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Even I should be able to manage this. Oh, and it's lovely big thing telling me the time because I do tend to go on a bit. So, thanks so much for inviting me. This is a real pleasure. I was able to speak to this meeting last year when it was virtual. It's just fabulous to be able to see so many people here and in person. And that is the great thing about a job like this just saying when I was in your position, I never thought that I would be here doing this. So keep your mind open because it's an absolute blast. You get to meet really good people all the time. I'm going to talk to you about radiology the next decade. I'm going to talk to you a bit from the, well, mainly from the college, the RCR angle because actually that is our business at the RCR and we are there to represent you. You, we are a membership organization as a trainee. You don't get much choice. You have to join because we control your futures. But after that, you will have a choice and we need to um and, and my job is to explain to you why it's a good thing to stick with us and why we should work together to improve the future for our specialties. As you know, it's not just about radiology, but we also look after the clinical oncologists. Radiologists are about 80% of our college, 75 80% and oncologists are about 20% and they do bring something very, very good to the party. Actually, it's, it's very helpful. So we're a global membership body and these are our roles um to advocate on behalf of the members to champion you with and keep um support you with data and insights so you can go out and champion the profession. And also what we need to be doing is setting the agenda in terms of N H S E in government, in terms of public opinion and getting people to understand what it is that we do. So we do this with training and education as you know, we set your exams as you know, but we're trying to make it. So that's not your only experience of the RCR everybody. So many people walk into the RCR building, say last time I was here, I was taking an exam and uh you know, let's hope we move on from that. And beyond that, we're talking about professional practice, standards, guidance, how to cope with stuff. Um So how do we do that? It's actually a really, really good time. For our specialty. I know after the war, people used to refer to people and they say, oh, he had a good war, you know, it made his career or whatever. We actually have had a good COVID. I mean, may not feel like that but for once with all the backlogs and all the rest of it, um diagnostics, you know, some, it's only people had no idea what a radiologist does and there's still a little bit of confusion between radiologists and radiographers. But actually, people now understand a bit more about diagnostics. We have come to the fore mainly because we're holding things up actually. But still people understand that diagnostics is really important, an increased focus on screening, increased focus on community diagnostic centers. Generally, we have much more focus centrally. A lot of people are thinking about radiology. And so that's very, very good for us. One of the ways in which we do it as well. The college itself has increased in size tremendously recently. I mean, before I came, but there are now just over 100 staff working at the college, including a very big external affairs department. Um And one of the things they do is they collect data for us. The census, the radiology census is really, really important. Um And uh what it does is it gives us really hard data to go to politicians with and say this is what the issues are. And every year we refine it and um it improves considerably. We find it very, very helpful. It has 100% response rate and that just isn't, I mean, people are really good about filling it in, but there's also a whole team of people who absolutely hound everybody to fill it in. So that makes it very strong. And after the last year, we had 480 pieces in the first week, there is media outlets about it. So this is all good for us. Um So we get a lot of more press coverage. We have to go on the dreaded Today programme, but usually okay and speak to journalists quite a lot. Um And we also uh it's all four nations as well. So we get a lot of exposure all over. Um So we also try and uh embrace uh contact with government. So we have special people in the college who know people in government who know how it all works and how to get us in. We've got a new A P P G, it's an all party parliamentary group looking at diagnostics and that's chaired by it's so it's cross party. So all sorts of interested politicians and they can lobby for you. You arrange round tables for them with experts to try. And the idea is then to raise parliamentary questions and again raise our profile. Um It's been quite a difficult time. It won't have escaped your notice in terms of where to align ourselves politically, you just get to know one person and they move on. Um But uh and of course, now we're coming up to an election probably. Um So we're working with both part, both major parties and also in the four nations, as I mentioned. Um And um we try and align our day with special day. So in our calendar, so, you know, pride Month, World Stroke Day, uh those sort of things we try and align our media work with national days, social media. I don't know why I'm talking to you guys about social media, but you know, it's really important. It is really, really important. And so do I, I'm very, I'm a bit lazy about it because it takes me so long to tweet, I'm just going to put it out there. You, you, I know you all suspected it anyway, but you know, it has a lot of effects. So do tweet advocate on behalf of your profession and remind yourselves that people will read it because they do. Um So let's think about our workforce, workforce, workforce workforce. That's the biggest issue for everybody, isn't it? Absolutely everybody across the NHS and the medical workforce is definitely changing. So in terms of international medical graduates, it used to be that the vast majority of our trainees of our workforce were UK medical graduates. And it's so not the case anymore. 