Annual Review 2012/13Better health care for women everywhere

Unless indicated otherwise, all appointments are as at 1 June 2013.

© 2013 Royal College of Obstetricians and Gynaecologists

Published by the Royal College of Obstetricians and Gynaecologists, 27 Sussex Place, Regent’s Park, London NW1 4RG

Registered charity no. 213280

All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK www.cla.co.uk

Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.www.rcog.org.uk

Produced by RCOG Marketing Principal photography by Shaun Armstrong, Mubsta Written by Bruce Robinson Designed by Cavendish Design & Advertising Limited Printed by Colchester Print

Contents

2012 at RCOG NEPAL

‘But they didn’t want to go...’

OuR mEmbERs INDIA

‘…books alone aren’t enough: either you need to work in the UK or use this programme…’

OuR PARTNERs uGANDA

‘…Amy and I made this model out of a shoebox, a margarine tub and a coca cola bottle on how to do vaginal examinations…’

4 Foreword

6 Introduction

7 Tomorrow’s Specialist

10 Our members

14 Our work

18 Did you know?

20 Our partners

24 Our health systems

26 Ourselves

30 2012 at RCOG

33 Unrestricted income and expenditure

34 Membership benefits

TOmORROw’s sPECIALIsT bRITAIN

‘…women’s needs and concerns must take centre stage…’

‘…things can go very wrong, very quickly in health care…’

OuR mEmbERs bRITAIN

‘…we had very wide, no-holds-barred discussions where there were no silly answers…’

OuR wORk bRITAIN

‘…I spent months and months assessing data quality…’

OuRsELVEs bRITAIN

‘…going forward, we’ll be spending more time focusing on the consultant body…’

Foreword

The challenges were largely a consequence of the Health and Social

Care Act 2012, whose provisions provoked such fierce debate among our membership that I requested an extraordinary general meeting to be convened to address their concerns.

While many attendees wanted us to cease all communications with the Government, by the smallest majority the EGM voted to continue the dialogue. Council agreed that our responsibilities to women and our membership compelled us to continue talks with our elected government. These discussions ultimately resulted in the appointment of a National Clinical Director in Women’s and Maternity Services.

This is a significant milestone, with the potential to deliver long-lasting improvements to women’s health. It also fulfils a central recommendation of

High Quality Women’s Health Care, which argued for an integrated, life-course and patient-centred approach to women’s health care that emphasises prevention as much as treatment.

TRAINING TOmORROw’s sPECIALIsT

Building on this document, last year the College published Tomorrow’s Specialist, based on the deliberations of a working party chaired by Baroness Julia Cumberlege.

It outlines the changes in education, training and working practices required to turn High Quality Women’s Health Care into reality.

Tomorrow’s Specialist is pragmatic, challenging and timely. It recognises the need for more affordable health care, delivered locally whenever possible. By requiring a commitment to lifelong learning and greater flexibility, it will challenge many

This has been a challenging year but one in which we can claim to have made some important advances for women’s health.

clinicians. Finally, its emphasis on teamwork is particularly timely in light of the Francis Report, which spelled out the appalling consequences for patients that can occur when the central principles of good teamwork, such as dignity and respect, break down.

We know that the quality of obstetric and gynaecological care in most hospitals is outstanding. However, we also know that in some places it falls far short and we have a responsibility to try and resolve that. As doctors, we should stand up and apologise for the failures at Mid Staffordshire and remain ready to speak out if we find our duty of care compromised in any way.

ENsuRING GREATER ACCOuNTAbILITy

For now, the Francis Report adds further impetus for higher clinical standards and greater accountability. The introduction of revalidation of

specialists is making the appraisal process more robust, benefiting our patients and increasing public confidence. As such, we support it strongly and have developed various products to help our membership through the process.

Over time, however, revalidation will require the publication of accurate, objective and comparable measurements of individual performance. Such measurements would also have made it much less likely that Mid Staffordshire’s failings could lie unchallenged for so long.

With these considerations in mind, the College recently produced the first of what will become an annual report of clinical outcomes in UK maternity units. In future years we intend to extend the scope of these reports, ultimately making them an invaluable tool to help doctors measure their performance and improve wherever necessary, thereby benefiting the women we treat.

mODERNIsING OuR COLLEGE

Closer to home, the College has undergone substantial change. We have reformed our governance,

restructured our business and become less introspective. The importance of Tomorrow’s Specialist required us to go outside our profession for expertise and opinion. The recent review of the MRCOG exam took a similar approach and forthcoming changes to our Women’s Network will enable us to talk more regularly to a wider range of women.

From this year, outside experts will also play an important role in the way that the College is governed. We recently finished implementing the recommendations of the governance working party led by Baroness Julia Neuberger. A new Board of Trustees, with four lay members, has assumed responsibility for the College’s charitable and business responsibilities, leaving Council free to pursue our medical, professional and clinical obligations.

Our operations have also changed considerably. Closing our book publishing department and bookshop was difficult but has allowed us to channel investment into critical areas, such as our websites. Wellbeing of Women is

now in new premises where we look forward to continuing our close partnership and our new Global Health Unit now has more resources to improve women’s health where this is most needed.

Finally, I must mention last year’s Congress in Kuching. Its spectacular success was a testament to our conference and marketing departments, and to the Obstetrical and Gynaecological Society of Malaysia, who organised much of the conference on our behalf.

However, all this work will only help women if we can manage our affairs professionally. The restructuring of the College has improved our financial health and increased our ability to pursue our mission. For this, I must thank the College Council, the Officers and our Executive Team, who have delivered everything asked of them. It has been an enormous privilege to work with them and to lead our College, working on behalf of our membership for women everywhere.

Dr Anthony Falconer President

4 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 5

Introduction

This required a fundamental review of the College’s management, teams and

functions in order to judge how effectively each was contributing to our core activities: publishing clinical standards and guidelines, and training and assessing specialist clinicians. In a few cases, we reached the painful conclusion that the work, however impressive in its own terms, was no longer essential.

As a result, we have closed the College’s bookshop and book publishing function. This decision, together with more professional management of the College’s finances, has enabled us to channel investment into activities which add more value. For example, e-publishing and e-learning allow us to use digital technology to support clinicians with resources wherever and whenever they need them most.

The modernisation has also been about making sure that we stay relevant over the next decade by remaining willing and able to keep pushing for new improvements to women’s health and health care. This demands an ability to identify fresh opportunities and challenges to women’s health and a capacity to invest in the new areas of activity that they create.

In this respect, the College’s new Board of Trustees will play an essential role by introducing valuable professional expertise and fresh perspectives while retaining the experience and judgment of the College’s Officers. This combination should provide sound leadership that continues to create value for the College’s membership. In addition, the new position of Director of Development will allow us to generate fresh sources of income

which can be invested in those activities that best help us meet the challenges and opportunities ahead.

Now largely complete, the restructuring programme has given the College and its staff a clearer sense of purpose and direction. Consequently, I believe that we are working with more energy, imagination and, I hope, confidence. For this success, I would like to pay tribute to the College’s staff for their professionalism and hard work and to thank the President, Officers and Executive Team for their leadership and support as we have moved the College to a far stronger position to improve women’s health and health care around the world.

Ian Wylie Chief Executive

Tomorrow’s Specialist Introducing, explaining, implementing

Billed as a ‘radical rethink of training and the future role of the specialist

doctor’, Tomorrow’s Specialist formed the cornerstone of our work in 2012. The report presented the conclusions of a working party led by Baroness Julia Cumberlege and supported by Sir Cyril Chantler, and developed themes first outlined in our 2011 publication, High Quality Women’s Health Care.

