The clouds will go away and the sun will shine on us again

It seems as though there is finally a glimmer of sunshine behind the clouds, after many months of uncertainty and incredible hard work. The first case of COVID-19 was reported in Wuhan, China at the end of December. Since then many of us have lost loved ones and many have cared for, nursed and treated those stricken by this deadly virus. A huge number of you have been working in pressurised jobs on the front line or in places or wards that are new to you. Many of our younger Affiliates have only just graduated (or not even graduated) and are facing up to new challenges in a very dramatic environment. To everyone who has, and is continuing to work in our NHS, I send my profound and grateful thanks. It goes without saying that these have been and still are deeply difficult and challenging times.

As lockdowns ease all over the world, the very hard task of restarting all the things we put on hold begins. We need to restart elective operating, not just in the field of cancer but the many life-saving and life changing benign procedures. I have been lobbying government throughout this pandemic to ensure that areas of hospitals can be set aside to keep them COVID-free to allow operations to progress to save lives. And this can only be done with the proper provision of PPE and with the availability of testing. The hospital environment remains one where there is a higher risk of COVID transmission.  And the R number while not monitored, must be higher than 1, even now. We have to continue the regime of testing and follow social distancing in hospitals to ensure that normal services can be resumed.

At the start of this pandemic I wrote an article for The Times as I was very concerned about the talk of approaches to “fighting the virus” and setting a military tone by developing “war cabinets and councils of war”. I argued that the way through this pandemic was through care and compassion and thinking of others and putting ourselves forward in order to look after those in need. Whilst talk of military campaigns continued our members and fellows and the general public did exactly what we all hoped for and stood up and looked after each other. It has been a very difficult time for everyone in the NHS and also for the politicians who have been making difficult decisions not just based on the science and the clinical situations but the politics as well. Dealing with the economy and healthcare is always a delicate and political balancing act.

Indeed, there has been so much sadness and tragedy it has been difficult to find evidence of joy and happiness, but I must mention the actions of Captain Tom Moore (now Sir Tom Moore) that captured the imagination of the Great British public. He was a true World War II hero but through his actions demonstrated nothing but compassion, kindness, caring and commitment to raising over £30 million for our national health service. He did not use militaristic phrases or battlefield cries but simply reassured, “For all those people who are finding it difficult at the moment: the sun will shine on you again and the clouds will go away”.

Our own hotel, Ten Hill Place, has been quite remarkable in support of our healthcare workers in Edinburgh. So many needed to travel long distances in order to fulfil their shift patterns during the Corona virus outbreak, others simply needed to isolate from their own vulnerable families while they put themselves in harm’s way to save lives. The Hotel provided over 2500 nights of free accommodation to the healthcare workers of Edinburgh In order that they did not need to travel large distances after completing a harrowing and demanding shift. Not only were they provided with a beautiful room and facilities but also an evening meal and breakfast prior to starting their important work once again in the morning. The staff of Surgeons Quarter and Ten Hill Place were an absolute example of professionalism and care in providing this wonderful service completely free to our important NHS workers.

While our hotel remained open for important key worker business the College itself has been closed since lockdown began towards the end of March. It was with sadness that together with our interim Chief Executive Tony Oxford and Mr Morcom our Senior College Officer we closed the doors and prepared our workforce to work at home. This has progressed seamlessly. Whilst the buildings have been closed the College has remained open ‘virtually’ throughout this period. Indeed, we have been as busy as ever despite certain aspects of our business as usual being significantly curtailed. Our examinations and assessments Have necessarily been put on hold Both domestically and internationally. Nevertheless, the Exams teams have been working very hard reassuring our understandably anxious trainees that they are here to expedite all postponed exams as soon as the lockdown and social distancing allows. They are now prepared for a series of exams possibly starting in September and are working out how to manage the significant backlog that has resulted.

All our committees and all council meetings, including strategy days, have continued on a virtual basis using a variety of media platforms. This has been an extraordinary success and it is very interesting to note that attendance at the virtual meetings have been higher than those held here at the College in Edinburgh or in Birmingham prior to the outbreak! There are many lessons to learn regarding different ways of working and delivering our important services. We intend to offer more balance to our activities in the future.

