29 January 2021

Dear Fellows and Members,

It has been a difficult January for all in the health service. When I last wrote, the COVID-19 trajectory was ominous and so it proved. The daily incidence exceeded 8,000 per day, hospital inpatient numbers exceeded 2,000 and ICU capacity became critical. In every aspect, the challenge was a multiple of that faced in spring 2020, yet our healthcare system has coped. The statistics tell us that Ireland went from best in class last November to the worst in Europe in six weeks. It can only be hoped that the third wave has reached the shore and that the COVID-19 tide is receding. Your dedication and resilience is remarkable, however I fear the race is not run yet and 2021 will be a long year of ongoing restrictions and slow recovery.

The news that agreement has been reached with the private sector to provide surge capacity and to accommodate urgent scheduled care is welcome. Many difficulties remain in dealing with time critical surgical interventions that have been deferred due to COVID-19. The NCPS has issued revised guidance on patient prioritisation that Fellows and Members should refer to. There is a persuasive argument that such patients should receive priority vaccination ahead of scheduled care as COVID-19 infection in the peri-operative period may have serious consequences. In concert with our sister colleges in the UK who have written to the UK Joint Committee on Vaccination and Immunisation, I have written to the Chair of the National Immunisation Advisory Committee and the Chair of the National Vaccine Taskforce to highlight this need. While all can understand the pressures of vaccine prioritisation, patients in need of time critical surgical intervention are among the most vulnerable in our society and must be protected.

COVID-19 restrictions continue to affect training and career progression. While the proportional reduction in training case numbers are similar in Ireland to the UK, the absolute numbers are less. It is very unlikely that any of our senior trainees will have difficulties with progression to CCST. I have previously brought the attention of Fellows and Members to opportunities for post-CCST fellowships in Ireland and to recently published NDTP workforce plans. Those approaching CCST may wish to consider these opportunities.

Trainees in the early and middle years are disproportionately impacted, and every effort is being made to lessen the effects of deferred MRCS part B examinations. Trainees with concerns should liaise with the CST Programme Office. With the support of the Forum of Postgraduate Training Bodies and the Medical Council, I will continue to advocate that every surgical case is a training opportunity and this must extend to scheduled care outsourced to the Private Sector.

I know many Fellows and Members are concerned regarding the potential for complaint to the Medical Council regarding delayed diagnosis and deferred surgical intervention. I recently wrote to the President of the Medical Council, asking that the Council would reassure practitioners that adverse outcomes arising from resource or pandemic related delays would not be appropriate grounds for progressing a complaint against an individual practitioner. Dr Doyle in her reply made clear that while the Council is statutorily required to investigate every complaint received, any complaints about medical practitioners are considered on the specific facts of the case and the particular situation in which the doctor is working. This will include reference to any relevant ethical frameworks in place in the healthcare environment, or any relevant guidelines in place in the healthcare environment. I hope that Fellows and Members will be reassured by this supportive statement.

RCSI Council agreed at its meeting on 14 January 2021 to make a submission to the Oireachtas Justice Committee on the ‘Dying with Dignity’ bill, introduced in 2020 and now in Committee stage. In preparing the submission, Council took reference from a comprehensive review undertaken by RCPI in 2017, updated in 2020, submissions from the College of Psychiatrists and Irish Association of Palliative Care and opinion from RCSI University colleagues. The submission makes clear that ‘Dying with Dignity’ is a much broader topic than the narrow but highly emotive issue of assisted suicide. In the opinion of Council, the legislation as currently drafted is defective and has potential for very serious unintended consequences. It is hoped that RCSI’s contribution will lead to wider public consultation and serious discourse about end of life care in our society.

This week I learned that a surgical trainee was attached on his way home from work leaving him with serious injuries. The attack appears to have been racially motivated. I have offered every assistance to the individual concerned. RCSI utterly condemns verbal or physical assault on any healthcare worker and racial abuse must be called out as intolerable in our society.

Although not directly related to the assault, Fellows and Members will be aware of my commitment to address the broader issues of discrimination and inequality in our healthcare system, particularly the needs of those in so-called ‘non training’ positions on whom our surgical services depend so heavily. The Professional Practice and Development Committee led by Chair Mr James Geraghty has constituted a forum to perform a needs and gap analysis. I hope that the forum will allow open discussion of the difficulties and inequalities faced and that this will inform interaction between RCSI, HSE and NDTP.

Fellows and Members will be aware that next week is Charter Week. If you have not yet registered to participate, please join the more than 1,600 who have already done so here. There is no registration fee and CPD credits are available for the sessions attended. The programme extends over five days and features outstanding lectures, symposia and presentations from 120 contributors across five continents. COVID-19 may have imposed travel restrictions but it has forced innovation that may well restructure scientific and clinical discourse into the future.

Thank you for your continuing dedication and personal sacrifices on behalf of society and your patients. Please do take care of yourselves and make time for exercise and personal interests. I hope you will find Charter Week interesting and motivating. I look forward to greeting you, virtually of course.

Professor P. Ronan O'Connell
President, RCSI