That report advocated a new, patient-centred approach to women’s health care that focused as much on prevention as on cure. It proposed new clinical networks, headed by a National Clinical Director for Women’s Health. These would take an integrated, ‘life-course’ approach in which every clinical contact could be used to promote good health.

Tomorrow’s Specialist maps out what’s required of clinicians for High Quality Women’s Health Care to work in practice. Unusually, the Tomorrow’s Specialist working party sought out the views of women and included many members from outside obstetrics and gynaecology.

Over the past year, the College has undergone major changes, driven by a need to refocus the College on its core purpose of raising standards in women’s health and health care.

PATIENT-CENTRED EVERyThING

The report argues that women’s needs and concerns must take centre stage, not only in health care but also in clinical education, training and assessment. To ensure that women can be certain of receiving the right care, at the right time, from the right person, immediate access to specialist obstetricians and gynae cologists should be available 24/7. Meanwhile, the need to deliver more cost-effective services requires a consolidation of obstetric units, supported by a network of maternity services in local communities.

Clearly, this will require many more specialist doctors but far fewer junior positions. Tomorrow’s Specialist will therefore transform training before specialist accreditation and working practices thereafter. Training must become more concentrated and more effective. Once qualified, specialists will find themselves moving regularly between hospitals and communities and working in multidisciplinary teams that share responsibility for patient care.

The need to work more flexibly will require specialists to continue learning throughout their careers. Mentoring will help newly qualified specialists navigate structured, but unfamiliar, career paths. And specialists will have to develop new skills, such as teamworking, management and leadership.

By advocating a patient-centred approach, and by emphasising professionalism, teamwork and communication, Tomorrow’s Specialist anticipated the key recommendations of the Francis Report into Mid Staffordshire Trust. This highlighted the catastrophic consequences for patients and their families that can occur when communication fails and mutual respect disappears.

However, obstetrics and gynaecology still has a poor track record for bullying and undermining behaviour. We’ve worked closely with the Royal College of Midwives to address this and have just appointed a new, College-based position of Workplace Behaviours Officer to provide an immediate point of contact for

6 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 7

What we are proposing is an entirely new way of working that is fairer for all doctors and better for the women we serve. Professor Wendy Reid, Vice President Education

any person or department wanting help. We’re also researching the causes of this behaviour to see whether adjusting our training regimen will help stamp it out.

TOmORROw’s sPECIALIsT, TODAy

Meanwhile, work to implement Tomorrow’s Specialist has started. Fourteen cross-departmental teams are tackling specific projects, ranging from advice for commissioning bodies to work on Advanced Training Skills Modules.

Implementation falls into three broad categories. The need for flexibility means that the old, self-starting model of continuing professional development (CPD) short-changes both specialists and women. Instead, the College must provide a package of support that offers specialists the added structure and direction required for successful lifelong learning and improved patient care.

A working party is now exploring the specific details, starting with doctors in the first years of their specialist career. This will include helping specialists identify which

path they wish to take and then providing formal, accredited training that gives them the necessary tools to pursue their chosen direction, along with mentoring and other support. The working party is expected to report early next year.

suRGERy AND sImuLATION

We’re also tackling specific activities that have long needed resolution, such as emergency surgical skills to reduce obstetricians’ reliance on other specialties. Tomorrow’s Specialist provides a framework that we can use to combine all our existing work in this area into a blueprint for future training.

Alongside this work, we’re identifying important issues where we can best leverage our role in setting standards and writing curricula to provide leadership and drive progress. For example, a new post will set standards for simulation training and will develop ways to expand this across the UK.

Finally, the implementation strategy includes regular projects given extra vim by Tomorrow’s Specialist. Even before the report, our curriculum needed to be more outward

facing so that the public know that a doctor with a certain amount of training can perform specific procedures with competence, confidence and minimal risk.

The curriculum review is currently waiting for the General Medical Council to publish The Shape of Training, its own review of all medical training. But our review will share the philosophy underpinning Tomorrow’s Specialist, suggesting that it will focus less on specific clinical skills than on the principles of sound medicine and good medical practice. It’s therefore expected to signal important changes in how we train doctors to work in tomorrow’s NHS and to deliver high-quality, patient-centred health care for women. ■

Dummy runs

‘sImuLATION goes to the heart of the College’s priorities regarding a

patient-centred approach to health care. Patient safety is a primary aim of training; it’s much better for trainees to learn new clinical skills on mannequins and other simulators than on patients. In the North west, we’ve delivered a simulation training day to our junior regional trainees for years now, using the standard model pelvis and baby doll. we’re also helping trainees interact better within the environment and their team via human factor simulation training. This uses high-fidelity, whole body mannequins in a hospital environment. Physiologically, they behave like real patients, responding to the specific intervention used

on them, so it creates total immersion in a true-to-life scenario but with no patient risk.

‘my new role is advising the College on how simulation can be used across our entire discipline. In obstetrics it’s now on the curriculum so we’ve started to get it recognised. but it’s still early days. Putting simulation on the curriculum certainly embeds it into our training and will set standards, but we need to do this in a way that’s achievable nationally.

‘Cost can be a big problem – the most sophisticated simulation suites and gynaecology simulators are very expensive. so we need to make the most of the regional simulation centres that already exist and have the right staff to deliver training properly. I’m starting off by looking for champions from every region who can identify and promote simulation locally and help us develop realistic

recommendations on how we can standardise simulation training nationally.

‘This matters because things can go very wrong, very quickly in health care and we need to teach people how to cope when this happens. human factor simulation enables trainees to improve not just their skills but also how they interact with other specialties, such as nurses and midwives. It develops their awareness of what’s going on around them, so it helps them improve their teamworking and communication skills and their decision-making when things go wrong. It’s a huge way to helping us save mothers’ lives.’

Alison Gale is a consultant obstetrician and gynaecologist at Lancashire Teaching Hospitals and advises the College on simulation training in obstetrics and gynaecology.

Tomorrow’s Specialist

Royal College of Obstetricians and Gynaecologists 908 Annual Review 2012/2013

One of the best ways to improve women’s health is to ensure that their doctors

are trained properly, supported effectively and assessed rigorously, both before and after qualification.

In the UK, the revalidation of specialists is central to this process. We’ve produced advice and guidance about what revalidation means, how it works and what our membership can do to prepare for the annual appraisals that currently form its backbone. We’ve also set up a revalidation helpdesk to address specific problems.

A key element of revalidation is a record of each specialist’s continuing professional development (CPD). We’ve improved our e-portfolio resource, where specialists can log their CPD activities, to provide for summaries of annual appraisals and the results of patient and colleague questionnaires. We’re also reviewing The Obstetrician & Gynaecologist (TOG), our CPD journal, to see how we might use it to help specialists with revalidation.

OuTPuT, NOT INPuT

As revalidation evolves, its real value will be less its tracking of CPD input

Our membersTraining, assessing, supporting

than its reporting of clinical output. Measuring this accurately enough to assess individual specialists isn’t currently possible in obstetrics and gynaecology. However, our Clinical Indicators Project, published recently and detailed elsewhere, marks the first stage of work to provide objective, accurate and comparable clinical outcomes. In future, we hope it’ll be of real value to clinicians undergoing revalidation.

Meanwhile, we’ve been using the opportunity offered by the changes outlined in Tomorrow’s Specialist to improve how we educate and assess doctors in our discipline.

Last year, work began on our first comprehensive strategy for clinical education and training, both inside and outside the UK. It incorporates the emphasis within Tomorrow’s Specialist on lifelong learning for doctors and the need to educate women about their own health. And it recognises the central role that e-learning will play in delivering education and training to our membership.

