Purpose – Delivery – Impact – Environment – Transformation
As I demit from my role as President I am proud that the challenges presented by COVID-19 have been met with resilience by the Society, due first to the enormous talent of its members, but second, and very importantly, due to the restructured operational systems of support and approach at the BSG, which have come to the fore during the COVID-19 pandemic.
The danger and pitfalls of leadership are such that it is important to focus on the priorities of an organisation’s sphere of influence and practice, not straying from its core principles and purpose. However, by critically examining an organisation’s function, especially under the exigencies of the COVID-19 environment, it becomes clear that we cannot claim to support our purpose as a charity sustainably, without taking on some of the more fundamental issues facing society at large.
In my last bulletin, I spoke about the inequalities of health care and how COVID-19 has brought those inequalities into sharp relief. Likewise, the realisation of how colleagues from the BAME communities have been disproportionately affected by COVID-19, has highlighted the responsibility of professional groups to bring to debate injustices in health care systems within the UK and abroad, which fail to acknowledge and tackle discrimination of any kind – social, racial, gender. These are difficult and sensitive issues, but ones with which we will need to grapple, in order to make a sustainable and relevant contribution as a professional organisation to the wider societal debate.
The issue of ‘sustainability’ for membership organisations was something I touched on very early in these bulletins. The BSG has a strong heritage of delivery against our charitable purpose and reading again my comments from last July, the focus then was on sustainable organisational change to allow the BSG to continue to develop and flourish as an active professional network. Its charitable purpose, then as now, remains the promotion of good health in GI and Liver disease through research, education and training, clinical best practice and membership support. The concept of sustainability, however, has to be applicable in the wider context and as I reflect on the past 2 years at the BSG, I am struck by the priorities which COVID-19 has brought into relief.
There is no doubt that in pursuing organisational sustainability the BSG has become more rapidly responsive to the ‘professional environment:’ working with and communicating with the wider health care sector. To remain relevant to and engaged in the professional health care agenda is a priority for the Society.
This does not mean that we need to change the character and purpose of the BSG: we remain a professional, multi-disciplinary society (not policy makers and not regulators, nor a trades union), which can build on opportunities to work with and through others who are active in related fields of specialty health care. These ‘sustainable partnerships’ will and should include the Royal Colleges, cross-specialty working groups and stakeholders such as ACPGBI, the Alcohol Alliance, AUGIS, BASL, BAPEN, BSPGHAN, JAG (to name but a few) and third sector patient groups.
Collaborative leadership by the Society means acknowledging the wider context in which we operate, in order to influence healthcare outcomes for public benefit. We cannot do this alone.
These ambitions need to be delivered through a ‘sustainable operational framework’ supporting the Society’s activity. Again COVID-19 has sharpened our collective minds, accelerating the thinking around small pilot forays into digital education during 2019. Using our new digital platform, education / clinical updates and the dissemination of learning will continue to be a priority as we develop BSG teach-ins and Webinars which support research and clinical practice. We have the capability to measure the impact of our new site; its content, membership activity and engagement. This remains the most important objective for 2020 and beyond, to develop through your feedback, a continuously improved and valued online educational offering.
Likewise, the coordination and priority setting for research in our specialty were objectives set out in the 2018 BSG Research Strategy. The message from the COVID -19 pandemic has been the need for large national and international data sets, ethically curated and analysed with scientific rigour in order to inform safe and optimal clinical practice. The BSG has responded with several initiatives helping to facilitate, inform and prioritise research focus and this has allowed the Society to lead on professional advice, based on the emerging evidence base available on this new disease.
Similar principles of sustainability underpin the objectives of the BSG International Strategy 2019, identifying the need for long term reciprocal benefit for in-country projects and international collaboration. If the pandemic has taught us anything, it should be the value of international research, learning and clinical practice, shared openly and rapidly for the benefit of all. To this end, the BSG co-owned journals, GUT, Frontline Gastroenterology and BMJ Open Gastroenterology, have done huge amounts to rapidly review and publish the science and evidence base for GI/hepatology specialty medicine during COVID-19.
The sustainability of the Society’s work is by definition, dependent on and delivered through the efforts of its members. Again COVID-19 has brought this into relief. Support for the membership to contribute to regional and national activity facilitated by and channelled through the BSG needs a sustainable framework by which our charitable objects of best clinical practice, research, training, education and membership support can be delivered.
