A coiled spring
This year has seen a number of threatening and controversial medical issues hit the headlines and you may be aware of the position I have taken on behalf of the College on some of these. The ongoing serious demand pressures on the NHS continue to have an impact and the winter crisis feels less like a winter only phenomenon. We have been encouraging providers to critically consider how best to use and modify their resource allocation to mitigate the risks of another dangerous scenario developing when the winter specific pressures do apply next year.
Some of the most difficult and contentious issues relate to how clinicians behave in the workplace, particularly in the light of the recent legal case which created a huge outcry and disturbance within the profession especially amongst our younger colleagues. This involved the conviction of a paediatric registrar for her performance in a case in which a young patient lost his life as a result of septic shock. The doctor concerned was working in extremely challenging circumstances. She did not have the support we might expect and the systemic inadequacies of the hospital IT system, the rota, the lack of induction guidance and the absence of senior supervision were all factors. In addition there were additional confounding factors resulting from well meaning but misguided interference in the care of the patient. The issue is that virtually every doctor working in acute care delivery in the NHS comes across elements of this systemic challenge every day of their working lives. The fact that a colleague has lost her entire career in what is sometimes trumpeted as a ‘no blame’ culture does seem to stretch credibility. Clearly there are complexities to this case that cannot be covered in the media – especially the social media storm which resulted. We have tried to provide a more thoughtful response here and have subsequently contributed to the request from the Secretary of State for Health to review and comment upon the use of the criminal law in situations like this. It is a shame that the GMC did not weather their perceived role very well and will undoubtedly have learned some difficult lessons. Now they have to rebuild a semblance of trust and respect within the profession.
Many Fellows and Members took up the challenge of offering their views on a range of other controversial and medically relevant topics about which I asked for specific views. In particular, the controversies that surround medical practice at the beginning and end of life, issues relating to consent – particularly in the context of transplantation and the implications of gender identity.
In order to gather some representative views, the information trawling exercise was very helpful and revealed the strength of feeling and indeed spectrum of opinion that applies. The topics our Fellows and Members felt were of most importance were concerns over adequate resourcing for health and social care provision, the function and performance of the GMC, issues relating to medical negligence and the promotion of healthy eating and obesity control. The other topics I asked about included presumed consent for organ transplantation, assisted dying, gender identity, decriminalisation of abortion, Brexit and global citizenship. Of these the gender and abortion controversies were rated below the others in order of importance.
It has been extremely helpful to have these areas explored in this way. To give you a snapshot I can summarise the outcomes as follows.
Our College is almost evenly split in respect of the value of changing to a presumed consent for transplant donation compared with the current opt in arrangements that apply. It remains of interest to see the effect on donations of the change in legislation in Wales, which has adopted a presumed consent framework.
The possibility of decriminalising abortion revealed a spectrum of opinion. It is clear that while there is no strong appetite for a change in the current law there is clear sympathy for those women whose pregnancy results from sexual violence. There remains considerable antagonism to the possibility of termination beyond 24 weeks gestation.
With respect to assisted dying (which while not currently before parliament, is being tested in the courts), the outcome was fairly evenly split with more support for assisted dying in those with terminal illness and intolerable symptoms. Interestingly there is real concern that a change in the law would result in a degree of pressure on vulnerable individuals, the risk of a slippery slope is evident and only a small minority of practitioners would be willing to personally participate in such a policy.
While the gender identity issue was not seen as a priority for the College the strength of feeling on this issue was considerably greater than for any of the other topics. There was very little support for the use of pre-pubertal sex hormone therapy or gender reassignment surgery, and few supported the view that gender reassignment surgery should be available on the NHS.
Thank you to all who took the time to thoughtfully consider these issues and reply.
Food for thought!