60% of our applicants for training posts or international medical graduates. So hello on the on the camera there. Um we don't have any data on the number of consultant applicants, but we do know that 19% of consultant appointees are international medical graduates. So um looking at where people's primary medical qualification was in terms of the proportion, it is just of increasing gradually over the years, year on year, steady increase. And this is absolutely fabulous for us, isn't it? I mean, we in radiology, some specialty still can't attract enough people. But in radiology, we are able to attract the brightest and best from across the world because we have a great training scheme and it's a great specialty and it's really going places. So, you know, well done everybody, you made it. But, you know, you are the creme de la creme. So um our consultants are not enough for our workforce. There's an increasing number of S A S doctors um in the, in the radiology network. Um And that's an area that we, we want to expand and we want to improve opportunities for everybody. So as they have flexible career options, you know, the same path does not suit everyone and we want to make sure that people are able to contribute in a way that suits them and their lifestyle. Um We do know however that international medical graduates, people whose primary medical qualification was overseas and S A S doctors don't tend to stay so long in the workforce. Uh and in fact, 53% of people who joined in 2013 who qualified abroad had left by 2021. So, um that's not necessarily a problem, but it's just something that we have to know. Uh you used to appoint somebody and there they were for the next 40 years, but that is no longer the case. Um And 16% of radiologists left in that time. So we do have a much higher turnover than we used to, which is probably good in that. It brings new information, new thought, new brains into our system. But we do need to account for it and understand it number of locum XYZ increasing in the workforce steadily year on year. Um I'm not sure whether that is a good thing. I know that sometimes a lot of locum doctors are poorly protected um in terms of their job plans and in terms of their job security and my preference would be for everybody to be in some kind of post which has some kind of protection or career pathway at least. Um because I think locum can be abused um in terms of ethnicity, the top one is um the ethnicity of the medical workforce as a whole. And the bottom one is clinical radiology workforce. You can see that we roughly um we roughly reflect the overall medical ethnicity with a slightly lower proportion. The blue one is white British and then there's Asian Indian is the red one and those are the largest proportions in our workforce. Still very much an underrepresentation of Black African people in comparison to the population. And it's, well, it's well known that a medical workforce or a healthcare workforce that is more representative of the population better represents that population. And so that is something that we should actively strive for, to represent the population. We serve the medical workforce, racial equality. Um statistics, I don't know if any of you have come across these before. Uh, but it's really, the report is well worth read short concise and actually really shocking 22.4% of our staff identify as black or minority ethnic. Um, and, um, uh, there has been an increase in senior management roles from B M A backgrounds, but one point white applicants are 1.6 times more likely to be successful in job applications. And the same is true for exams and A rcps and that sort of thing. Um, 16.7% of people from black or minority ethnic backgrounds report experiencing discrimination. We've got a real problem and it's not, I mean, it's not just us, it is the whole of the NHS. But now of all times we need to address that it's not getting better. Actually, it seems to be getting worse and certainly things in COVID seems to make it worse. So that's something that needs to be part of all of our everyday consciousness all of us because we can only do it together at the college. We need to review the data and you know, that sounds easy, doesn't it? I've been trying to do that for ages. Data about protected characteristics generally is collected in different forms from just about every, every organization collected slightly differently. So you can't actually compare it or get it together. And we have huge amounts of data now delivered from the G M C and also from H E particularly trainees, which is all slightly different and has quite a lot of information. And so we're bringing all that together to understand in radiology and what we will be able to do is to understand what the difference in attainment is for people of different protected characteristics in each Dean Ary. So that will be useful information for us and will help us to understand where they're areas of good practice. Um We also support rad reach which is a great mentoring program. So mentoring is really the only thing that has been shown to make a real difference um in this field. So mentoring is something that we are investing a lot more in and we would very much like as many people here as possible to get in involved in our mentoring program. So you can either be involved as a mentee or a mentor. And to be honest, you get just about as much out of it, whichever, whichever you are. Um it is really good to have time and energy and focus on another person and to devote that time to do it. And as such, to understand what it's like living in somebody else's skin and that is good for all of us. And it's something that should be our core business. As Doctors Rod Rich is a collaboration between the widening participation, medics network and the R C R. And it's aimed at getting underrepresented groups to apply for our specialties. And that's been very, very successful and everybody's really enjoyed their involvement with that. Um Women in radiology just about the same, 37% stay the same all the way through. Uh no change there. Um It doesn't really reflect the number of women doctors. Uh not quite sure why that is um intervention particularly struggles to attract women and still very, very much under represented in intervention. Only 12% of IR consultants are women actually. Um So um looking at the attrition again, um talking about retention, the age at which people are leaving the workforce is getting younger. Last year, it was 50 for the consultants left on average this year, it's 51 51 a virtual child. But that's pretty shocking. I mean, presumably they're going somewhere else to work rather than going to the golf course. I'm not sure. But anyway, I mean, that is, that is pretty shocking because I would suggest I would, wouldn't I but you still have a few good years left in you at 51. Um, so, um, in particular, if we, if we look at the, if we look at a retirement age of 60 even 20% of our workforce is due to retire in the next five years. So, um, and that's a relatively high proportion of those specialties, their chest lung. So if you're thinking, if you think about career choices, anyone, you know, just a, just a quick, lots of places there. But I mean, we do have a really issue. No question. So there's a really good piece of work um public published by, I think it's Mark West. Is it Mark West his first name? I can't remember Michael Michael. All the Ems. Thank you, Michel. I knew that was wrong. Michael West who wrote a really good book called Compassionate Leadership for any of you interested in leading uh the