For some time now, if I offer any criticism of the media activity of Royal College of Emergency Medicine (Scotland) officers, I get long 'hurt' comments from Anonymouses. The media keep calling trade union reps, oh, OK 'royal college' reps, 'leading' doctors. They're not especially though all of them are more impressive figures than me. It's misleading and offensive to all the other doctors, some actually leading large teams, some at the 'leading edge' of new methods. Second, they insist on a 'crisis' when performance is demonstrably better than in NHS England where their colleagues seem less concerned to condemn government. Where their research reports are dodgy. Why am I so concerned by the media activity of royal college reps? They are endangering a government (SNP) which has ensured better pay and conditions than in England via far more respectful treatment by ministers and, notably, not one major health service strike in Scotland. Imagine they had helped Anas Sarwar become First Minister, what would a supine Labour Government in Edinburgh have done for them? Reduce them to the same conditions and the same treatment by ministers that their colleagues in England have faced and the same crises leading to millions of lost appointments due to multiple strikes. Think!!!
By Professor John Robertson (75) former Faculty Research Ethics Chair
From STV News yesterday, the above and:
A leading emergency doctor has said “things are only going to get tougher” for emergency departments across Scotland in winter. Research from the Royal College of Emergency Medicine (RCEM) in Scotland shows that nine in ten A&E clinical leads in the country are concerned about the pressure they will face.
“Emergency Departments in Scotland have spent this entire year in a state of crisis”, Dr Fiona Hunter, RCEM Scotland Vice President, said.
“Thousands of people each month come to us, only to face waits for more than half a day before they are treated and sent home, transferred elsewhere, or given a hospital bed.”
The RCEM surveyed 163 clinical lead across the UK about how they are managing and their views ahead of winter. Of the 25 respondents in Scotland, representing almost every emergency department, all but two told RCEM they were either “very” or “extremely” concerned about the pressure they will experience this winter.
So, the facts – I can only, even with AI help, only see the press releases and so cannot scrutinise the actually research for the kind of flaws common in trade union/royal college research – leading questions?
Without being asked a leading question by me, AI was quick to remind me, because I had used the word ‘research’:
It is not a formal academic paper but a snapshot “snap survey” of doctors in charge of A&E departments. RCEM surveyed 163 clinical leads across the UK (covering most EDs). Of the 25 respondents in Scotland (representing almost every ED), the results showed:
- All but two (roughly nine in ten) were “very” or “extremely” concerned about winter pressures.
- All but one (96%) said current pressure was “high” or “very high.”
- The same number said their department was poorly prepared for winter.
- Three-quarters said pressure was much higher than the same time the previous year.
It really matters what questions were asked. Researchers know that you can draw responses of the above kind from any public servants – nurses, doctors, teachers, police officers – if you ask questions like: ‘Is pressure higher than last year.’
‘Pressure is higher than last year’ they shout and it is, has been climbing since the end of the pandemic, but when you check the actual attendance figures it’s actually, essentially, the same as before the pandemic. In September 2019 in Scotland’s Type 1 ED’s there were 124 558 attendances and in September 2026 there were 118 326.
Finally on ‘Thousands of people each month come to us, only to face waits for more than half a day before they are treated and sent home, transferred elsewhere, or given a hospital bed”, see our earlier response noting:
10.1% wait for more than half a day (12 hours) in England but only 5.4% do in Scotland.
I fully recognise that working in A&E can be an experience of intense pressure, often. I am saying, however, that the royal college reps should think and think far more deeply about what they do and how they do it, honestly.
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If Emergency Depts were not concerned about how the coming winter may work out for them we should be a whole lot more concerned. If they sent returns that appeared smug or over confident in their ability to cope they would be making a rod for their own back should they fail to live up to the standard they have espoused.
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“The media keep calling trade union reps, oh, OK ‘royal college’ reps, ‘leading’ doctors.” Already sent you the reference https://en.wikipedia.org/wiki/Royal_College_of_Emergency_Medicine and the first paragraph sums up the true nature of the RCEM. The Trade Union for doctors is the British Medical Association.
