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Um Our next speaker is Doctor Paul Sadler who's going to give us an update from the H E. Um Dr Saddler is a consultant in critical care medicine and anesthesia. Um He has a strong interest in managing education and has a multiple roles in this domain including a specialty tutor, a regional advisor, program director, head of school, associate dean, and then Director of Education for Portsmouth N H S and he's currently the postgraduate dean for H E Wessex and is, we're very pleased to have you here this morning. Thank you. Thank you very much. Can you all hear me okay? I'm just using the mobile microphone. So I just wanna check that's working. It sounds like it is. That's good. Thanks very much for the invitation again. Um I'm surprised you invited me back after last year. That's really good of you. Two years on the trot. I take that as a real badge of honor that I've been once and I was invited back again and Stella, we're both here again. Um But one thing I said last time was must avoid the Sunday morning slot after the dinner the night before because you know, I was walking in this morning and I was, there was one of the chairs of another session who's going only had four hours sleep last night. I was looking a bit worse for wear and I was thinking, yes, sadly, a good bit of the audience maybe like that. So that would be nice to avoid. Um, I was also saying that, you know, last year I had a really interesting time because I suddenly at the last minute got asked, could I do this debate? And it was in Aberdeen, I was going to be debating and on the other side was the presence of the Royal College of Surgeons of Edinburgh. And I was asked to debate that flexibility was really a bad idea for surgical training. I'm glad to say I lost that debate. I've never been glad to lose a debate before, but I was glad I lost that one. But I learned a lot from last year and we've seen it again this year as well about rewarding excellence in education, you know, the silver scalpel silver Suture award, taking away those sort of things. Lovely to see those sort of things going on and just hearing some of the inspirational work that people have been doing. But also that big theme about flexibility and inclusivity. Uh just seeing some of the examples, you know, last year was zoom presentations from around the world about pieces of surgical research which were being done and being presented and welcomed by this coat by this conference was really great to see so that inclusivity and like I said, flexibility is a big theme. But most of all, I thought when we walked away of all the sessions I went to is pretty much we all generally agree. And when I say all, there is an awful lot of people to agree in this and there's an awful lot of people to include in, in the debate in what we do. And you look at it now, there's NHS it just in England, there's NHS England, there's health education, England, which is separate until 25 days' time and we merged together. Um and there's all these other stakeholders involved in education and I, I speak to lots of people and no one who really would have a sort of stake in this game about how they would set up education for surgery or more broadly for medicine would do it the way it is now with so many different stakeholders involved in different ways. But that's the way we are now. And a lot of people have spoken about to me about the merger that's happening with A G. It was like something out of Star Trek like we're being assimilated by the borg. This is something actually what should be happening, this merger, it really should be happening. It is the right thing to do. Of course, we need to do it in the right way. But actually it's bringing us together people who should be working more closely together. You look at things in terms of okay hee women to be redeveloping the workforce for the NHS in England. And we know now and I presented data last year showing you that we know what surgical trainees do. We not foundation trainees do when they leave the NHS, where they come back after leaving the NHS getting time. Course we've got a good idea and how well they progress as Colin shown as again, how they progress, how you're progressing, how you're progressing through exams, how many you're going to progress get satisfactory outcomes year on year. So that's really good. But actually only have part of the story. We didn't really know about the demand. The demand is held by NHS England. Therefore, we're looking at part of the picture bringing together. That's just one example of why we should be together. And also if you're an organization trying to run training programs, you don't want to speak to 20 different organizations and groups every time you want to change one thing, sometimes it feels like that. I'm sure you probably felt like that in the clinical workplace sometimes. Yeah. And if you don't speak to everyone beforehand, someone gets hacked off and then things don't happen, it grinds to a halt, people start debating and putting blocks in the way and we've got to get away from doing that. So we've got to think about how we bring people together. Another being spoken about is of course, if we bring this together when I mean, talk about a broader role, there is a whole, we're talking about developing the workforce to deliver care for patient's, that's what we all want to do. We're specifically in this room, we're talking about delivering, you know, developing