President Newsletter 02

Re: Presidential Newsletter / Update

Dear Colleague,

I wrote to all members of the Association in an email on 24th December 2008 with an update on where the Association was at that time and the plans and developments that were in hand.

Since December 2008, many important things have happened, not least the launch of IAEM’s new website www.emergencymedicine.ie. The intention is that this site will showcase Irish Emergency Medicine (EM) across the broad range of facets of the specialty, including clinical standards, political advocacy, history of the specialty and training, to name but a few areas. We would like to see significant further development of the site but clearly this is dependent on the work of individual colleagues in EM and appropriate material being made available to us.

If you have not already done so, I would strongly encourage you to visit the site and register as a member. This will give you access to certain material which is restricted to members. One simple example is meeting minutes going back to 2005 being available to members. Other materials will be uploaded as the site develops. In addition to contemporaneous material, it is our intention that the site will also act as a repository of the history of the specialty and other archive material. Given that the specialty has now had a number of its senior figures and earliest Consultants retire, it is important that this archive material is gathered now and made available to current and future members. `

Achievements since the previous newsletter

Our position paper on Access to Out-of-hours Social Services has been published as has the document on the Emergency Department Assessment of Women with Acute Coronary Syndrome. We have also made submissions to the Review of the Implementation of Protecting Our Future; The Report of the Working Group on Elder Abuse, Prevention of Intravascular Catheterrelated Infection in Ireland, Draft Guidelines 2009 and most recently a submission to the Expert Group on Health Sector Funding and Allocation of Resources.
The NIMIS Project is moving to its conclusion with a decision on the national system now made, for initial implementation in Sligo, Limerick, Mullingar and Beaumont. The determined work of Gerry Lane with Una Geary’s assistance has ensured that the needs of EM have been paramount in this process.
The 2009 IAEM Annual Scientific Meeting will take place in Athlone and will run from lunchtime on Thursday 15th to lunchtime on Saturday 17th October 2009. Rob Eager and Sean O’Rourke have developed a very interesting programme and we look forward to as large an attendance as possible. Registration is now open and registration forms are available on both our site and on the IAEM 2009 site iaem2009.com.
Although ED Overcrowding continues to be a major problem, we have begun a process of engagement with the Dr Tony Holohan, Chief Medical Officer and Dr Barry White, incoming HSE Director of Clinical Care. Hopefully these key individuals will be convinced of the unacceptability of patients waiting in EDs beyond the time of decision to admit and this will drive the necessary political and managerial changes that are necessary. Hopefully the fillip will help the introduction of a Full Capacity Protocol (FCP).

Future Challenges and Issues for the Association and Specialty

Development of specialty self-sufficiency

It is recognised by all that the specialty needs to become self-sufficient so that one authoritative body is responsible for the specialty in Ireland. This body needs to be sufficiently well developed so that it can be responsible for training (both Basic and Higher) and interaction with the Medical Council on the one hand but also continue to enhance its political advocacy role on the other. For the specialty to move to this position it needs to become big enough and financially secure.

It is timely at this stage for the specialty to actively consider how it best might get to this point. There are a number of possible models and a number of interim steps that might be appropriate. The specialty is currently too small for there to be either an evolving or permanent separation of functions. Various elements of what should be within our direct remit are currently outside the direct control of the specialty e.g. the position of RCSI via the Irish Surgical Postgraduate Training Committee as the body in which training in EM is vested. It has been necessary therefore to have a body of convenience i.e. the Advisory Committee on Emergency Medicine Training (ACEMT) to oversee this element on our behalf. With the advent of the Irish National Board of CEM, there is now a new player in existence. Given the overlap of remits in training and setting of clinical standards, the opportunity exists for these functions to be merged and a concerted effort made to wrest control of Higher Specialist Training and also Basic Training from RCSI to EM.

