The Royal College of Surgeons of Edinburgh (RCSEd) has announced two appointments in Northern Ireland as our health service continues to face significant backlogs and waiting lists in the wake of Covid.
ndrew Diver, Consultant Plastic Surgeon at Kingsbridge Hospital in Belfast, and Mano Shanmuganathan, Consultant Neurosurgeon at Royal Victoria Hospital Belfast, are Regional Surgical Ambassadors and will play a key role in the college’s endeavours to supports members here.
An event two weeks ago in Belfast to mark the appointments discussed the current state of play within the Northern Irish healthcare system and the problems unique to our region.
“It was a really successful meeting, trying to support not just the healthcare workers and surgeons of Northern Ireland, but patients because it is patients that at the moment are the real losers across the United Kingdom, but in particular in Northern Ireland, with the terrible waiting lists that there are, not just for surgery, but to be seen, to be diagnosed,” says RCSEd president Professor Michael Griffin.
“We met with the Chief Medical Officer, Sir Michael McBride, who really acknowledged the spirit of consensus and collaboration that we wish to bring to the table, that we want to work with everybody to try to come to a solution that provides transformational change and how we do things in Northern Ireland and how we improve access to healthcare and particularly surgical healthcare in Northern Ireland.”
A joint symposium event this summer will look at that transformational change, about different ways of patients being seen, being heard, being documented and then being treated.
Things do need to change. Waiting times to book GP appointments, agonising waits for ambulances and a shortage of medical professionals means Northern Ireland is in the middle of a healthcare crisis.
“Tragically, with all the faults in the health service that existed before Covid, those faults are now great big crevices and chasms, and demonstrating the serious issues that we face,” says Professor Griffin.
“But I will say that it is my belief that the biggest problem is our healthcare force and particularly in surgery. We had across the United Kingdom, but particularly in Northern Ireland, a haemorrhage of staff away from surgical theatres.
“You can imagine that during the pandemic, when surgery stopped, all of a sudden the healthcare workers and nursing staff that worked in theatres were redeployed across the United Kingdom in other Covid positive areas, and so they were the ones that suffered as much as anything.
“They, along with the surgical trainees who were not operating and not learning their trade if you like, were redeployed to very alien environments to look after patients who needed looking after. It was one way of dealing with the issues of understaffing and it had to happen.
“But of course, in terms of surgery and surgeons in training, their training just stopped. It was paused.
If you stop surgeons training, that means if there’s no training today, there’s no surgeons tomorrow and you don’t get consultants at the end of it.
“So in effect, we’re a year or two behind in our surgical training and getting surgeons to come off the ladder at the end, ready to take up those important consultant posts.
“And equally if we lose our surgical theatre workforce because they felt, ‘I didn’t enjoy what I had to do instead of being in the operating theatre,’ and they’ve left the health service, staffing theatres across the UK and in Northern Ireland is a huge problem.
“We have to attract and not just attract, retain what staff we have.”
Resolving the difficulties in staff shortages is paramount to fixing the system, he continues.
“I think that a lot of thought has gone into how we can bring in healthcare workers, nurses, doctors, surgeons from abroad, which I think is all well and good, but taking them from low-income countries, at a time when they are hit as badly as anybody for Covid management, that is the wrong time to be robbing Peter to pay Paul.
“We should be looking at ethical recruitment and we should be far more focused on retention of our staff and making sure that our staff are valued, looked after, are cared for, are cherished.
We are nothing without our healthcare workforce, so if they’re leaving and voting with their feet, something is very wrong, and we have to put that right.
It must be difficult, we say, to leave a role that is so vocational, where a duty of care to patients is top priority.
“You’re right but if you’re not in a comfort zone, you feel you can’t do what you’ve been asked to do, then it is a massive challenge,” says Professor Griffin.
“People inside the operating theatres have been transferred to a Covid world, sometimes to ITU [Intensive Therapy Unit], places like that, and they were seeing many people succumb to Covid certainly during the first, second and third waves. They weren’t used to that.
“That has a really bad effect on mental wellbeing. Our healthcare workers really suffered during this pandemic, and it is hard to blame them for voting if you like with their feet and looking for a different way of spending their lives.
“What we have to recognise is that we have a duty of care to our patients, number one, and we have a duty of care to our staff, and we have to make our staff feel valued and wanted and to look after them. At the moment I don’t think that the National Health Service does that.”