the surgical workforce. If we're talking about that in isolations about doing the course surgical and higher specialist training programs over here. And we're talking about Caesar programs over here. We're talking about other workforce groups and other professions, doing important roles in surgical healthcare in other places. We're not looking into the joint up way and especially even if you're just talking about capacity to train, if other people, lots of different people are running different parts of it, then there's gonna be competition, there's going to be conflict. And again, there's going to be an efficiency but certain things gonna just, I thought specific points I wanted to raise as well with things like certain things going to stay the same things like responsible officer function. You will all get a letter if you're in England at the moment with the organization chaining, don't worry about it. It's just your responsible officers with your designated bodies names going to change a little bit. That's all. If you're, if I'm your dean at the, at the moment will be your dean after the first of April that won't change. Units of application aren't changing. You see that I'm, for example, you saw my name, think I'm Dean for Thames Valium Wessex. Now there are still separate units of application that's really important to people, especially when you look at the values. Now, we all hear about people want to limit the amount of time they're moving, want to be able to be settled more in one place. And I think in terms of our units of application, we're looking at that in terms of how we actually think if a program is big enough and we can deliver the curriculum, can we break it down into smaller geography is which way people rotate to give people that better quality of life, that better chance of just sort of, you know, doing other things outside work in their lives and having a good time doing it, some things will change. The with this merger, there may be occasional changes in your post graduate medical education team, the people you may contact certain of our people, there is going to be an economy of scale. We are losing people from all, all our teams, whether you be in NHS England now or health education, England now or any digital, there will be occasional lost chip. People change in P Jamie and quality, but we're still going to be doing the same job. We're still responsible for the same mandate you in terms of otherwise should not notice any difference in terms of your training going forward when the merger happens. One thing I wanted to mention as well. A lot of people heard about the distribution expansion workers going on. If you haven't heard about it for, this is all about redistributing funded NTN numbers according to the national training numbers, according to where the population need is. And this has worked out on population density and you know, socioeconomic background and other sort of factors to look at it just because for historical reasons, the where where the NTN now are not necessarily properly matching the population and that's within local officers as well as between offices as well. And you know, we are, as I've said before about patient need. And so, and what we do know is if we train workforce close, if we train workforce in the location, they are more likely to work long term in that location. And, but things to reassure you about if you're in a training program already, you're not going to move during your training program, we're not going to suddenly lift you from the northeast and put you into uh peninsula because you know that we're moving, the number's about it's going to be future appointments. We're going to be doing that and we're only going to move when there's, we can be sure that the quality of training in these places is going to be able to deliver the curriculum that we require in a good way and there's a link there at the bottom to try and help to people who want to see more detail about that. Now, a while ago, we ran a surgical I, I organized a surgical round table and we got GM see colleges, NHS England Hee, a statue, education body, the other three nations education bodies as well. Uh surgeons in training groups, surgical educator groups, various other, just about everybody we could into a room, virtual room to talk about. Okay. We've done things like improving surgical training. We're done. We're doing these other bits. What do we need to look like in terms of future surgical training? And these are just some of the priorities which came out and I won't go through them all. But, you know, a lot of it was, you know, good to hear, you know, things like developing the team, not just the individual very much looking at, that's where one of the reasons extended surgical team concept came from, but thinking about other things such as okay, I think linking to what Collins said, training, beyond learning, beyond CCT, the meant importance of mentorship. I've always found it very strange that the most risky time in your career is when you see CT in terms of having issues uh in your practice and yet when you finish yours, get your C C T as a statue, education body, we waved goodbye and wish you good luck and go. Congratulations. Well done. And we sort of very much cut the cord and it feels very, very much a final thing. And is there something we should be doing about that? Also, very much just thinking about heart of, you know, serve this hubs and things and see where we train