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A letter from Sussex Place, June 2014

David Richmond, RCOG President, writes...

I am now eight months into my role as President and it seems like yesterday, partly because of the sheer spectrum of issues but also it is simply the most stimulating and rewarding job I personally have ever undertaken.

Recently, the big issues in our profession have been the release of the draft guidance from NICE on intrapartum care and the many stories from mothers and some fathers ranging from maternal complications to disastrous outcomes for babies born outside the hospital environment. I strongly believe that in supporting choice we must ensure this is informed choice.  If we focus on good outcomes both for baby and mother perhaps some of the criticism of interventions of caesarean section, induction or instrumental delivery would be more muted. Often it seems that outcomes for the former have had to take a bit of a back seat in the decision process, particularly surrounding choice of place of birth.

Configuration of our hospital services has also been a significant concern. On the one hand, we are not going to get more trainees. We are unlikely to get more money to provide the full gamut of services we would like, except possibly in relation to greater scrutiny of the litigation bill and the deleterious and delayed consequences this has on service delivery. Therefore, surely we as a profession need to look at the configuration of our services. We simply cannot afford to continue staffing each and every unit with trainees and varying consultant support. I firmly believe that as an emergency specialty with massive overheads in the shape of insurance payouts we simply cannot continue to see our services spread so thinly. The debate needs to be led by the profession for our patients.

Furthermore, and as I have alluded to in the RCOG women’s health blog, there seems to have been a flurry of disturbing stories in the media of women subjected to the most unbelievable atrocities in far corners of the world, from stoning to gang rape. The conviction of a pregnant doctor in Sudan for apostasy and her sentence of death beggars belief. One of my ambitions for this College is to be seen as the voice of women wherever they are. I marshalled the professional bodies of FIGO, ACOG, SOGC and even wrote to the PM himself. It looks as if the Sudanese verdict will be overturned but tragically the other two recent cases seem just to have been yet another catalogue of abuse with some of the perpetrators held to account. It will happen again and yet perhaps through this College and our global reach there is an opportunity to raise the bar, to raise our profile in such matters and discourage such views through education at the bottom and pressure at the highest level, where issues of human rights abuse are evident. I am more than happy to fly the flag from the highest roof top.

On the home front I have been assisting the Department of Health in their development of Guidelines for the management of Abortion following some of the issues highlighted in the media over the last 2 years. The Guidance is a DH interpretation but I believe helpful to all involved in this aspect of work. There is still much to be done at a practical level recognising that there is no appetite for un-picking the ‘67 Act. Solutions need to be found at a hospital or trust level. We have had a warning shot across our bows and we need to get our services in order to prevent any further attention from the media or regulatory bodies. I urge you to address these issues at a local level.

FGM as we speak is topical and again, we as a College, need to assist Government and our patients in a way forward. The practice is abhorrent and illegal in this country. How we influence our global colleagues remains a challenge but I have set up a RCOG Task Force to help me and others in the field with professional  advice and support.

With regard to other clinical matters there have been recent initiatives to look at the trauma of third and fourth degree tears in our delivery units and I anticipate a joint initiative with the RCM to try and reduce this severe morbidity. Also, many of you will be aware of the issues surrounding the use of mesh for the management of stress incontinence by mid urethral tapes and for the women with pelvic organ prolapse, following the recent request from the Scottish Health Secretary, Alex Neil MSP, to suspend the use of all mesh for the treatment of urinary incontinence and pelvic organ prolapse in Scotland (Fellows and Members based in the UK and Ireland will have received a letter from me yesterday). I am pleased to say that NHS England are coordinating a multi professional and multi agency group to resolve issues surrounding consent, patient information, device registration and also mandatory reporting of adverse events. There are undoubted issues with this type of surgical intervention and there is a danger of governmental intervention and suspension of its use unless we recognize the measures put in place by NICE and about which I wrote to you before Christmas.

At a separate level in the UK, there appears to be an increasing “squeeze” on job plans and Supporting Professional Activities. I recognise that Scotland has struggled with 9:1 contract for some time and in some units I believe are recognising that this is too tight. In Wales they still manage 7:3 and Northern Ireland somewhere in the middle. However, for most consultants particularly those who are newly appointed, it seems that a 9:1 or 8.5:1.5 is becoming the norm without much room for manoeuvre. I would be interested in colleagues’ opinions. It is almost impossible for Colleges and specialties to make separate arrangements suffice to say that many other disciplines are in the same boat. The Academy of Medical Royal Colleges is pulling evidence together for a response to DH and BMA. It may be helpful for us as a College to try and put together a template of activities and Programmed Activity currency. Again I would be interested in colleagues’ views.

Finally I am delighted with the launch of our Women’s Voices Panel, initiated to engage with a broader group of women to assist us and them to better understand women’s health issues. This will be a very valuable asset for us at the College but potentially other healthcare organisations too.

If you have any comments regarding any points raised in this letter, please send them to Rebecca Jones.

Let's hope the summer is around the corner!