medical officer and organised a national workshop to bring together the patient and clinical voices.
Over the summer, we were asked by the Wales Cancer Network to coordinate a clinical engagement exercise on developing a national service specification for acute oncology services in Wales. We organised a roundtable and workshop and conducted one-to-one interviews with doctors, nurses and therapists working across oncology, palliative medicine and haematology in every health board in Wales. Look out for the launch of our report and recommendations in the new year!
No place like home, our report on virtual wards and hospital at home services was discussed in the Senedd where the minister for health said she ‘read the report with interest and agreed with very many of the recommendations.’ We have since been working with regional partnership boards (RPBs), and recently hosted RPB teams and other royal colleges for an integrated care workshop.
Finally, we continued to work with the Women’s Health Coalition on the women and girls' health plan and quality statement for Wales. RCP Trainees Committee chair Dr Melanie Nana wrote the chapter on maternal medicine and the final report was launched in May.
Leading the prevention of ill health
Over the past three years, we have taken every opportunity to highlight how the social determinants of health cannot be ignored. Without concerted action, the health of the nation will continue to deteriorate, and so we have led work to push for a Welsh cross-government plan on poverty and inequalities. In July, we published Mind the gap, a paper on the barriers to implementation of the Welsh legislative framework on health inequalities, which was endorsed by 50 organisations and published in July in partnership with the Welsh NHS Confederation Health and Wellbeing Alliance. A few weeks ago, we launched a new briefing paper, Everything affects health during the RCP Update in medicine – Cardiff, showcasing the work taking place across Wales to reduce inequalities.
Throughout 2022, we have been highlighting the dire workforce situation in the NHS and demonstrating how vacancies, rota gaps and staff sickness impact the delivery of safe patient care. Your contributions to the survey and annual census are hugely appreciated and allow us to give policy makers an insight into the situation. We believe that Wales needs a robust health and care workforce plan and after months of calling for this, we recently met with the minister who promised that one would be published early in 2023.
During the summer, we convened a group of 27 royal colleges and professional (RCAP) bodies working in health and social care in Wales to publish Bringing the clinical voice to the conversation. In November, the group published an open letter to the first minister calling for a workforce plan.
We also led the work of the Welsh Academy of Medical Royal Colleges to support Welsh government in updating good practice guidance for NHS consultant appointments. The new guidance has been published and health boards should be following it; do let us know if they are not.
We continue to work with members of the Senedd and political parties, as well as the Welsh government, health boards and national NHS organisations. In such a small country, working collaboratively becomes even more important, and we regularly team up with colleagues in other royal colleges and the third sector to make sure our messages are heard at the top.
I’m delighted to say we’ve had another very busy year in the media, with over 100 broadcast interviews across the BBC, S4C and ITV Wales, and countless more mentions online and in print. A huge thank you to all colleagues who have agreed to be interviewed, including Dr Hilary Williams, Dr Dai Samuel, Dr Sam Rice, Dr Sacha Moore and many more. We really hope that you feel represented on the national stage and that you see yourselves reflected in the media.
Interesting, challenging and rewarding – that’s how I’d describe this role over the past year. I hope my efforts have had some impact, and that I’ve been able to represent you in the way that you wish to be represented. Overall, I hope you feel that we have listened and acted on what you’ve told us. I am proud to call myself a physician, and humbled by the dedication, commitment and amazing work I witness among physicians in Wales.
The vice president for Wales normally steps down in December, but I have a few months’ grace. I’m looking forward to wrapping up some projects and handing others over to my successor. Whoever they are, they will be leading an exciting portfolio! Nominations have now closed for the 2023 RCP senior officer elections and we will be in touch in the new year with more details about the voting process.
In the meantime, this year, we introduced guest bloggers to the Wales bulletin with contributions from Dr John Glen, Dr Orod Osanlou, Dr Jamie Duckers and many more. It would be interesting to hear what you think of my newsletter – let me know if you’ve got any ideas or wish to contribute.
Dr Olwen Williams