“It’s misleading and offensive to all the other doctors, some actually leading large teams, some at the ‘leading edge’ of new methods” Total nonsense…the ‘vice-president’ and ‘vice-chair’ of the RCEM in Scotland (the titles recognise the devolved nature of the RCEM in Scotland) are elected by their peers in the 25 departments you speak of and in their own time and without remuneration represent their colleagues professionally. Why not phone those departments and ask instead of using Elon Musk’s distortion of AI? Watch ‘The Pitt’ TV series and you’ll get some idea of what these finest of human beings do – all NHS, perhaps the last true home of the spirit of medicine, no ‘private’ moonlighting…and you’re denigrating them because of your own prejudices? For shame!
“Second, they insist on a ‘crisis’ when performance is demonstrably better than in NHS England” As I have repeatedly pointed out the Consultants concerned speak in absolute terms. They simply want corridor care in Scotland to be zero. Your otherwise excellent original article on ‘corridor care’ showing much lower rates in Scotland than rUK was ruined not just by the usual RCEM rant but by outright misogynistic remarks such as ‘Mrs/Dr (?)’ – both the leading doctors (and they are leading) concerned are female. You eventually took that page down.
“They are endangering a government (SNP)…” NO!! They are providing an A&E service in Scotland which is measurably better than rUK, something a government (SNP) can boast about.
You think, Professor!! These comments are completely flawed and prejudicial and really degrade the TUS website. Which is IMHO a real pity and also why I, and I imagine others, did not contribute to your last round of funding. ‘Mrs/Dr (?)’ was a real low.
‘Pressure is higher than last year’. The comments by RCEM members across 25 departments are not intended to be higher level research but likely Consultant genuine impressions. Little change in absolute numbers may not reflect the degree of pressure e.g. a higher intensity case mix. And the Consultants/RCEM are simply fighting for increased resources for A&Es.
Here are some more appropriate targets: My incomplete understanding is that NHS hospitals etc. pay business/non-domestic rates but ‘private’ hospitals do not nor is VAT applied to the fees they charge since they are ‘charities’. And, of course, the majority (not all) of ‘private’ medical and surgical services are supplied by NHS Consultants (a significant minority – most are opposed) ‘moonlighting’ from the day job. In their own time, of course, since private sector inpatients never develop complications during NHS Consultant working hours (?!!?) nor does ‘private’ work conflict with or diminish their support for the NHS (?!!?). And increasingly many other healthcare professionals have followed this example with similar detriment to services. Many patients really are second class in some areas of the NHS (arguably least likely in A&E). They are often identifiable immediately by the poisonous amalgam in their teeth, now almost unique to the UK, instead of white composite. Why not campaign on issues like these?
I fully recognise that working on TUS can be an experience of intense pressure, especially with such a high output of objectively referenced articles (but not this one). I am saying, however, that Professor Robertson should objectively think and research far more deeply about what he writes about some of the best people Scotland has, working their hearts and souls out for their fellow human beings in some of the most extreme situations imaginable. Of course ’Royal College’ titles are pretentious but that’s the prevailing system until independence. Get a grip Professor Robertson, honestly.
Here’s hoping this will be published on TUS…so far editorial tolerance of legitimate opposing views have been one of the better features of this site.
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Who are you?
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Someone who worked in and around A&E for years when it was a bit of a free for all in terms of who dealt with each emergency. Read https://en.wikipedia.org/wiki/Royal_College_of_Emergency_Medicine. RCEM (and its predecessor organisations) have completely transformed hospital emergency medicine. The two leaders in Scotland are not and never will be politicians, and are simply trying (successfully in Scotland) to make the absolute numbers better. When they’re gone, they’re gone and what’s left of the NHS with them. Can’t see anyone else in A&E Consultancy wanting to do this on top of the day (and night) job. It really is worth watching ‘The Pitt’, perhaps the nearest US (TV) medicine gets to the NHS, not least for the anguish the medics themselves go through. Stop adding to it, people. Please.
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How do you deal with the evidence that almost twice as many wait ‘half a day’ in England?
