26 March 2021

Dear Fellows and Members,

Exactly one year ago, RCSI President Kenneth Mealy opened his President’s newsletter with the words "it is clear to all involved in healthcare education and delivery that we face uncertain times". Only those with an eye to history could have anticipated that the pandemic would run its course and that one year later in Ireland 233,000 individuals would have been infected and 4,631 deaths would have been recorded. In the interim, so much has happened and yet so little has changed. There seems little prospect of significant relaxation of COVID-19 related restrictions in the near future. We can only hope that vaccines will keep ahead of viral mutation. However, as COVID-19 becomes endemic, some restrictions are likely to continue into next year and possibly beyond.

Fellows and Members continue to experience difficulty in delivering scheduled care. What maybe considered routine today may well become time-sensitive tomorrow and critical the day after. The HSE has identified addressing, 'as far as possible', backlog issues from pauses due to COVID-19 as one of the priorities in the 2021 National Service Plan. Shifting care into the community to free up hospital capacity is undoubtedly necessary but will not necessarily impact on surgical workload unless there is clear separation of acute and scheduled care and surgical resources are protected. Transforming care pathways may facilitate process and increase use of underutilized resources, however there remains a critical shortage of operating theatres access across the public hospital sector. Fellows and Members will be aware of the many representations made by RCSI in this regard.

Following discussion at Council, I wrote to Mr Ciaran Breen, Head of the State Claims Agency, to express concern relating to the probable medicolegal consequences of delayed diagnosis or treatment occasioned by the COVID-19 pandemic. It is very likely that litigation will be threatened against individual medical practitioners arising from such delays. No possible liability could attach in such circumstances. I indicated that Fellows and Members would welcome guidance regarding protocols they should follow when a letter of claim is received relating to delayed patient care. In that context, it is interesting that, as reported in the media, the President of the High Court has asked the Government to nominate up to 20 new judges in anticipation of 'a tsunami' of litigation once the COVID-19 crisis eases.

This week marked the publication of an independent review on diversity and inclusion for the Royal College of Surgeons of England, prepared by Baroness Helena Kennedy at the behest of Professor Neil Mortensen, President of RCS England. The report, while specifically reflecting governance and practice within RCS England, makes interesting and challenging reading that we in RCSI would do well to reflect on.

I am pleased to report that the interviews for entry to Higher Surgical Training in 2021 were completed this week. All were conducted online and on time. Great credit is due to all in Surgical Affairs, particularly Padraig Kelly and Caroline McGuinness, for successful completion of the interviews. Thanks also to all of the trainers who gave their time to ensure the smooth running of the process, and congratulations to the successful candidates.

Good news also with regard to the JCIE examinations which have recommenced with FRCS examinations in Neurosurgery held this week. The schedule of JCIE examinations in all disciplines is in place over the next six weeks.

This week’s Wednesday evening webinar on GI endoscopy, chaired by Past-President Kenneth Mealy, included excellent presentations from Dr Jan Leyden, Clinical Lead, and Professor Fiachra Cooke, Surgery Advisor, HSE Acute Operations National Endoscopy Programme. The data presented clear show the value of quality assessment/quality improvement programmes within the endoscopy programme. It behoves all performing endoscopy to be informed and engaged. The presentations and subsequent discussion can be viewed here.

COVID-19 has restricted many of the activities within RCSI, however it has also opened many doors and increased engagement with our 9,600 Fellows and Members in 83 countries. Great credit is due to our colleagues in the Alumni Office for validating the database and ensuring connection with our Fellows and Members through weekly webinars, the monthly Surgical Bulletin and the Surgical Scope magazine. Given this level of engagement, it is probably now time to incorporate the President’s Newsletter into the Surgical Bulletin which all Fellows and Members receive. Be assured however, a bespoke newsletter will continue to be issued from time to time if and when events require.

Robyn Byrt, lead for Fellows and Members in the Alumni office, is leaving to become head of the Alumni Office at Dublin Technical University. We wish her every success and thank her for all her work on behalf of the Fellows and Members. It has been a great pleasure working with her. I welcome Ms Jenelle Sherlock who has taken over Robyn’s role for the present and I look forward to working closely with her.

Keep safe,

P. Ronan O’Connell