We’ve made good progress, particularly in lifelong learning, with the new CPD working party and an expansion of the Advanced

Training Skills Modules. We’re also exploring radical changes to the curriculum, including training in non-technical skills such as teamwork and communication.

ExAm REVIsION

Meanwhile, a long-planned review of the MRCOG exams shared not only the same values as Tomorrow’s Specialist but also its approach, with a working party that included specialists from other disciplines, trainees and non-clinicians.

Similarly, the revised exam will benefit from greater input from non-clinicians. The review also proposes more robust training for examiners and a tiered pricing model for international candidates. And we’re changing the format of some written questions to test candidates’ knowledge more effectively and enable the same topics to be examined in a variety of ways.

TImE TO sPLIT uP

Finally, the review recommends uncoupling the written and oral components of the Part 2 exam. This will enable the oral assessment to be designed separately, making

Omelette/eggs

‘I sTARTED training just after the new specialty training scheme came in. There were lots of creases to iron out and

we’d all sit in a pub and have a moan, but I wanted to actually do something about it, so I became a trainees’ rep. since then I’ve done some work on the College’s exams and assessments committee so when the mRCOG review came up I was asked to be one of the trainee reps.

‘I’d recently gone through the exam so could point out where trainees felt it wasn’t helpful to training and progression, and where it was actually a bit of an obstacle. For example, the Part 2 exam where the written and clinical parts were joined together – if you passed the written and failed the clinical you had to go back and do both again. One of the big things we got, and this was a big ambition of mine, was to split those

two elements so that you pass one stage and then move on to the next. I think a lot of trainees are very happy with that.

‘we’ve recommended that the exam committee should include a rep from the women’s Network, so that we can get patients involved in examining, which is important. And we’ve got a plan for implementation, with timelines, so this isn’t just a pie-in-the-sky report that sits on a shelf for 10 years.

‘This was a proper root and branch look at the exam. There was a good mix of people – academics, educationalists, people from other colleges – and we had very wide, no-holds-barred discussions where there were no silly answers. This wasn’t just lip service, a few mates getting together to do what they always do – the College really wanted to pull the exam apart to its nuts and bolts and get the right exam for the next 10 years.’

Andy Heeps is a senior registrar at Chelsea and Westminster Hospital. He is a member of the RCOG’s Trainees’ Committee and also the GMC’s Education and Training Advisory Board.

its requirements clearer to all candidates. It will also allow the new Part 3 clinical assessment to be tailored to local practices abroad, as long as it remains accredited and quality assured by the College.

The proposed changes await ratification by the General Medical Council but, if approved, should make the MRCOG exams more flexible, rigorous and relevant. They will allow examiners to include topical issues in women’s health, such as flu vaccination of pregnant women, driving clinicians’ learning in areas of particular interest to women and their families.

Uncoupling the Part 2 exam, which lets candidates concentrate on one part at a time, should make the MRCOG more accessible to trainees outside the UK without diluting its rigour. This is very good news for women’s health. Enabling more doctors to achieve this gold standard in women’s health care is possibly the most effective and sustainable method we have of securing lasting improvements in women’s health around the world.

Royal College of Obstetricians and Gynaecologists 1110 Annual Review 2012/2013

UK Trade & Investment. Another potential partnership might help us open up a College training centre – the first outside the UK.

The final element is the RCOG educational excellence programme (REEP). This is a new programme, initially developed for use in China. Over the course of five years, it prepares doctors for MRCOG exams while also enabling senior doctors to become accredited RCOG trainers. Both China and the Gulf states have enormous and exciting potential for us to use our reputation and expertise to improve the standard of doctors and the quality of patient care. ■

Inside the ERP

‘ThE programme will be useful for people who have never worked in the uk because

it tells you about things that are routine practice there, like clinical governance and risk management – things which wouldn’t be done elsewhere. That’s useful, especially for non-uk candidates.

‘we also had examiners from the uk, so if we had any queries regarding what is the best practice, or what is done in the uk, you could get an immediate answer – ‘we do this’, or ‘this isn’t done anymore’ and things like that, so having a live examiner in the sessions helped us to get answers straight away.

‘The first time I took the Part 2 exam I passed the theory; it was the OsCE (oral exam) that let me down. Although the programme didn’t help

much with my knowledge, my technique improved a whole lot – the examiner pointed out the key words we needed to look for. That was a big help and boosted my confidence the second time around.

‘Apart from a couple of sessions towards the end, the programme didn’t include a lot of preparation for the OsCE, but in any case the OsCE requires more face-to-face feedback from the examiner. but the final part of the programme was a three-day course that took place in India, and that helped. The books alone aren’t enough: either you need to work in the uk or use this programme to be in touch with examiners who can tell you where you’re going wrong, otherwise it’s difficult.’

Pakhee Aggarwal is assistant professor at Lady Hardinge Medical College in New Delhi and was one of the first people to take part in the College’s Enhanced Revision Programme. She passed her Part 2 MRCOG exam last September.

Our members

place over the internet. Candidates had weekly hour-long sessions with a UK-based specialist who taught them how to apply their clinical knowledge to practical situations and provided feedback on their homework. The programme ended with a final, three-day course held locally and in exam conditions.

Although the pilot hasn’t immediately delivered huge increases in the pass rate, it was very popular with candidates and the technology proved itself robust. After a short break to fiddle under the bonnet, a new, improved programme will be launched later this year. This will be larger in scale and broader in scope. Each programme will be able to support more candidates, and we plan to expand it into new countries, such as Pakistan and Sudan.

GOING GLObAL

Beyond India, the establishment of our new Global Health Unit and closer working with our international liaison groups has helped us expand our training and assessment work into several new countries. In 2011 we returned to Baghdad after a 30-year suspension;

last year we followed this up by holding revision courses for the Part 2 exam. We opened a new exam centre in Nigeria and, in Pakistan, held the first ever RCOG basic practical skills course in Peshawar, conducted by the Pakistan Liaison Group. We’re planning more courses in Pakistan later this year.

We’re also focusing our energy into places where we can make the biggest difference – places like China and the Gulf states. The Women’s Hospital Zhejiang University first approached us almost two years ago to help them improve their doctors’ training and assessment regimen. This year we held the first MRCOG exam in Hangzhou; longer term, the hospital wants to develop an MRCOG training centre and a centre for the Part 2 oral assessment.

However, it’s the Gulf states that offer the greatest near-term opportunities to use our education and assessment expertise to improve women’s health worldwide. To improve our access to local decision makers and help us expand our presence there dramatically, we’ve started working with the government body

PAssING FANCy

For this reason, we’ve been working hard to give more doctors outside the UK the chance to sit our exams. This past year, we’ve been working particularly closely with India. Hyderabad will host our 2014 World Congress and we’ve signed a new, strategic partnership with FOGSI, the Federation of Obstetric and Gynaecological Societies of India. Among other provisions, this will increase the number of candidates sitting the MRCOG exam.

However, giving international trainees overseas the chance to sit the MRCOG exam is one thing; giving them a fair chance of passing it is another matter entirely. We know that candidates outside the UK are relatively disadvantaged when they sit the MRCOG. They’re not as familiar with the institutions or clinical practices of the NHS and are often less acquainted with the exam techniques they need to do themselves justice.

Given that we won’t change the standard, we need to improve the training. Last year we piloted our enhanced revision programme (ERP), a 15-week course that takes

12 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 13

Indicators on

‘wE sTARTED with a long list of almost 200 different indicators – every

indicator that’s been used, or even considered, in the uk or by other countries, covering the whole range of obstetric care. Then we started to narrow this down by what we could actually calculate, given the available data.