The sadness however for the “friendly college” is the lack of personal interactions. I do not need to emphasise this as everyone all over the United Kingdom has made significant sacrifices, avoiding contact with loved ones including grandchildren, grandparents, brothers, sisters and parents. The unconfined joy for me when reunited with my granddaughter after nine weeks (at a distance of two metres) was quite extraordinary. I am sure this will have been replicated all over the country for so many of you. For us as a College it has meant not seeing our colleagues and friends face-to-face and in particular missing our diploma days and ceremonies where we meet hundreds of friends from all over the world. The “friendly college” will really look forward to renewing all of these acquaintances hopefully in the New Year. This is a large part of who we are. 

Many of you will have followed our educational commitments in the form of our COVID-19 webinar series. In excess of 25,000 registrants will pay testimony to the quality and the extent of the educational offering. The COVID-19 series of webinars has been an outstanding success once again facilitated by our IT team and Ryan Lowry in particular. The commitment from Ryan and his team as well as the many fellows and members from our College to delivering this educational content has been fantastic. I would also like to emphasise that the webinar series for medical students and junior doctors has been a wonderful addition to our education delivery. This webinar series has been set up, led and delivered by Mike Silva, the newly appointed Director of our Regional Surgical Ambassador network. The whole network has joined in to deliver a really engaging and educational series which will be an excellent resource for some time to come. I thank everyone for their contribution.

As the number of COVID patients reduces in our hospitals around the United Kingdom most of the talk now is around the recovery phase and the attempt to get back to a new normal way of working. Much will change over the coming years but the biggest challenge to our profession is addressing the huge numbers of patients waiting for highly complicated and important cancer surgery as well as the myriad of non-cancer, life-saving operations that are awaited by many. News suggests that the waiting lists for these types of operations could reach 10 million. We then need to address restarting standard elective surgery and re-configuring diagnostic facilities for patients with suspected cancer. The delivery of the surgical and diagnostic service requires the development of COVID-lite or COVID protected sites. The College as mentioned earlier has been campaigning for weeks now to identify these sites all over the United Kingdom.  

Our Faculty of Dental Surgery, which has around 7000 members and fellows, and led by our Dean Fraser McDonald has also been calling for additional PPE to allow General Dental Practitioners to return to work. Dentists have already had to change their way of working due to dealing with cross contamination with other outbreaks such as AIDS, H1N1, Bird Flu and Swine Flu not to mention the annual attack of seasonal flu close to the operator’s face. But this is a step beyond. Nearly all of the procedures carried out by Dentists are Aerosol producing and therefore carry a high risk of cross-infection from COVID-19. But patients will suffer if they cannot restart treatments and the effects could be long term with significant deterioration of dental health and awareness. Dental check-ups are also useful screening points for signs of cancer as well as protecting the longevity of teeth.

The importance of winning the trust and confidence of the public to encourage them to come back to hospitals and dentists for investigations and treatment cannot be under-estimated. Key to the success is a timely testing program not just for patients but for healthcare workers and also the understanding and the commitment of patients to self-isolating for 14 days before coming into hospital for treatment. None of this is going to be easy nor is it going to be managed quickly. Indeed, we as a profession need to manage the expectations of the public that everything will be returning to the normal that existed prior to the pandemic. Together with NHS leaders we have to win the confidence of the public to create new ways of working as Surgeons in order to deliver the highest possible standard of care in very difficult circumstances. The college will be pivotal in helping to deliver this.

There is very much to do for all of us in the aftermath of the pandemic. It is care, kindness, compassion and commitment that will see us all through this troubled time and allow us to appreciate the words of Captain Tom that “the clouds will go away and the Sun will shine on us again.”

Mike

Professor S Michael Griffin OBE PRCSEd MD FFSTEd FRCS(Eng)FRCP&SGlas Hon) FRCSI(Hon)FCSHK FCSSL(Hon)

Professor of Surgery

President Royal College of Surgeons of Edinburgh

Published by The Royal College of Surgeons of Edinburgh

The Royal College of Surgeons of Edinburgh (RCSEd) is an organisation dedicated to the pursuit of excellence & advancement in surgical practice since 1505.

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