It is hoped to have a brainstorming session to discuss of the future direction of the specialty at the AGM in Athlone on 17th October 2009. In advance of this, some documentation on possible options will be circulated and I would appreciate your active participation in this necessary debate. If you cannot attend the meeting please 3 ask a colleague who is attending to voice your opinion or preferably email me your thoughts. We are at a crucial stage in our development as a specialty and the decisions we make now will have far-reaching consequences. We need to know your opinion!

ICEM 2012

The 2012 ICEM Conference is looming increasingly large on the horizon. While this is a huge opportunity for the Irish EM community to raise its profile and run a successful meeting, there are also significant risks (not least the financial risks) involved. While the officers and the main organising committee will lead the Association’s work in organising and overseeing the conference, all members of the Association (both full members and associate members) will need to actively contribute. This contribution may take many forms but unlike previous ventures the Association and the specialty cannot leave the entire responsibility to “the usual suspects”. When organising committee members or myself come to you to ask you to participate in a particular way, we hope that we will have your wholehearted support and commitment to this project which is being managed on all our behalves by the Association.

Participation in Specialty Affairs

At the upcoming AGM in Athlone, two vacancies on the Executive will arise. Gerry McCarthy will step down as the Irish representative on the Training Standards Committee of CEM and as a consequence, this role and the linked seat on the IAEM Executive become available. Furthermore, the ordinary member seat currently held by Sean Walsh comes up to be filled at the same time. The Association needs people joining the Executive to commit actively to the significant workload that the Association faces currently and will increasingly face in the future. I would ask that all full members consider how they might best serve the specialty and would be grateful if they would allow their names go forward for consideration for these roles. The days of the Association being little more than a social or support club are long gone and we need individuals to step up to the plate and undertake a share of the work that needs to be done.

Acquisition of Charitable Status (Tax exempt status)

The Association hoped to be in a position to achieve this goal within the past year. The Accountant working on our behalf had received “positive noises” from the Charities Section of the Revenue Commissioners and expected our application to be a mere formality but early this year the attitude of the Charities Section changed completely and a series of obstacles were placed in our path. As you will recall, we were at the stage where the Executive had agreed Constitutional changes which had been approved as ‘appropriate’ by the Revenue Commissioners which we intended to seek approval for at a special meeting in March 2009. Unfortunately, we were obliged to cancel this meeting when their attitude changed. We have resolved to continue this fight and are currently in the throes of a detailed submission which we are going to have to support with a personal visit to the Charities Section in Nenagh. We also intend to seek the assistance of a PR Consultant to ensure that the submission is as likely to succeed as possible and also prepare us for the reception we are likely to receive. Clearly the implications of being unsuccessful are very significant for the Association as our income which currently has not been returned for tax is likely to be halved. There would also be a liability for tax on income from previous years.

Reconfiguration

The reconfiguration agenda continues with the report on Cork and Kerry finally published and a similar process underway in the South East. While the Association still supports the appropriateness of reconfiguration, we do have concerns about the increasing use of “UK norms” which are not even applicable in many of the more rural parts of the UK, much less in Ireland. In addition, we need to ensure that any process which is used to justify reconfiguration is methodologically sound. The recent attempt to impose a meaningless information gathering exercise in the greater Dublin region which would have been used to (inappropriately) justify a reduction in the number of EDs in Dublin was thwarted. While the Association accepts that there will be reconfiguration in the greater Dublin region, our concern is that an inappropriate and flawed process may be used to justify what is a predetermined outcome.

It is important that all Consultants in Emergency Medicine in the areas being considered for reconfiguration engage positively and pro-actively in the process to ensure that the model of care that is ultimately recommended is one that is appropriate and accords with international best practice.

In Summary

The Association needs your support at this stage more than ever. We need to ensure that the increasing burden of work that the Association faces is distributed among a greater number of colleagues. I would ask therefore that you consider making yourself available for election or indeed cooption to particular projects.

The Association needs both the experience and expertise of previous officers who have drifted into the background as well as the dynamism and enthusiasm of younger colleagues.

With best wishes for the remainder of 2009

Yours Sincerely,