15 May 2020

Dear Fellows and Members,

As we move towards the next phase in Ireland’s response to COVID-19, I hope that you and your families remain safe and well.

This week we marked a very special and momentous day for RCSI. For the first time in our history, we hosted a virtual conferring ceremony for our School of Medicine Class of 2020. In response to the unprecedented challenges of COVID-19, the Class of 2020 graduated earlier than scheduled so they can join the frontline global response. The virtual conferring ceremony not only celebrated the achievement of our new graduates, but embodied the very core of what we are about – educating future healthcare leaders. You can watch the virtual ceremony back here.

As these new doctors enter the health service, I encourage you to support them in every way you can. These new interns will have a shorter induction period than the norm and will be entering the health service during a very challenge period. The support of you and your colleagues will be critical during the early stages of their internships.

As the COVID-19 pandemic evolves, our focus moves from ensuring the ability to accommodate the surge in demand due to coronavirus infections, towards providing the services to respond to the regular healthcare needs of the population, particularly because, as we know, routine care has been altered such that those with other conditions have been disproportionately affected.

As the ability to provide for non-COVID care resumes, new and evolving themes will develop which will require different ways of working in order to prevent coronavirus infection and to reflect the positive changes in practice which happened during the crisis. It will be crucial to consider how to provide a safe environment and surgical care pathways for patients and staff working in this new healthcare era when coronavirus infection remains a risk.

The RCSI National Clinical Programmes in Surgery and Trauma & Orthopaedics have worked tirelessly over the past number of weeks with the HSE and the Department of Health to develop guidelines for a phased return to planned surgical services while also developing a recovery plan. Based on this work the HSE published their first set of interim guidelines in relation to resumption of services and these are now available on the RCSI COVID-19 resource hub and the RCSI National Clinical Programme in Trauma and Orthopaedics has published recovery management guidelines which outline the core principles to consider when returning towards planned activity in trauma and orthopaedics.

As we enter the second phase of the pandemic response, there has been a reduction in COVID-19 patients across our hospitals thus increasing the availability of facilities and staff to commence some planned orthopaedic work. This must, however, be done cautiously, given that we are at the early stage of understanding this new disease. Planned care should only return on the understanding that trauma remains our most critical concern and preparation should be made for an increase in trauma volume as social restrictions are eased. The establishment of a recovery management team in each hospital is recommended to develop a robust process to utilise the reduced elective capacity to best effect.

The programme delivered a well-attended webinar on Trauma Assessment Clinics (TAC) on Wednesday. COVID -19 has radically changed how healthcare is delivered and innovative ways of delivering care, through trauma assessment centres for example, have developed rapidly. These centres should be funded and their benefits protected. Please note, for the avoidance of any doubt, that the Clinical Indemnity Scheme (CIS) covers the conduct of such clinics. Credit is due to the clinical teams who have adopted these new ways of working in order to ensure continuity of care. Whilst the COVID-19 crisis has necessitated these measures, they should be supported and protected in the longer term to streamline our services in a cost effective and patient friendly manner.

The RCSI National Clinical Programme in Surgery is currently working with the National Clinical Programme for Anesthesia to develop new pathways for getting people in and out of hospital safely which will be published in the coming weeks. This week the programme published a guide for consenting in the COVID situation and an updated guide for prioritisation of urgent schedule surgical conditions which incorporated updates from plastic, reconstructive and aesthetic surgery.

At an intercollegiate level, the guidelines for patients undergoing surgery during the COVID period are constantly evolving as we become more knowledgeable regarding the risks associated with surgery. For example, we now do not advocate pre-operative thoracic CT scanning for patients undergoing planned cancer surgery. We do understand, however, that confusion can arise as a result of the numerous documents produced by the various professional bodies but we will endeavour to update each of our guidelines as best practice evidence evolves.

Our weekly webinar series for surgeons continues to be very popular. So far, eight COVID-19 webinars have taken place with over 1,200 fellows and members participating. This week’s webinar, dealing with the changes to outpatient clinics in the COVID-19 era, highlighted the changes that will be necessary and the critical role to be played by Advanced Nurse Practitioners in the post COVID-19 era. Contributions from Mr Tony Moloney, Consultant Vascular Surgeon and Prof. Peter Gillen Advisor to the National Healthcare Communication Programme clearly identified the importance of telemedicine and it is clear to me that RCSI can take the lead in the training of our surgical teams in this very necessary new way of working.

Next week’s webinar will ask if resilience is realistic during the COVID-19 outbreak. This session will take a slightly different approach with Professor Peter Gillen, Associate Professor in Surgery in conversation with Dr Eva Doherty, Clinical Psychologist and RCSI Director of Human Factors in Patient Safety. They will focus on the personal health and well-being supports our surgical teams need during this crisis. You can register for the webinar here.

It is now eight weeks since we launched the RCSI COVID-19 resource hub to support surgical practice and the continued positive engagement and feedback show the value of this resource.

In these eight weeks:

  • over 28,000 people have visited the resource hub;
  • RCSI’s National Clinical Programmes in Surgery, Trauma & Orthopaedics and Emergency have completed 36 COVID-19 specific initiatives to support surgeons in practice and the HSE;
  • eight COVID-19 specific webinars have taken place with more than 1,200 Fellows and Members participating. An additional 1,900 people have requested video recordings;
  • the National Clinical Programmes have developed and launched 18 new national guideline documents and published 16 guidelines for other recognised bodies;
  • 50 Fellows of the College are actively involved in delivering the New GP-Surgeon connect initiative and there has been more than 2,100 visits to the section of the website;
  • RCSI has hosted 24 online specially training courses in support of specialty training, with a further 15 planned for the next four months, and has updated the CPD and academic programmes so that they can run online if necessary next September; 
  • RCSI has launched an online course on telephone communications in the COVID-19 era in order to upskill people in both 'normal' telephone consultations and in the novel experience of breaking bad news over a telephone to family members whom one may not know.

We know there is there is still more to do and I encourage you all to share your thoughts on additional supports the College can provide for you and your colleagues by emailing pcs@rcsi.ie. It is also vitally important that the public recognises that they must continue to seek medical assistance if they have symptoms which cause concern, or they already are being treated for a serious health condition. The risk of developing other serious or life-threatening conditions remains unchanged and people must be fully confident that they can and should, seek medical assistance if they are worried about themselves or a relative.

The health service not only remains open to see people with urgent and serious problems, it is actively asking that such people seek help. Urgent and acute illnesses or conditions will continue to be treated and the public must not hold back from seeking help regarding serious illness in themselves or their family.

I look forward to sharing a further update with you next week. In the meantime, please stay safe.

Best wishes,

Mr Kenneth Mealy, President of RCSI