To realise a demonstrable impact on specialty health care provision, the BSG should seek to quantify and qualitatively assess the value it provides. It should strive to describe, evaluate and report its activity in terms of the impact it delivers both for and through its membership. We can collectively select the metrics by which we choose to do this but for each BSG workstream we should be able to report impact using quantity and qualitative methods. Examples might be, the impact factor of our co-owned journals; the assessment of wellbeing through surveys; feedback from professional development support programmes or the number of BSG members working in research active units, as measured by participation in nationally adopted studies. A start has been made on this and accelerated during COVID-19 but there is a long way to go to embed these practices as routine to what we do.
This crisis has given us opportunity to further reflect on how seriously we take our commitment to sustainable organisational growth and a reduction in our carbon footprint through travel. We have taken steps to recognise that the ‘promotion of health for GI and Liver disease’ means at some level supporting global fundamentals such as clean water ( hence our donation to Water Aid at last year’s Annual Meeting) and lifestyle choices which impact on UK public health: alcohol, obesity, GI cancer and the long term management of chronic disease.
Pre-COVID, the decision to enhance and strengthen the BSG IT systems means that our ability to stay connected virtually was already up and running before the pandemic hit. We have capitalised on this during lockdown and remain committed to continuing to reduce our carbon footprint (although we will all welcome some opportunity to meet face to face occasionally again as conditions permit)!
Reduction of paper waste as the society moves to a digital operations base, has further reduced our carbon footprint and has increased recycling. In parallel there has been a growing realisation that considerable wastage is produced on a day to day basis by the practice of our craft specialty itself. Members who work internationally in low- and middle-income economies will be well familiar with the need to conserve (and recycle) resources and BSG members, active in the cause of sustainability for our specialty, are shortly to publish on the environmental impact of endoscopy.
We now have an opportunity to consider as we lead the debate on specialist service recovery post COVID-19, how this can be done sustainably at a national level: supporting the creation of a health system embedded in a policy of a less polluted environment, better health education and prevention and the ‘greener’ delivery of service. Data from Scotland pre COVID-19, has already demonstrated the environmental benefit of telemedicine. As the BSG makes recommendations for the national recovery of specialty outpatient services and inpatient practice, it recognises that sustainability in all its forms needs to be acknowledged. The Society has therefore supported the principles outlined in a letter to the G20 leaders, from a wide coalition of health professionals and health organisations including the WHO and the surgical and medical Royal Colleges.
The Society has already demonstrated its commitment to sustainable investment and financial planning by a conscious, pre-COVID-19 Trustee Board decision to disinvest from carbon and fossil fuels and to continue to pursue an active ethical investment strategy. Even if the financial costs of restructuring and re-investment in the organisation have produced an operational deficit for 2019, our balance sheet remains strong and the Society has achieved a more sustainable and realistic infrastructure for a small organisation supporting a large membership with high levels of professional activity. This cycle of change will need time to properly bed down and deliver best results, but the early benefits are beginning to show.
The word transformation is much over-used but the exigencies of COVID-19 have meant that returning to the old normal of service provision is not feasible or desirable. The BSG Service Recovery and Consultation Documents stress not just the practical time and carbon saving of virtual and asynchronous consultation, but most importantly the interposition of senior decision making early in clinical pathways to increase the rapidity of specialist response. This in turn resolves easily soluble clinical problems without unnecessary waits or complex investigation and reduces the volume of referrals requiring onward attention.
Productivity can only be increased in specialty care if we embrace the opportunity to prioritise our activity and reduce the amount of clinical time spent on some referrals in relation to others. The growing expectation of specialist referral as a result of mandated clinical referral pathways, is unrealistic and will need to be managed. Early and detailed senior clinical triage can address this and help reinstitute clinical priority supported where possible by biomarker risk stratification and prioritisation. Patient acceptability of this approach and the governance framework around the systems supporting earlier virtual triage (and discharge), will need to be assessed and audited.
It has been an immense privilege to represent this agenda of change and sustainability both nationally and internationally, on your behalf as BSG President. As I hand on to Alastair McKinlay to lead the BSG Trustees, Executive and Council, I urge you all to reflect that there has never been a better time to re-engage with your specialty Society; to help the BSG articulate your voice and views in the delivery of service, training, education and research in GI medicine and hepatology, in a manner that assures our long term sustainability.
I sign off knowing that your contribution is what will continue to make the Society sustainable and vibrant.
Please keep well and safe during the coming months
With my thanks,
June 2018 – June 2020