Watching the news particularly during the initial waves of Covid highlighted the very real impact the pandemic and its repercussions had on medical professionals, already working above capacity.
Opportunities to speak with colleagues and talk through difficulties is therapeutic but these occasions are diminished compared to when Professor Griffin was a trainee, he says.
“When I was a youngster, I never, ever didn’t want to go to work. You’d always see your mates and you would go to the canteen, and you’d meet the nursing staff from the ward, you’d meet the radiographers from X-ray, and you’d be chatting about different patients and different things. It was a community.
“There was 24/7 hot food in those days. And now there’s vending machines and there isn’t the opportunity for people to meet other colleagues, other friends, have a coffee and talk about what a good day they’ve had or what a bad day.
“That’s just one of the examples that the NHS has not done well over the last 30 years. They’ve got rid of what we took for granted.
“I’m a massive fan of staying healthy and that hospitals should provide healthcare facilities like gyms and so on for the staff to be able to look after themselves, to perhaps do some exercise before their shift, during lunchtime, or after their shift.
“Again, it engenders a sense of community. I think that we have to get our hospitals back to being places that you want to be rather than somewhere that you’re scared to go to.”
He speaks of other companies that offer gym memberships to their employees.
“Well, what about the National Health Service? We are the National Health Service for heaven’s sake. We have to look after the health, not just to our patients, but our staff. If we don’t have the staff, we can’t look after the patient.”
With the new appointments of Mr Diver and Mr Shanmuganathan as Regional Surgical Ambassadors, tackling workforce issues and improving workplaces for surgeons and healthcare workers is key.
“They’re stars,” says Professor Griffin of Mr Diver and Mr Shanmuganathan.
“They have been selected to be our representatives in Northern Ireland for any member or fellow of affiliates to contact to ask about educational events and training events and assessment exams, anything to do with their professional lives or difficulties or concerns that they have in their practice, for them to contact them.
“If they can’t help and support them in the issue that they have, they will then obviously contact us, and we will contact them. It is really an opportunity for any member or fellow of the College to be able to have a point of contact.
“They will organise events within Northern Ireland that our college will attend, be part of, again to provide education, to provide support.
“One of the things that we did see during the pandemic, a very unfortunate part of it, was we saw an increase in reporting of bullying and undermining. When people are under pressure, these sorts of things can rear their heads. And again, our regional surgical ambassadors are trained to deal with these sort of difficult issues.”
With Northern Ireland reported to have the highest prevalence of mental health problems in the UK, it too is a factor within staff and patients alike.
“A fit body is a fit mind, generally speaking, and we have really struggled through this pandemic and that is one of the reasons that people are leaving the health service is because they want to look after their mental health,” says Professor Griffin.
“They felt that the environment has been not one conducive towards making them happy and we all acknowledge nobody is to blame for this pandemic itself, and it has been a very difficult time.
“But I think that in the aftermath, we have to be looking at ways that we support and look after and cherish our staff rather than putting them under more pressure in the elected recovery, working harder, doing more hours in order to attack the waiting lists.
“We’ve got to do other things that make our staff feel it’s worth being at work.”
Mr Diver, who is involved in developing a mentorship programme which looks at tackling mental health issues and burnout experienced among healthcare professionals, encouraged attendees at the Belfast event to be open about discussions on mental health.
“In the surgical profession, the biggest obstacle can often be that surgeons themselves do not recognise they have a problem when it comes to their mental health, so they don’t always speak up.
“However, this is slowly starting to change for the better within the surgical community.
“We must overcome the notion that surgeons need to get on with the day job and be more resilient even in the face of the mounting pressure they’re experiencing.
“It’s far healthier for people to speak out when they’re struggling and to know that there are resources for people to get help. The College is here for everyone and to help anyone overcome challenges they face in the workforce.”
Professor Griffin spoke about the Making It Better campaign, which supports the surgical community and speaking out on issues that affect the workforce.“ In particular the workplace, because that is one thing which is actually really cheap to put right,” he says.
“Put the infrastructure in that people can get hot meals, they’ve got places to go, they’ve got places to meet for coffee and for different times when they can meet their friends and colleagues and talk about things. And also, we could put into place recreational facilities which make it to be a better place to actually work.
“I really think those are very easy winners.”
To find out more about the Royal College of Surgeons of Edinburgh, go to www.rcsed.ac.uk