‘because we were using hospital data, we decided to focus on childbirth, when women are actually in hospital. we ended up with a shortlist of 30 indicators, which were reviewed by a panel of obstetricians, midwives, statisticians and health service academics until we ended up with the 11 indicators in the report.

‘Previous reports like this hadn’t adjusted for case mix, so clinicians couldn’t really make fair comparisons between units. but my colleagues at the London school of hygiene & Tropical medicine and I spent months and months assessing data quality and looking at which risk factors we could adjust for. some things aren’t recorded, like body mass index, but most of the important risk factors are included, such as age, ethnicity and previous history of childbirth. This means that hospitals serving high-risk mothers are no longer unfairly penalised, and that’s new.

‘One of our main challenges was the data quality. In a minority of hospitals we found that 100% of records were missing vital information so we weren’t able to calculate the indicators for them at all. we’ve since heard from lots of clinicians who said that they weren’t previously aware of these problems and

are now taking action to overcome them. It seems that, in most cases, the data is there, and it is being recorded – it’s just not getting through properly.

‘As the quality of data improves, as new data becomes available and as we refine our techniques we’ll be incorporating new indicators. Right now we’re trying to build on our existing work by using more detailed information from maternity units, starting a pilot project with around 15 trusts. And next year we hope to have data from wales, scotland and Northern Ireland so that the report can show a truly national picture of maternity care.’

Hannah Knight is a research fellow for health informatics at the College’s Office for Research and Clinical Audit. She has spent the past 18 months working on the Clinical Indicators Project report, published in May 2013.

Our workEvaluating, informing, guiding

Good training and high standards are essential tools to improve women’s health.

But are they being used in practice? We need to measure the care that women actually receive and use this information to improve performance.

The Clinical Indicators Project does just that. Responding to demand from doctors for an objective measure of their performance, it was developed in collaboration with the London School of Hygiene & Tropical Medicine and the Royal College of Surgeons. The first report was published in May 2013 and presented a series of 11 maternity indicators, including elective and emergency caesarean rates and induction of labour.

The indicators are based on Hospital Episode Statistics (HES), information routinely submitted by every NHS hospital in England. For the first time, this data was crunched to flatten out differences in factors affecting maternal outcomes, such as age, ethnicity and social deprivation.

suNLIGhT – ThE bEsT DIsINFECTANT

This ‘case-mix adjustment’ allows comparisons to be made between

hospitals serving completely different communities, enabling the performance of maternity units across England to be measured against each other fairly. This allows true benchmarking of clinical practice and outcomes and greatly reduces the shadows in which sub-standard units can hide.

The first report did not identify individual hospitals by name. However, every hospital was sent its own data to enable managers and clinicians to see how far their own results strayed from national norms. And the report did pinpoint enormous variations – some hospitals reported rates of induced labour, emergency caesarean sections and instrumental delivery that were twice as high as others.

These figures could mean that some women are receiving substandard care or that resources are being wasted. In such cases, outlying hospitals will hopefully combine this data with published standards and guidelines to normalise their performance where necessary.

However, some variation was certainly caused by poor quality data. The report’s secondary aim is, therefore, to encourage

hospitals and clinicians to take greater ownership of their data and improve its accuracy.

ANNuAL ChECk-uPs

The report will be published annually and in the near future we plan to include hospitals in Wales, Scotland and Northern Ireland. We’re currently working on including more clinical outcomes; over time, we’ll also incorporate some qualitative indicators, such as patient satisfaction, and begin covering gynaecological care.

As the data becomes more robust, we’re going to remove the security blanket of anonymity from individual hospitals. This will give a new degree of transparency to maternity care, which should prompt further improvements in women’s health. Ultimately, we hope that the data expands beyond hospitals to individual clinicians. This will enable us to measure individual performance accurately and objectively, and will eventually provide our membership with an invaluable tool for revalidation.

Meanwhile, we’re currently examining variation in treatment of women with heavy menstrual

When I’m trying to get my own data for me personally, for David Richmond, it’s actually very difficult and that’s not acceptable... Dr David Richmond, Vice President Clinical Quality

14 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 15

sit on the steering group and 16 of our membership work in its team of national assessors.

ImPROVING PATIENT sAFETy

Our own steps to improve patient safety centre around our patient safety alerts. We also take a lead role in sharing information and best practice and last year held a very successful Patient Safety Day for Fellows, Members, midwives and health managers. This will be followed up by a quality improvement day later this year.

However, the best way to improve patient safety is via high standards and effective guidelines. This year we published five more Green-top Guidelines. Of particular interest was our guideline on group B streptococcus, an infection which can harm or kill mothers and newborn babies – we’ll be publishing more work on this condition later this year.

We also renewed our contract to run the National Collaborating Centre for Women’s and Children’s Health (NCC-WCH). This is one of four National Collaborating Centres in the UK set up by the National Institute for Health

Our work

bleeding as we prepare our third annual audit into this condition, which will be published later this year. We’ve also been responding to changes in NHS commissioning by producing guidelines to help clinical commissioning groups better understand what high quality health care for women means in practice.

We took every standard developed over the past six years by the College, the Faculty of Sexual & Reproductive Healthcare and the specialist societies (responsible for individual disciplines within obstetrics and gynaecology) and put these into a single, interactive resource. This lets users search by subject for accurate and up-to-date information on what the relevant standards are and what they mean. The resource will be released later this year.

EAsTERN PROmIsE

Outside the UK, similar work has taken us into completely new territories. Our Eurovision project is a partnership with the UN Population Fund (UNFPA) to improve medical standards in Eastern Europe. We use their existing medical

expertise and encourage their clinicians and health managers to develop best practice by sharing knowledge and experience.

Last year, we helped Moldova, Romania and Kazakhstan develop, adapt and implement evidence-based guidelines with training modules developed by the Global Health Unit and a team of RCOG clinicians. A masterclass on these topics, held last November, was very successful and we’re currently providing refresher training and other help to the delegates who are now running their own courses back home.

Back in London, we’ve teamed up with MBRRACE, part of the National Perinatal Epidemiology Unit in Oxford. MBRRACE-UK is a new, national collaboration that replaces the Centre for Maternal and Child Enquiries (CMACE) in studying maternal deaths, stillbirths and infant deaths, using its findings to improve services for mothers and infants. College representatives

and Care Excellence (NICE) to produce national clinical guidelines for healthcare professionals.

The College is contracted to produce seven major guidelines at any one time, covering broad topics such as antenatal care for pregnant women. These are distributed throughout the NHS and, besides laying out expected standards, they’re used to train NHS staff and inform research. This makes the guidelines instrumental in driving improvements to women’s health care not just now, but also in the future.

PROmOTING PROms

Last year also saw the publication of our Scientific Impact Paper on patient-reported outcome measures (PROMS) – a series of questions which ask patients to assess their own health. The report followed two years of research into the strengths and weaknesses of PROMS data and how best to use them to improve gynaecological services.

Its publication in May 2012 anticipated the findings of the Francis Report, which emphasises the need to take a patient-centred

approach. We agree, and have been working hard on giving women better access to more information, thereby enabling them to make considered and informed healthcare choices. We produced nine patient information leaflets last year. These focused on maternity care, but this year we’re publishing leaflets on gynaecological conditions, such as ovarian cysts.

We also won a Google Grant to promote RCOG patient information in internet search rankings. The grant, open to all non-profit organisations, gives us $10,000 in paid advertising on Google each month, making it easier for women to find accurate information on common conditions, such as miscarriages. Our Women’s Network will soon be exploring new ways of providing information to women who can’t access the internet to enable more people to benefit from a preventive, life-course approach to health services. ■

16 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 17

22Ib

Did you know?

