ASiT Yearbook 2011 - The Association of Surgeons in Training

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ASiT EXECUTIVE
not allow all trainees to compete for a surgical career.
We will continue to pressure those in authority to allow
surgical education to be available to all and eagerly await
the outcome on the MPET review on the funding of
medical education.
trainee posts was a deliberate act of workforce planning
designed to increase the proportion of care delivered by
consultants, especially out of hours. This opportunity to
provide higher quality and consistent patient care has
not realised.
STUDENTS
SCIENTIFIC TRAINING & CAREERS POLITICAL PORTFOLIO ASiT COUNCIL
Independence
Independent representation for surgeons in training has
always been a principle that ASiT has stuck to. Many of
you will have been surprised this year when ASiT,
BOTA and the TSAB representatives were removed
from the Royal College of Surgeons of Edinburgh
Council. We have tried to promote the benefits of ASiT
to the RCSEd but our request for re-instatement on the
council has not been successful to date. The RCSEd is
experimenting with a new approach to gathering trainee
opinion. After lobbying from ASiT and also a governance
review at the RCSEd a surgeon in training will be
reinstated on their council. Unfortunately this Royal
College insists that this trainee can only come from
within the membership of their college.
In 1976, right at the foundation of our association, the
then President of RCSEng suggested that ASiT should
be the trainee organisation of the RCSEng. He was
worried that the association might form an independent
pressure group. His offer was declined and it is now not
difficult to see why. An isolated trainee on any council
will always be open to potential pressure and coercion,
as they do not have the protection of a mandated
independent body. It may also allow ambitious trainees
to present themselves and not necessarily convey
true opinion. The risk to the RCSEd is that their
representative may tell them what they want to hear
and their college may become subsequently overlooked.
All new leaderships strive to innovate and make changes
for the better - hopefully this will be a temporary
dispute and will not interrupt more than 30 years of
good relations with the Edinburgh College. I hope that
ASiT members will not negatively interpret this move
by the RCSEd as parochial and that the trainees
appointed in the future will be experienced, supported
and committed to the same goals as ASiT.
European Working Time Regulations
Professor Sir John Temple’s report looked into the
effect of EWTR on training. The report upheld many of
the concerns that ASiT has highlighted in previous
position statements since 2006. As a result of the report
we have re-invigorated our EWTD campaign by adding
pressure, with the RCSEng, to those in power. We have
written to the Secretary of State for Health and are
shortly to have meetings with Medical Education
England. Rather concerning is that the recommendations
from the Temple report will take years to
implement and offer little hope for those already
enrolled in the system. Urgent changes are needed but
the necessary reconfiguration of services is a grand and
expensive plan. Prolonging training may not be a longterm
solution but would also provide some elasticity in
the workforce. The increase in consultant posts and
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ASiT - the pursuit of excellence in training
Future of the Surgical Workforce
It always surprises how new agencies are rapidly
introduced and have ambitious timescales; some even
provide reports prematurely. The Centre for Workforce
Intelligence (CWFI) was born this year. A month
after the CWFI’s inception their first report was
published with recommendations! Organisations with
decades of workforce experience were not consulted
and it does not inspire confidence in the agency’s ability.
The debate on whether the CCT is fit for purpose is
again upon us with some prominent individuals arguing
that the qualification has been degraded. This will again
bring to the surface the sub-consultant grade debate.
With newly qualified consultants already being offered
different contracts in the private sector it is a worrying
time. The title “Consultant” is one that is recognised by
patients, relatives and staff alike. It is also one that has
been proven to provide high quality and the most cost
effective model of healthcare. We must not focus on
the negative effects that have occurred as the training
structure has changed, but instead on improving training
and the mentoring of young consultants, sadly this may
be too forward thinking for some. As for the existing
sub-consultant grade - plenty of consultants are already
in that role - they just need adequate recognition by the
colleges!
What Does the Future Hold?
The recent (July 2010) White Paper on health, “Equality
and excellence: Liberating the NHS”, revealed a greater
commitment to evidence based commissioning. This will
be at the heart of the future NHS along with outcome
measurement and accountability. For education and
training - there is the intention to return the decision
making to the profession including structure, content
and quality. I hope that this is a role the Royal Colleges
can return to again as the quinquennial visits of the SAC
were excellent at identifying poor quality training posts.
One of the benefits of a detailed and rigorous inspection
of a department’s training posts was that it often
brought to light service difficulties, problems and
conflicts and so acted as an early warning system to
failing departments and trusts. As someone who has
been interviewed for a school of surgery visit, I was not
satisfied that the same level of scrutiny or commitment
to protect training opportunities was present compared
to the old-style SAC visits.
The cynical amongst us will be wondering if the
profession having more control over the commissioning
is really a “longer game” being played out from
Whitehall. The funding for the NHS struggles to keep
pace with technological advances and increasingly
specialist practice. Knowing that we are entering a
period of severe financial austerity, it would be foolish