-Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath since 1998

-Honorary Professor of Anaesthesia, School of Medicine, University of Bristol since 2016

-Director of National Audit Projects and College Advisor on Airway at the Royal College of Anaesthetists

 

I work at the Royal United Hospitals Bath NHS Foundation Trust and am a full time District General Hospital consultant in Anaesthesia and Intensive Care Medicine.

 

Academically, over the last 15 years, I have been fortunate to have been centrally involved in leading and guiding five Royal College of Anaesthetists (RCoA) National Audit Projects learning from major complications of anaesthesia: as clinical lead for NAP3 and 4 (NAP3 - epidurals/spinal anaesthesia, NAP4 - airway management) and as co-lead and director of the program for NAP5-7 (NAP5 - accidental awareness during general anaesthesia, NAP6 - perioperative anaphylaxis and NAP7- perioperative cardiac arrest which will launch next week). These big projects involve the nation’s anaesthetists collaborating to shine a light on patient-centred aspects of anaesthetic practice and safety. They are a form of professional-citizen science and are recognised to have changed the landscape of UK anaesthesia clinical practice and anaesthesia research engagement. 

Like many colleagues I have an overall interest in improving safety and quality in anaesthesia and intensive care using a bottom up approach. I have been honoured to be awarded the RCoA Macintosh Professorship 2012-13, the Difficult Airway Society Professorship 2014, an honorary Professorship in Bristol University in 2016.

I became aware of the pandemic risk of COVID-19 early in January 2020 and spent time in January/February 2020 highlighting the risk and raising the alarm to my colleagues locally and nationally working with the Royal College of Anaesthetists and Association of Anaesthetists to disseminate information which I hope led to early preparedness. Clinically, I spent several months working from home and since have returned to Anaesthesia and Intensive Care medicine in Bath. Together the teams at the hospital have provided high quality care for patients with COVID-19 with outstanding outcome figures and I would like to highlight the work of the whole hospital in this regard. In advisory and academic roles, I have worked with colleagues in Bath, at the Health Service Research Centre at the Royal College of Anaesthetists, at Bristol with the AERATOR study group and several who (perhaps typical of the pandemic) I met virtually such as GP Simon Lennane and actuary John Roberts.

In the last 18 months work I collaborated on

-helped raise the alarm that the pandemic was coming and what this meant in terms of the specialties of anaesthesia and critical care working together to maximise our organisational and personal preparedness and ‘surge response’

-first highlighted the concerning rates of deaths among healthcare workers from COVID-19 and reported the differential impact on ethnic minorities and staff such as nurses working in the frontline. This work was quoted in parliament and in inquiry work on the topic and has been widely influential.

-provided clear and early guidance for UK anaesthetists on how to anaesthetise patients with COVID-19 and prepare them for ICU treatment. This guidance was the first such guidance globally and has been widely used internationally.

-communicated to staff nationally (working especially with Prof Will Harrop Griffiths) with advice about personal protective equipment, risk to anaesthetists and ICU staff, restarting elective surgery in summer 2020 and spring 2021, preparation for the second surge and the impact of shielding on staff and organisations

-was the first to systematically document the mortality globally, of patients admitted to ICU with COVID-19. Showing a reduction as the first surge progressed and how this plateaued in autumn 2020.

-was among the first research studies to show that procedures undertaken during anaesthesia such as intubation and oxygen treatments are lower risk for aerosol spread than coughing. This work has dispelled previous dogma. It has made a significant contribution to the understanding of aerosol spread of SARS-CoV-2, highlighting the importance of increasing protection for staff on the wards and for ventilation in all public locations.

-discussed the real potential for UK healthcare services to be overwhelmed and how an ethical framework might support triage in such an eventuality.

-reviewed the relative risk of different groups of healthcare workers for infection, hospital admission and death: using this to emphasise the importance of early vaccination of healthcare workers to protect healthcare services, the relative safety of colleagues working in anaesthesia and critical care and the greater risk (and vaccine priority) of healthcare workers such as ambulance staff, healthcare assistants, porters and nurses.

-modelled the impact of vaccinations on deaths, hospital and ICU admissions in the spring of 2021.

-documented the impact of the second COVID-19 surge on anaesthesia, critical care and surgical care in UK hospitals. Showing the rising systemic stress on the healthcare system in October through December and into January with falling rates of elective surgery, expanded ICUs, staff redeployed to critical care and transfer of patients between hospitals.

-advised on the challenge and practicalities of managing the return to elective surgery and working with endemic COVID-19 in our surgical population.