1930The first RCOG report was completed in February 1930, on maternal mortality

1994The first Green-top Guideline was published on ritodrine The RCOG became the first royal college to introduce continuing medical education for its members

1931The College’s first Honorary Fellowships were awarded in 1931

1935Our longest serving member is Dr GA Cook, an MRCOG since September 1935

1942The College asked the Red Cross for help sending medical books to members who were on active service or were prisoners of war

1949The only female RCOG President (so far) has been Dame Hilda Lloyd, elected in 1949

1949HRH Queen Elizabeth the Queen Mother was the first member of the Royal Family to be admitted as an Honorary Fellow

In 2006, Sophie, Countess of Wessex became the latest member of the Royal Family to be admitted as an Honorary Fellow

Green-top Guidelines account for the 10 most popular pages on the RCOG website (after the homepage)

13FELLOws

&

2mEmbERs

are over the age of 95

41

yEARs OLD the age of College’s

youngest Fellow (at the moment)

4mEmbERs

were born in 1984

Wong, Chan, KhanThe three most common MRCOG surnames

William is the most common first name for an RCOG President

The average weight of a baby born at full term is around 3.5kg (7lb 11oz)

8,600of these were at Liverpool

Women’s Hospital – the UK’s busiest maternity unit in 2012

In 2012 there were 907,776 births in the UK

Our loneliest member is in samoa (1800 miles from the mainland)

Our loneliest Fellow is in hawaii (more than 2200 miles to the mainland)

There are more Fellows and members in Athens than in any other city in continental Europe

There are MRCOGs in 106 different countries

2012/13

4,100DOwNLOADs

of our Green-top Guidelines app since its launch

In 2012, the RCOG served

11,744 LuNChEs

35,232CuPs OF COFFEE

to delegates on College courses

sorry, no word on tea, but visitors and staff got through

14,040PINTs OF mILk

Pity a mother in September 1955 whose newborn weighed 22lb 8oz (still a world record)

8Ib

18 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 19

Our partnersListening, talking, cooperating

The work conducted for High Quality Women’s Health Care and Tomorrow’s

Specialist sought an unprecedented range of evidence and opinion. For the first time, we went outside the membership to talk to women’s and patients’ organisations, as well as healthcare managers, academics and clinicians from other disciplines.

The resulting evidence was invaluable but uncomfortable. It revealed a huge gap between doctors’ opinions of the care they provided and what their patients thought. While obstetricians and gynaecologists believed 80% of their patients were satisfied with their care, just 54% of the women we surveyed agreed.

Clearly, we need to listen to women and patients much more. But just listening isn’t enough. To give life-course health care any real meaning, we need to be talking as well, providing accurate information about women’s health care to a far bigger audience.

No surprise, then, that we’re over-hauling how we involve patients and women in our work to make it better, broader and more frequent. Volunteers on the RCOG Women’s Network (previously the

Consumers’ Forum) currently sit on many boards and committees across the College. While invaluable, this means that we don’t always hear a sufficiently diverse range of views. So last year the Women’s Network reviewed its work and concluded that a shake-up was needed.

PLANNING ThE jOuRNEy

This is happening now, led by our Patient Experience and Public Engagement Facilitator – a new post at the College. It’s still a work in progress but the direction of travel is already clear.

First, we want to make much better use of the Women’s Network while reaching out more widely to women from a broader range of ages, ethnicities, backgrounds and circumstances. This needs to be a two-way conversation: listening to what women think and want but also making sure they know what health choices they have.

We also want to make much better use of new technology, using our website, online surveys and virtual forums to develop a wider network of women who we can call upon to ask specific questions that will improve our work and, ultimately, their health care. Our commitment

to promoting health equity makes us particularly keen to use the skills and experience that some Women’s Network members already have in order to reach out to women from vulnerable backgrounds or communities that are often difficult to reach.

We piloted this new approach with a series of telephone interviews where we asked women for their views of the maternity outcomes covered in our Clinical Indicators Project. We’re also the only royal college in National Voices, the umbrella grouping of health and social care charities in England that give a voice to patients and their families. In future, we want to team up with like-minded organisations to share contacts, user groups and other resources to involve lots more women than we do right now.

CONGREss/PARTy

But partnership isn’t just about women. Our 10th RCOG International Scientific Congress was held last summer in Kuching, Malaysia. It was a huge success, attracting a record 1366 delegates to a four-day programme of lectures, symposia and social events. This success owed a lot to the hard work

How can the College advocate for women’s health unless it knows what women think and what they want from their health services? Cath Broderick, Chair, RCOG Women’s Network

and superb organisational skills of our local partners, the Obstetrical and Gynaecological Society of Malaysia, which took ownership of the event, working closely with our own staff.

The local involvement worked well and provoked considerable domestic interest, particularly with the Chief Minister of Sarawak as the guest of honour at our opening ceremony. More than 500 delegates also attended the charity gala dinner, which raised an impressive amount of money for three charities, including the Sarawak Women for Women Society.

Other factors helped too. Our digital strategy was far more comp rehensive and coherent than before. Delegates could go online to register or submit research abstracts, and the e-newsletters and congress website were more sophisticated than in previous years.

Good planning and great logistics, combined with superb local support, delivered a congress that many declared the best ever – 97% of delegates who responded to our survey said that they would recommend a future RCOG congress to a colleague.

20 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 21

Our partners

The new Global Health Unit represents a clear commitment to achieving our goal of improving women’s health care worldwide... and we can see the benefits already. Professor James Walker, Senior Vice President Global Health

TO LIVERPOOL, AND bEyOND

Kuching was our last International Scientific Congress: to avoid confusion, all future gatherings will share the same title of ‘RCOG World Congress.’

This year we’re in Liverpool, where we’re expecting even more delegates. After Liverpool, we’re in Nottingham for SpROGs, our trainees’ conference, followed by Hyderabad in 2014 and then Brisbane. All these events are sure to benefit from the experience we gained in Kuching.

Over the past two years we’ve reappraised how we work with other organisations to make sure that we achieve maximum impact from our resources and capabilities. Nowhere is this truer than in our work to promote women’s health globally. On top of reorganising the old International Office into our new Global Health Unit, we’ve decided to prioritise our work more carefully, focusing our energies outside the UK on fewer, but more integrated, activities and partnerships.

COORDINATION skILLs

This new approach is evident in the volunteering programme that we coordinate for our membership. Employing a dedicated staffer enables us to coordinate our own volunteers with partner agencies such as VSO, the Department for International Development (DFID) and the Tropical Health and Education Trust.

This means that our volunteers are now used more effectively. They work in countries where women’s health care is poor and in projects where they can make a meaningful, sustainable difference. Although they spend much time treating patients, more time still is spent teaching, developing clinical programmes and guidelines and then assessing these to make sure that they work in practice and will be sustainable once the doctor has returned home. Very often a succession of volunteers will work at the same project, enabling each doctor to build on the work done by their predecessors.

But the benefits of volunteering don’t travel one way only. The issues affecting women’s health are global in nature, differing only in degree from one country to the next.

Our volunteers return home with new skills and fresh ideas that enrich and improve the health care delivered to women in the UK.

GLObAL PRObLEms, GLObAL sOLuTIONs

The global nature of women’s health problems also means that there are global solutions. Around the world, a woman dies every minute from complications of pregnancy and childbirth, often from conditions that are easily treated. Together with the Liverpool School of Tropical Medicine, we developed a standardised three-day training package in life saving skills for obstetrics and newborn babies.