education space in most employers has been squeezed and squeezed because of patient care, especially over COVID. It's things we need to think about. But also how do we with, especially with all new technology, robotic surgery, for example, how do we keep up with it better and not have to rewrite the curriculum every five minutes. But if any of you've ever seen regular surgical curriculum, it's not a small document and that for anyone who's ever tried to write one, it's not a small piece of work to do it, to put it mildly. We can't be doing that every five minutes. But these are some of the challenges which highlighted in that workshop as well. You know, workforce change takes years. Clinical pressures are now how do you do one with the other? We train in the service in the service. We, we are going to carry on training in the service for many years to come. And I can't believe we will ever change from that completely that therefore, we've got to think about that. And there is competing pressures on your time as learners and on your educators times as well. And clinical pressures often will, will seem to Trump a lot and we've got to think about how we do this better. So making sure we balance commitments going forward. And if you look at what the impact of COVID, uh you know, COVID has been etcetera, you know, we've broken a lot of people say, well, we've broken a lot of the things we had made in the past. But actually, what I got to think about is this principle of cancer G or cancer guy, depending on how you pronounce it. We've actually how we repair this. We've got to make it more valuable and it's not just about recovery, it's how we rather than just recover, we reform. I'm a firm believer that the meaning of education is achieving a sustained change in behavior. So helping enabling someone to go through a process to achieve a sustained change in behavior. That's what we should be talking about when we're talking about sustained reform. And one thing we can't lose sight of, we've got to think about our staffing models. We do know that wherever there's good staffing models, surgical training is better because you can get released for it better and get to those learning opportunities. We want you to get to an extended surgical team is one of the most positive pieces of work I've been involved in. Now, I can't talk about all these in detail, especially as other people have spoken about them or I'm going to speak about them next. But these are some of the most positive. I'll be honest with you. I'm proud to be part of some of these pieces of work, you know. And one of the things I would highlight that there, which may not be spoken about is the National Court Surgical Training Program which Catherine Smith, one the T P D s in East Midlands with Celia, the head of school in London and the other heads of school as a whole have all been involved in. We're now looking at we're trying to sort of engage with the specialist surgical societies now with the colleges with everybody and go okay. Can we do something similar for every surgical specialty? And I've, we've secured some resource to try and do this over the next couple of years because we think this is important that we do that one, the learning things going forward also working with, you can see here this is all about collaboration. This is what I'm on about trying to get everyone in a room with the cross organizations about the independent sector in the collective hub work, you know, statue education bodies, colleges, independent sector providers, NHS England, Acid Botha, all in a room together to come up with some useful guidance, looking about contracting challenges and how we make it easier for you to move. If you have to train across a number of sites and locality, how we make it better. But it's all of these pieces of work above only happened because of collaboration between multiple organizations and that's how we got to do it going forward. So, so I think the big thing going forward, I've already said it and I'm going to say it again, collaboration, how we get everybody in the room together at the start of a process to make sure everyone's engaged with it. We're all pulling in the same direction, communicating effectively about this one. The big things learning from improving surgical training, which I was when I first started was about was actually we didn't tell people what it was all about. Enough people on the coalface didn't really know what it was meant to do, how we achieve greater flexibility in training and for our trainers as well. If we don't achieve it for our educators, if there's no educators, we can't do this going forward. And I would highlight the NHS educator strategy, which we're at last starting. And I think something which decades overdue in terms of getting this in terms of initiative, we need to do. So we don't have any educators. We're not going to be training, how we make service hubs, equal training hubs and no, only training today equals no workforce tomorrow because that's what we got to do. And I know John Lewins, I was there. And when we originally wrote the first paper during COVID about that where he came up with that, hashtag about no, no training today know, surgeons tomorrow. I think it's, it's broadly applicable across the whole of the healthcare workforce. Thank you very much. Thank you very much there for a great talk and we'll keep going just for the address of time and we'll keep questions to the end if that's okay.