3 July 2020

Dear RCSI Members and Fellows,

Another week, a new Irish Government and new ministers. I welcome Stephen Donnelly, the new Minister for Health. I will be writing on behalf of the College to wish him well in his very challenging role. I also welcome the appointment of Simon Harris as minister in the new portfolio of Minister for Higher Education, Innovation and Research. I will also be writing on our behalf to thank Minister Harris for his leadership during the first phase of the COVID-19 pandemic and to wish him well in his new position. RCSI is well positioned to be supportive of both ministers in their new roles.

As the health services begin to restore scheduled care it was valuable to have Dr Colm Henry, HSE Chief Clinical Officer lead the Wednesday webinar on Solutions for Scheduled Surgical Care. His insightful and reassuring contribution was followed by presentations by Council Members David Moore, joint clinical programme lead in Trauma and Orthopaedics, and Deborah McNamara, joint clinical programme lead in Surgery. The message was clear – there is no experience elsewhere to benchmark the situation we are currently faced with; we are about to turn on the lights again, but the room has changed! We must start from the premise of patient and staff safety in a timely, equitable and prioritised fashion.

Heretofore, our public sector hospitals had been working at close to 100% capacity, where overcrowding and trolley waits in ED had become the norm. The new normal must preserve capacity for a second surge, protect staff with appropriate PPE and work to a maximum 80% capacity to provide for social distancing and surge capacity. Some capacity will be freed through enhanced community care, virtual clinics and accelerated discharge planning however, over the past three months some 35,000 procedures have been deferred, added to the already unacceptable waiting lists. Dr Henry and his colleagues are all too familiar with the difficulties and they need help with the solutions.

Protection of scheduled surgery pathways is essential if we are to address the needs of those on waiting lists. Where this is not possible, increased capacity should be secured in level 2 and 3 hospitals and the private sector. The National Treatment Purchase Fund has been used in the past for short term initiatives, however it is not suitable in its present form for medium to long term capacity issues. Continuity of care, outcome audit and training can only be assured if Hospital Groups identify patient pathways that protect scheduled care, ensure appropriate COVID-19 screening and facilitate continuity of care and clinical training.

Next week’s webinar will focus on the Medicolegal Impact of COVID-19. Our speakers will be Ms Margaret O'Donnell, RCSI Council Member and Clinical Director at Blackrock Clinic; Mr Tom Hayes, MPS Head of Service delivery (previously healthcare partner in Mathesons Solicitors); Dr Rob Hendry, MPS Medical Director; and a representative from the Clinical Indemnity Scheme. I have no doubt that this will prove to be interesting and informative. You can register for this webinar, taking place at 6pm next Wednesday, here.

On Thursday, I represented RCSI on an American College of Surgeons international webinar on Surgical Leadership during Crisis Situations. Other panellists included Dr Valerie Rusch, ACS President and Honorary Fellow RCSI, Dr Godfrey Muguti from Zimbabwe, President of COSECSA and Professor Chintamani, FRCSI, New Delhi India. I was able to provide an account of how we in Ireland have coped and how effective safe surgery continued to be delivered for acute and urgent care during the acute phase of COVID-19. It was clear from the contributions from around the globe that Ireland has done well and is closer to recovery of services than most other countries.

This week, 60 new surgical trainees commenced their surgical careers by completing a week-long virtual surgical Bootcamp. Each day this week, these new Core Surgical Trainees participated in a series of virtual lectures where they received intensive tuition in basic surgical skills and basic management principles for surgical patients. Each of the trainees has also been provided with suturing and laparoscopic training aids with which they can practice these skills in their own time.

I would like to welcome these new trainees to the RCSI family. They join our 350 other trainees across all our surgical specialty programmes and Emergency Medicine as they embark on their consultant training careers.

To better support our trainees, RCSI Surgical Affairs, with the support of colleagues in RCSI IT, have just launched our new RCSI Surgical elogbook which has been expanded to cover the needs of Specialty Trainees. This new elogbook is now available to Higher Surgical Trainees and RCSI Surgical Affairs plan to make it available to consultants and all surgical NCHDs in the near future. Unfortunately the July conferring of Memberships and Fellowships has had to be deferred because of COVID-19. I am hopeful that a formal convocation will be possible in December when we will also award an Honorary Fellowship on Professor Derek Alderson, outgoing President of the Royal College of Surgeons of England. My sincere congratulations to all who have achieved Membership or Fellowship and I hope we will have the opportunity to meet when the in-person ceremony is possible.

Finally, I would like to acknowledge a research paper published last week in the American Journal of Respiratory and Critical Care Medicine entitled 'Characterization of the Inflammatory Response to Severe COVID-19 Illness'. Oliver McElvaney and colleagues at RCSI, Beaumont Hospital and the Mater Misericordiae University Hospital showed that COVID-19 cytokinemia is distinct from that of other types of pneumonia leading to organ failure. Dr Brian Marsh from the Mater and RCSI Professors Gerry McElvaney and Ger Curley are to be congratulated on their leadership.

Until next week, keep safe,

Best wishes

P. Ronan O’Connell