A two-year pilot version of the training package improved the knowledge and skills of almost 3000 healthcare workers.

Now the full version of the programme has been approved by DFID and we’re delighted that the Liverpool School of Tropical Medicine has been awarded £15million to expand the programme into 12 of the world’s poorest countries, helping thousands of mothers and babies. ■

Take one shoebox…

‘whEN I wAs a student I did my elective in Tanzania and always wanted to go back to Africa

when I thought I’d be a bit more useful. uganda’s got one of the fastest growing populations in the world so, when I got there, I spent lots of time doing family planning. I was asking women why it wasn’t used much and it became obvious that they wanted more family planning than they were getting. so I started going on the outreach sessions with contraception, and encouraging women who’d already used it to talk about their experience in front of the others. That engendered the idea that other people were doing it even if they weren’t talking about it, which helped quite a lot.

‘I also did lots of work trying to reduce the number of caesareans – they accounted for 40% of all births the month before I arrived. Often, the doctors making the decisions had only been out of university for a year and, though they could all perform the operation, they didn’t always know when it was really needed. so we did some tutorials, put up some posters, got them to call me or the consultant first and after a couple of months we’d brought the rate down to 23%. unfortunately, it later rebounded to around 30%, where it’s stayed – it’s going to take lots more time and work to keep it down permanently, I think.

‘some of the nicest things were the surprises. A friend of mine, Amy, was also volunteering and we made this model out of a shoebox, a margarine tub and a coca cola bottle on how to do vaginal examinations. The next day, we were using it to teach some nursing students when we were called away to a patient. when we returned we found one of the newly qualified midwives using it to teach the nursing students herself. That was definitely a highlight – after all, the whole point of us being there was to give the ugandans the tools to teach themselves, and each other, so that when we disappeared back to England, some of that would remain.’

Rachel Ion, a registrar at St Michael’s Hospital in Bristol, was funded by the College to spend six months at Kisiizi Hospital in Uganda, as part of the Ugandan Maternal & Newborn Hub.

22 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 23

Our health systemsRepresenting, negotiating, influencing

Over the past two years, the nature and scale of the reforms in the

Government’s Health and Social Care Act 2012 have provoked huge debate among our membership.

Despite its serious concerns about some of the proposed reforms, Council took the view that the Bill represented the policy of a democratically elected government. It also felt that the College could best serve women’s health by making its case to the Government from inside the room, rather than outside the door.

Many members backed this policy of critical engagement. Others wanted the College to call for the Bill to be withdrawn. To find out what the membership thought, and to reflect its views when talking to ministers, the President called an Extraordinary General Meeting of Fellows and Members in the UK – the first in the College’s history.

The EGM debate centred on the Bill’s impact on women’s health care and the College’s strategy. Opinion was divided and the final votes were inconclusive, although the EGM narrowly backed the motion to maintain

our engagement. Council agreed that it was unrealistic to expect the Government to withdraw such a massive piece of legislation at such a late stage and that the College’s responsibilities to women and its membership therefore required it to remain involved in the process.

bROADENING ThE REmIT

Maintaining dialogue with ministers and civil servants gave us the chance to improve the Bill before it became law. We pushed hard for new clinical networks to provide more integrated care to women. We also lobbied for changes to the National Clinical Director’s remit. In the Bill, this was limited to maternity care; we argued that this pigeonholed all women as mothers, going completely against our own mission and values. Instead, we proposed that the director’s remit should be expanded to include women’s health more broadly.

Clinical networks and a national director for women’s health were both central recommendations of High Quality Women’s Health Care so we were very happy when the Government took our points on board when it came to implementing the Act.

We’re delighted by Dr Catherine Calderwood’s appointment to the job. As an MRCOG and the first National Clinical Director for Maternity and Women’s Health, she’s in a strong position to imple ment the Act’s reforms in a way that improves women’s health and service delivery. We’re looking forward to working with her very closely.

The Bill is now an Act but our advocacy work is far from done. A stream of secondary legislation is now expected, determining how the Act will be implemented in practice. All of these Bills are open to debate and our decision to stay engaged means that we can still work with ministers to influence decisions and improve outcomes for women and our membership.

This influence proved valuable after damaging stories in the press last year brought abortion services into the spotlight. We spent much time talking to the Department of Health, MPs and the General Medical Council about the possible consequences for medical training and service provision and trying to balance the many different opinions on this issue to protect women’s access to sexual health services.

also have opportunities to attend internal seminars at the King’s Fund.

Although our decision to set up a policy unit was heavily influenced by the work required by the Health and Social Care Bill, its work isn’t confined to the UK. The unit also supports our global health agenda. We have an influential role advocating improvements in global women’s health and meet regularly with international health leaders.

Meanwhile, London’s diverse pop ulation makes it easier to maintain close links with international specialists. They’re an

important resource, giving us first-hand experience and knowledge when addressing complex issues and lending weight to our voice when arguing for change. In the last year we’ve contributed written and oral evidence to inquiries by parliamentary select committees and all-party groups into issues such as female genital mutilation and child marriage. Working together, our new global health and policy units will strengthen these contributions, helping us to make sure that issues concerning women’s health are more widely, and more accurately, understood. ■

Having a National Clinical Director for maternal and women’s health is a great advance, with colossal implications for women’s health in the UK. Dr Anthony Falconer, President

POLICy PARTNERs

To support all this work, we recently set up a Central Policy Unit. It will make submissions to government consultations and, in time, produce policy recommendations for the NHS. The Unit’s new director is supported by staff from other departments and we’re helping them gain the knowledge and skills they need via a partnership recently agreed with the King’s Fund, a health policy think tank. One of its senior policy directors will advise us as we develop our policy function and capability; our staff will

24 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 25

Over the past two years the College has transformed its governance, executive,

structure and culture. Fulfilling our mission properly required us to become more efficient agents of change; managing our business professionally meant we had to modernise the way we are governed.

These two considerations can often overlap, as witnessed by the changes to our governance. In 2011, Baroness Julia Neuberger led a working party which examined the best leadership structure to make us fit for purpose in the 21st century.

In line with the working party’s recommendations, our governance has now been split between Council and a separate but equal Board of Trustees. The 10-strong Board includes four non-specialists, at least two of whom must have experience of women’s health issues, and is responsible for operational matters, such as our financial, business, HR, management and audit function.

bROADER REPREsENTATION

This means that Council can focus solely on key College issues of strategic leadership, clinical quality,

OurselvesChanging, renewing, reforming

education, training, and global health, ensuring that excellence in women’s health remains at the core of its work. Fellows and Members elected to Council represent all nations and regions of the British Isles, and, additionally, five Fellows are elected as ambassadors of the five global regions.

Council has also gained additional representatives from the Trainees’ Committee and the Women’s Network, where there has been under-representation previously. Finally, the chair of the Academic Board is made a full member of Council, thus ensuring that the science of obstetrics and gynaecology is represented at the top table.

Taken together, these changes should provide greater expertise, a wider range of opinion and experience, and a more singular focus on the College’s clinical and business obligations.

The same need for clarity, focus and efficiency lies behind reforms to our management and operational structure. In simple terms, much of our work involves certain core competencies: designing training and setting exams; writing guidelines

and publishing standards; marketing products and developing policies. With this in mind, we assessed every College activity to ensure that it was making a unique contribution towards our mission to improve women’s health.

This led to the closure of our bookshop and book publishing arm. It’s also brought big changes to our work outside the UK, with our international department upgraded into a new Global Health Unit, led by the Director of Global Health, a new post at the College.

