Dear Fellows and Members

This letter is something of an end of term round up as most of us are looking forward to a well earned break, not all though; many of our trainees can’t begin to enjoy their summer without knowing what the future has in store.

I have now met the new Secretary of State for Health, Alan Johnson, and had time to brief him on four main topics which are high on every surgeon’s agenda.

SHO employment and the lack of training opportunities in this round of recruitment

I have requested that the best candidates should be allowed to have access to further

That is simply not tolerable. Surgeons don’t do sticking plaster!

I have been informed that the required additional resources would have to be considered in the context of the public spending review, but I have to say the necessary funding is a small proportion of what the Department of Health will waste if it forces these trainees out without capitalising on the investment we have all, as taxpayers, made in their education.

Surgical Outcome data

Patient choice is a central theme of the government’s plans for healthcare, and it will only be meaningful if we can provide comprehensive and reliable data on outcomes. This work is going to be a priority for the College and all of the Specialist Associations over the coming year. The College has ambitious plans to develop and apply outcome measures in surgery, not only to support patient choice but also to underpin revalidation.

Additionality

I informed Alan Johnson of my efforts to remove the additionality clause which prevents home trained orthopaedic surgeons from working in Independent Sector Treatment Centres unless they have been out of the NHS for 6 months. Removal of this clause would help the Department to hit its 18 week waiting time target, while ensuring that a number of CCT holders presently seeking a consultant post could continue to provide a valuable service to patients.

European Working Time Directive

I am confident that the Secretary of State understands all of the issues around EWTD because of his time at the Department for Trade and Industry. The impact of this on surgical training, as we all know, has been profound and it continues to create major difficulties in providing a safe and effective service for patients around the clock. It is clear now, that there is no prospect of an opt-out for surgery and I have asked the Secretary of State to consider deferring the implementation of the further reduction in hours scheduled for 2009. But it is not going to be easy for us to present a winning case for deferment until 2012 unless we have the backing of the wider profession; including junior doctors and those in other specialities like nursing. This will be a major challenge for the autumn.

Ara Darzi is beginning to lay out the scope for his review of the NHS. What is interesting is that he is using his experience of working in the NHS to articulate the views of staff who perceive that the Department of Health focuses on patient centred care at the expense of NHS staff. The review will look at the best way for delivering quality care for patients through the active support of NHS staff. I am already seeing evidence that Ara Darzi’s unique position as an unelected health minister is going to allow him to examine the fundamental issues of service delivery in areas where others might fear to tread. One example of this is the proposed NHS constitution.

Next week will be a busy week for all of us involved in the training and supervision of the new intake of Foundation trainees. Some of these trainees will already have an interest in surgery as a career. If you are aware of anyone in your hospital who would like to be considered for a surgical career, at some time in the future, then please alert them to the new STEP™ distance learning course. The course for the Foundation programme is available now and completion of the course is going to be seen as a real advantage when applying for a speciality training post. Please take any opportunity that you have to build the links between trainees and the College by directing them to the STEP™ course website where they can find further information. There is a direct link to STEP™ through the College website.

Bernard Ribeiro CBE

President