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Officers' update, September 2015

David Richmond, RCOG President, writes...

Many of you are now back from your summer holiday I wanted to bring to your attention a number of significant areas of work and decisions that have been made over the last three months. The first relates to the Representation Working Party Report I wrote to you about in June and July. The report to Council made over 50 recommendations aimed at improving the engagement of Fellows and Members in the decision-making processes of the College.

Council accepted the vast majority of the recommendations, and has recognised the need to improve engagement of Fellows and Members in the work of the College. One of the most significant decisions surrounds the election of the President, and I am keen to support democratic change by expanding the electorate. This has been an extremely sensitive issue. However, I am pleased to announce that the resolution of Council on 29 May was that the responsibility for electing the President should no longer rest solely with Council. I am in the process of developing a timetable to seek the views of members at a series of UK regional and International Representative Committee meetings to canvas opinion and the timing of change.

The Lindsay Stewart Centre staff are producing a second National Maternity Indicators Report for English NHS Trusts. As I write, the draft has been circulated to all clinical and medical directors to check validity and accuracy prior to formal publication in late November. Individual Trusts will be able to compare and benchmark their outcomes. This has been a slower evolution than I had hoped but I believe the direction of travel, of openness and transparency, is key to service improvement. A smaller number of units have also contributed to a more detailed analysis of outcomes using their individual Maternity Information Systems. This rich source of data will be reported soon.

The National Maternity Review for England will publish its report at the end of the year. The main themes of the review deal with professional accountability and culture, models of care, choice and the levers and incentives required to allow the system to work more efficiently. I expect it to be pitched at a high level allowing local interpretation and implementation. However, one of the significant issues throughout the UK surrounds the staffing of rotas at trainee and consultant level with clinical staff struggling to provide the best possible care under difficult circumstances; often with reduced staff availability and this increased use of locums. This type of service, never mind care, is completely unsustainable and for me cuts across the government statements on seven-day working which for our specialty is a simple fact of life. Our constraints as with other acute specialties is not the medical presence but the ancilliary and managerial support which hampers appropriate service delivery. Seven day working requires more resource or we dilute the service which exists Monday to Friday.

Finally, many of you will be aware of the Supreme Court decision on Montgomery v. NHS Lanarkshire and the potential impact on doctor-patient communications, information sharing and informed consent. The thrust of the court ruling is that any intervention must be based upon a shared decision- making process. I met with a number of medico-legal experts at the end of July and will write more fully once we have a clearer understanding of the requirements on the profession. In some respects shared decision- making in gynaecology fits the same template as that of other surgical disciplines. In obstetrics however, we are dealing with a unique set of circumstances. First there are two individuals concerned in a normal physiological process which may change (sometimes dramatically) during the contact period. It covers both elective and emergency scenarios and will undoubtedly require a different approach to the one currently adopted. Providing standardized information available to patients and professionals at all points in a pathway is the key. Shared decisions can only occur if both partners have access to the same information and, above all, the time to make that decision. For professionals, it means finding the time to explain the risks and benefits of a recommended course of action and for patients, it requires them to reflect on their treatment options before deciding on what is best for them. We have a further meeting in early October and I shall keep you updated.

In the meantime, if you have any significant concerns about the Montgomery ruling, please send your comments to policy@rcog.org.uk.