AN OPENING sTATEmENT

Setting up the Global Health Unit sends a clear statement of intent regarding our plans to address global challenges to women’s health. It now works within a structure that gives advice on what we should be doing, and where, and organises our collaboration with different projects, volunteers and organisations. The additional investment reflects the increased scale and scope of our activities outside the UK and the restructuring will give us more capacity and better coordination, so that we have a louder, more effective voice to push for

improvements to women’s health and health care across the world.

Nonetheless, new activities need new funding. We can only pursue our goals if our finances are stable so we need to manage our affairs efficiently and professionally. This is now the case, following some key appointments in finance and resources and our first Director of Development. This new position is charged with identifying and attracting fresh sources of revenue. With these, we can develop new products and work in unfamiliar countries to improve women’s health care around the world.

LOCAL, EVERywhERE

We know that the best way to help women is to ensure that their doctors get up to scratch and stay there. Modern technology gives us new ways to make this happen, because it’s now much easier for us to deliver the right information – such as training or guidelines – to the right people, at the right time and in the right format. It means that the College can become local, everywhere.

This College was born out of a strong feeling of discontent with the status quo… if we don’t keep in mind that spirit of discontent and radicalism then we won’t be able to do our jobs. Ian Wylie, Chief Executive

26 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 27

web-based resource, which we originally developed with the Royal College of Midwives, and e-Learning for Healthcare, for NHS use.

This partnership is an important new step for the College – one that allows us to work closely with other organisations with similar goals to ensure that many more people, both inside and outside the UK, benefit from higher standards of health care. ■

But seizing these opportunities requires investment. This is happening now, thanks in part to resources freed up by the restructuring mentioned above.

The first step was the release of our award-winning Green-top Guidelines app. When surveyed, our membership told us they wanted an iPhone/iPad app containing the full guidelines, priced under £5. So that’s what we produced and we’re delighted by its success. At the time of writing, it’s been downloaded more than 4,000 times, becoming the top paid-for medical app in 27 countries. We’re now planning a version for Android devices.

The next step is far bigger : the overhaul of our websites. We know they’re clunky, confusing and tired. The work beginning now will make them faster, easier to use and, frankly, better all round. And they’ll finally be compatible with tablets, phablets and smartphones.

It’s a big job that will take some time. Eventually, we want our websites to become a comprehensive, convenient and authoritative information source for women’s health care, not just for clinical professionals but also for our

patients and the public. By the end of 2015, you should see huge improvements in our main website, in StratOG, our interactive e-learning system, and in the CPD/revalidation e-portfolio.

FREE sTRATOG

In the meantime, we’ve made StratOG free of charge to all Fellows, Members and registered Trainees, and we’re always looking to make it better. Right now we’re updating the core eTutorials; last year we added a new exam preparation resource, as well as new modules in the core training section. And we’re figuring out how we can make more of the College library available remotely to help our membership in their research or clinical practice.

This year we also teamed up with eIntegrity, a social enterprise Community Interest Company that licenses NHS training materials for use by others. We’re now working with other royal colleges and similar organisations to enable more people outside the UK to benefit from our e-learning materials. These include the award-winning Electronic Fetal Monitoring (eFM)

Qyou got involved with the College how, exactly?

I was invited to become a College examiner and it just mushroomed from there. Our training programmes and clinical quality work give the College a hugely important leadership role and our international membership provides us with a phenomenal opportunity to influence outcomes globally.

Q we’ve had all the headlines from the Francis Report – what happens now?

The College can bring leadership and accountability and promote a culture where people at all levels can voice their opinions and be respected. I can see Francis possibly leading to some regulation – perhaps a package of accreditation with greater professional involvement. Some of it could be self-reporting via an RCOG assessment toolkit so that if you satisfy certain measures then you wouldn’t need an inspection, but if you deviate – and our indicators show quite a lot of hospitals lying outside the expected norms – then you’d have to ask, what is going on here?

This could be badged nationally with the NHSLA and CQC but has the potential for a broader College ‘kitemark’ at a global level.

Q It’s a big world out there – how can we hope to make a difference?

I think we perhaps need to focus our energies on a smaller number of high-quality initiatives rather than spreading ourselves too thinly. We need to ask ourselves, what are we good at? Well, we’re good at education and training, we’re good at developing standards and guidelines, so let’s decide – perhaps with a needs assessment – what bits we can offer to a particular country with the resources between us.

Q Tomorrow’s Specialist asks a lot of Fellows and members – how can the College help out?

Tomorrow’s Specialist has enormous implications for Fellows and Members, in terms of lifelong training. We’re currently starting a working party on continuous professional development. That needs some more flesh on it before we’ll see what we can give

back to consultant colleagues. A lot of our energy has been previously spent on trainees but Tomorrow’s Specialist suggests that, going forward, we’ll be spending more time focusing on the consultant body.

Q what else will be on your Presidential to-do list?

Obstetrics and gynaecology are integ ral and must stay linked together. There’s been some discussion about splitting off gynaecology into a branch of surgery – that would be a disaster. Women’s health isn’t just maternity; taking a life-course approach from adolescence to old age, there are enormous opportunities for healthcare intervention generating much more of a proactive, preventive approach, rather than the reactive fire-fighting which goes on at present.

Also, we need to remember that we mustn’t be divorced from what’s going on in Scotland, Wales and Northern Ireland. Sometimes the emphasis is very much England and I don’t think we spend enough time on generic issues which are just as important in the devolved nations.

Q&A David Richmond is currently RCOG Vice President Clinical Quality; in September he takes over as President. But first, some questions.

Ourselves

David Richmond Vice President

28 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 29

2012 at RCOG

COuNCIL

hONORARy OFFICERs

President Anthony Falconer

senior Vice President James Walker

Vice President David Richmond

Vice President Wendy Reid

honorary Treasurer Paul Fogarty

honorary secretary Ian Currie

ELECTED FELLOws

LONDONMelanie DaviesDiana Hamilton-Fairley

EASTERNEdward Morris

NORTHERN/YORKSHIREPaul Hilton

SOUTH WESTJonathan Frappell

RECORD OF FELLOws AD EuNDEm AND hONORIs CAusA

The President had the privilege of admitting six Fellows ad eundem during the Fellows’ admission ceremony on Friday 28 September 2012:

Professor Gautam Chaudhuri, USA

Professor Lynette Denny, South Africa

Professor Jan Deprest, Belgium

Professor Klause Friese, Germany

Dr Harry Reich, USA

Professor Gillian Thomas, Canada

The President also had the privilege of admitting seven Fellows honoris causa during the Members’ admission ceremonies on Friday 25 November 2012:

Mr David Bloomer, England

Baroness Julia Cumberlege, England

Mrs Charnjit Dhillon, England

Mr Anthony Dunnett, England

Dame Joan Higgins, England

Dr Halcut Lawrence, USA

Dr Sheila Shribman, England

NORTH WESTCharles Kingsland

SOUTH EASTSean Kehoe

TRENTDiana Fothergill

WEST MIDLANDSMark Kilby

WALESSimon Emery

SCOTLANDAlan CameronChristine WestClare McKenzie

NORTHERN IRELANDAndrew CurtainRobin Ashe

INTERNATIONAL (ENGLAND)Lesley ReganJanice RymerShaughn O’BrienLinda CardozoJustin KonjeAlison Wright