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I think you have done a great job in highlighting it and making the comparisons. I’m simply defending perhaps the truest NHS service left with the Consultants/RCEM fighting for resources. Why not thank those who are giving everything for the emergency service – arguably one of the more equal public services irrespective of wealth or power. Why not praise them for delivering such a great service for Scotland? And condemn the bastards who are selling out the NHS and creating a pre-1948 two tier service. This true story haunts me…the baby who would have become my uncle died (in the 1920s) at full term birth from cord strangulation – something every midwife and doctor is taught to check for and correct if necessary – even though my gran had crossed the palm of midwife and doctor with the appropriate level of silver in anticipation of the birth. They were late! And that’s what we’re heading back to unless the true patient-centred NHS is defended. The ‘no new NHS patient’ dental practice is already here. Likewise the two tier dental practice. Amalgam (banned in most first world countries and beyond) for the ‘plebs’. And unlike the A&E indeed the noble majority of Consultants, there are those who put personal greed first and moonlight to VAT-free and discounted (80%+) non-domestic rates ‘private’ hospitals. WTF?? A Consultant saw my name on his NHS waiting list and phoned to invite me to his private clinic free of charge. I had to decline as politely as possible – how could I accept a superior service to my patients and look them in the eye? But said Consultant wasn’t present when I subsequently had my leg fkd by an ‘appointable’ less experienced Dr. Could be all manner of reasons….but not in the ‘private’ sector…quick, named Consultant service for those who can afford it. And distract those who would complain onto, say, true NHS A&E Consultants, and laugh at the ensuing brouhaha. They took the same oath… The Physician’s Pledge
AS A MEMBER OF THE MEDICAL PROFESSION:
I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient;
I WILL MAINTAIN the utmost respect for human life;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely, and upon my honour.
WTF happened?
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It’s a pity that dedicated, caring and competent people allow themselves to be used by the deeply hostile media as battering rams against the SNP government. There is an information war raging and the independence side has the majority of support from the Scottish public but is blocked from the media in a constant, daily propaganda blitz.
Perhaps leadership in those organisations such as the RCEM needs to issue guidance and training in handling media campaigns or advice to refer media to the press and comms department where a professional spokesperson can deal with inquiries. That would take doctors out of the firing line.
Meanwhile TUS is one of a very few channels which exposes media bias and sets the record straight. I would hope that professional people from all disciplines would support that.
Facts are chiels that winna ding.
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Well said Capella. The “Scottish Media” want an instant headline, preferably one that they can attack the Scottish Government with. I suspect that well meaning quotes from Health Staff are often twisted to suit.
As for TUS, its a great source of unbiased information and a benefit to us all. Happy to chip into the Fund Raiser again.
Stephen McKenzie
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They are simply trying to get the best resources they can for the most front facing service of the NHS. It is difficult for a non-medic representative to assimilate enough knowledge to present the A&E case since it handles at least some of the emergencies of every specialty. It wouldn’t matter who is in power. The ‘economy with the truth’ of professional politicians is as incredible as it is dismaying so it’s maybe a breath of fresh air to have amateurs doing their best and the public recognise authenticity. I don’t think all the media training in the world would protect the authentic truthsayers from a Baillie or Sarwar. The facts are that the RCEM is NOT a trade union…the BMA is. It is the RCEM and its members who have transformed hospital emergency. ‘The Pitt’, even though American TV, really does give a flavour. These people are just so incredible. And there is so much else that is wrong and corrupt in the NHS. Go for the right targets.
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I’m sure that anyone who has had experience of the skill and professionalism of emergency staff has nothing but admiration and gratitude for them. I certainly do. However I don’t expect them to be aware of the deviousness of the MSM and it’s political agenda. They may just be naive. In that case refer media to the PR department where trained professionals can deal with them.
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Sorry, Capella, you have no idea of the trouble you can run into simply by trying to do the right thing if NHS management politics dictates otherwise. It is sometimes totally absurd and in defiance of common sense. If health boards are reduced from 14 to 2 the best of mid to upper level management, the minority who actually make things work, will disappear in favour of the chiefs and what a mess there will be! I salute the courage of those Consultants who stand and fight for their NHS services. Have been there and it’s not pleasant. Maybe that’s why I feel so strongly about the Scottish RCEM leadership…they will be under all manner of behind the scenes political pressure. Talk them up…not down. Don’t be distracted – take aim at the true destroyers of service.
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Actually, I do have experience of “trying to do the right thing” in the face of management political hostility. Not in health but in education. It happens to anyone who has principles and refuses to be a “jobsworth”. Our esteemed host on TUS can testify to that.
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You have my apologies and respect! Such as our esteemed host owes to Drs Hunter and McLaren. We’re all in the same boat in that regard.
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