INTERNATIONAL (BRITISH ISLES)James Dornan

ELECTED mEmbERs

LONDONDaghni RajasingamNarendra Pisal

EASTERNMedhat Hassanaien

NORTHERN/YORKSHIREPeter BlakemanPadma Bharathi Pathi

SOUTH WESTJane Mears

NORTH WESTAndrew Pickersgill

SOUTH EASTAsh MongaDib Datta

TRENTRoderick Teo

WEST MIDLANDSJustin Clark

SCOTLANDAndrew Thomson

IRELANDCarolyn BailieCliona Murphy

sENIOR mANAGEmENT TEAm

Chief Executive Ian Wylie

Deputy Chief Executive Michael Murphy

Executive Director of Quality and knowledge Sara Johnson

Executive Director of Resources Fred Emden

DIRECTORS OF:Development Ann Tate

Education Policy and Quality Kim Scrivener

Finance Sandra Tetsola

Global health Rachel Cooper Loraine Rossati (maternity cover)

health Policy and Public Relations Gerald Chan

human Resources Rachel Dell

journals and E-Publishing Claire Dunn

knowledge, Information management and Technology Matt Gosden

marketing Nigel Moore

meetings Lynn Whitley

membership Relations Luke Stevens-Burt

NCC-wCh Moria Mugglestone (interim director)

Operations Jan Horsnell

Quality and Clinical Effectiveness Anita Dougall

– IN MEMORIAM –

During 2012 Mr Lindsay Stewart died. He was a great benefactor and servant to the RCOG and we are indebted to his remarkable generosity to this College; specifically, to the Lindsay Stewart Office for Research and Clinical Audit. His bequest will enable the innovative work of this unit to continue to produce vital information that will produce further improvements in women’s health around the world.

The College was also fortunate enough to receive a bequest from the late Dr Elizabeth Margaret Rose. This legacy will also be used to fund our work improving standards of women’s health care.

30 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 31

Unrestricted income and expenditure

from time to time. Funds are currently invested in short- and medium-term vehicles, generating a small but steady income that supports the College’s ongoing objectives.

unrestricted Income unrestricted Funds £

Generated funds

RCOG Trading Limited 1,330,762

Investment income 183,757

Donations and legacies 33,032

Other income 455,174

2,002,725

Charitable activities

Conferences and meetings 1,589,196

Examinations 2,383,287

Fellows and Members 3,378,747

Standards and clinical governance 125,541

Education and training initiatives 331,552

BJOG 465,198

Accommodation and service charges 266,800

8,540,321

Total incoming resources 10,543,046

unrestricted Expenditure unrestricted Funds £

Cost of generating funds

Investment management costs 27,466

Activities for generating funds

RCOG Trading Company Limited 647,322

Accommodation and service charges 163,268

838,056

Charitable activities

Conferences and meetings 1,525,070

Examinations 1,550,150

International initiatives 522,360

Fellows and Members 2,762,535

Standards and clinical governance 989,643

Education and training initiatives 1,522,479

BJOG 384,285

9,256,522

Governance 58,353

Total Resources Expended 10,152,931

On 31 December 2012, our free reserves amounted to £7,674,252. This represents approximately eight months of budgeted running costs and meets with the College’s policy on reserves. In line with best practice in the charitable sector, these funds allow the College to properly manage risk and to be capable of realising unforeseen opportunities that may arise

Each year the College awards prizes to Fellows, Members or Trainees who have conducted particularly outstanding research. We also award travelling scholarships and fellowships to enable study in a specific field, or to allow clinicians to work or volunteer in hospitals outside the UK.

Kathmandu to Kitovu

‘FISTULA IS MORE common in Nepal than the authorities think, but it’s hidden. I

was initially in west Nepal to develop caesarean services but we kept on seeing women with fistula (a hole in the birth canal, usually caused by prolonged obstructed labour). Because we didn’t have the right nursing care, we’d usually refer them to Kathmandu. But they didn’t want to go – with fistula you stink and you’re always wet, so most patients retreat into themselves. To reach us they might already have walked for four or five days, then had a day’s bus ride, so to sit on a crowded bus to Kathmandu for another 18 hours is often too much of an ordeal.

‘I first went to study fistula surgery under Dr Andrew Browning in Ethiopia in 2008. When I left I could treat the simpler forms of the condition. Back in Nepal, we started doing outreach work, looking for patients and telling them what fistula is and how to prevent it. We found that once we’d been in a particular district, we’d get a rash of patients coming along for treatment. And a high percentage of our cases are complicated – women who never got to hospital but delivered for 10 days or had untrained people do all sorts of things while they were in labour.

‘That meant I still had a lot to learn and the Bernhard Baron funding allowed me to go back for more study with Andrew. I spent two weeks at the Selian Lutheran Hospital in Tanzania and another two weeks at Kitovu Mission Hospital in Uganda.

The experience was invaluable: I did lots of operations using what I had learnt and, towards the end, Andrew operated on several complicated cases, giving me the chance to study his technique.

‘I want to make a film to educate women about fistula and stop them having their babies on their own in the cow shed. And I’m raising money for a fistula centre here in west Nepal. A permanent centre could offer care and training all year round; it’s one reason I wanted to up my skills. My hope is that, in the next 10 years, I can actually get a fistula centre started here so that this work can carry on into the future.’

Dr Shirley Heywood has been working in Surkhet, in western Nepal, since 2003. Last year she won the RCOG Bernhard Baron award for continuing study into fistula surgery.

2012 at RCOG

To find out more

To find out more

32 Annual Review 2012 /13 Royal College of Obstetricians and Gynaecologists 33

Membership benefits

KNOWLEDGE & RESOURCES

Enjoy a wealth of information and research services

Free access to the College library’s collection of e-journals

Library Enquiry and Clinical Enquiry services – professional researchers to support your work

help with essential databases, such as mEDLINE and the Cochrane Library

NEw Revalidation helpdesk

ACCESS TO COLLEGE FACILITIES

special discounts at DOmus, a boutique hotel in the heart of London

use of the College Reading Rooms

15% off use of College Facilities: function rooms for meetings and private events and a dedicated meetings team

DISCOUNTED BENEFITS

NEw Access to RCOG exxtra for discounts on travel, home insurance, accommodation and more*

NEw A reduced membership rate and no joining fee offered by the Royal society of medicine

NEw Free/discounted access to Electronic Fetal monitoring (eFm) web-based resource

Reduced rates on RCOG conference and courses taking place at the College

PRIVILEGES

Annual awards and Fellowships – including research grants, travel awards and lectureships‡

Online Register of Fellows and members

media advice on general communication issues

Voting rights

NEw RCOG LinkedIn professional networking group – create new connections with colleagues locally and globally

* uk membership only† separate subscription required

for those on a concessionary or international subscription rate

‡ Available thanks to the generosity of benefactors and the legacies of past members

PROFESSIONAL

use of mRCOG/FRCOG post-nominals

RCOG’s CPD programme, supported by a web-based e-portfolio†

NEw Free use of stratOG, our e-learning platform

RCOG exxtra provides exclusive discounts from a range of providers.

PUBLICATIONS

BJOG: An International Journal of Obstetrics and Gynaecology, published monthly – the definitive collection of original, international, peer-reviewed research into women’s health

The Obstetrician & Gynaecologist (TOG), published quarterly to keep you up to date and support your CPD

RCOG Scanner, emailed out every month with College updates and the most important news in O&G

RCOG Membership Matters, published three times each year – full of College news

StratOG continues to get better – we’re updating the core eTutorials and last year added a new exam preparation resource, as well as new modules in the core training section.

You’re part of an amazing community of dedicated professionals, working together to provide the best in women’s health care across the globe. We’re here to support your needs. Mr Ian Currie, Honorary Secretary

Royal College of Obstetricians and Gynaecologists 3534 Annual Review 2012/2013

Royal College of Obstetricians and Gynaecologists 27 Sussex Place, Regent’s Park, London NW1 4RG

Registered charity no. 213280

www.rcog.org.uk