NHS. And he also worked with a psychiatrist to do a piece of work on behalf of the G M C looking at retention in 2019. And it's a really, really good paper. Unfortunately, it had a whole list of actions as to what, what could be done. But unfortunately, we had a pandemic and so nothing was done. Well, I suppose I'm giving the GM see the benefit of the doubt. They're all, all of us, the benefit of the doubt. But I mean, you read the suggestions now and you think, oh, those are fantastic. Why haven't we done it? Um And he describes that retaining your workforce, making a happy workforce has three main components, um autonomy or control over your working lives. And I mean, that is something that we really don't do terribly well, uh particularly for the very junior doctors. I I say this because my daughter actually is an F two and cannot take her holiday. This will all be familiar with you. You know, and we are quite shocked as older doctors are quite shocked at this because we used to be able to do that. But, you know, I can't take your holiday. No control over your shifts. People are getting married and having to do sort of ate way swaps in order to, you know, go on their honeymoon. It's ridiculous. It's ridiculous. It really is. And we need to put a stop to that. And the same if you are overwhelmed with work, if you are overwhelmed and cannot get away, cannot join a sports team, cannot, you know, meet your family for dinner. It, that is not control over your life. Nobody wants to do that. Belonging again. Something that we've massively disrupted. And I like to think we try and do in radiology. Radiology is a small world as you know, it looks really small from my end. I tell you, you meet loads of people who you trained with and you met at various hospitals. But, uh and I think again, for the very Julia doctors by really doing away with the firm structure, we have really dislocated them. If you had to design a job, which didn't make feel people feel as if they belonged, you would do it like that. And so, you know, we are making people feel isolated and alone and um connection, belonging somewhere is really, really important and that's what we need to work on. And so that's why we need to stop thinking about, we need to start thinking about other things that we do, not just reporting numbers. I mean, that is true overall. Uh and for lots of reasons, but we need to spend time looking after each other and looking after the workforce, the final one is see even I can remember this acronym ABC um is competent. People want to be effective. Everybody has gone into healthcare because they want to do a good job. They want to deliver good care. And if you can't do it, it feels awful awful. And if you do that to people all the time, they just want to get out. So those are the key. Uh There are lots of good recommendations about how we can do these things. But I would again urge you all to keep those in mind when in your working lives because you all have a huge contribution are bigger strength is each other. We have a huge contribution to make to each other. Consider in everything you do diversity and ABC and you will not go far wrong. We don't always get it right. None of us always get it right. None of us always behave in a way that we think is ideal or is always considerate or understanding of other people. But just keep trying. That's all you can do. Older people have no interest to you. I'm sure. But anyway, you'll, or you may have heard about the pensions thing and people are talking to you about the pensions. I never really understood it and then got a 60,000 lb bill. So I urge you to get a financial consultant and discuss it. Uh um Older, older colleagues often don't want to do on call. Personally, I don't actually really believe in that. I think that everybody should make some kind of contribution to um not necessarily the overnight work, but you know, some out of our stuff in some departments, you find that everybody over uh 60 or over 55 is were working from Tuesday to Thursday, which is not terribly supportive for the rest of the workforce and, and it's not really doable actually. So I personally believe that older colleagues, we can be, we can be flexible, but I think people have to do some of the sort of weekend shifts, evening shifts, that sort of thing. Uh But also we should make more use of our older colleagues for all these other things, mentoring, teaching radiology events and learning real meetings actually, uh, um, the envy of the world. Um, and we are absolutely ahead of the game medically, uh, across all medical specialties and across the radiology world because we make mistakes. I mean, everybody makes mistakes as you know, but one thing is that medical students particularly are not very well prepared for the fact that they're going to make mistakes. Nora junior doctors, everybody's terrified of it. Medical students are not told you will make mistakes. You will do things that result in bad things for patient's and it will be awful and you will feel awful, but you are still a good doctor. You're still trying your best. We don't really prepare people for that. But in radiology, we're a lot further on than most people because one, our mistakes are right up there in black and white. Um When we used to have hard film, you used to find that if you've missed something, which obviously every time you walk past it now looks like it's got a kind of red flashing light on top of it. You, every time you walk past a meeting there, it was on up on the side and people were discussing it. Oh, the radiologist missed this. But I mean, you have to be humble, don't you? You have to be humble no matter how senior you are, whatever because you will make absolute howlers, things that you think. How could I do that? What I'm doing all these years. How could I, how could anybody do that? And, you know, you just have to suck it up and learn from it. And actually in departments where really is done well, it's good for everyone. It's supportive. It really helps us all move through and, and it is something that we need to, um, share, I think more widely and how to do that. I'll appreciate any feedback about that. I think we have uh we need to do something about the attitude in the medical profession too and the public towards risk and our attitude towards making mistakes because those two are intimately related. Now, I would um Right, good. I'm doing okay. So our global work, we are a global organization. Um We are really lucky here. We've got a great uh great structure in terms of our training, in terms of all our resources. And we need to share that more widely with places where they don't have the same, the same opportunities. Um And also we need to learn from abroad, obviously. Um it's a global community now, we all work all over the place. We got lots of people working in the NHS who actually live abroad. Um And I think we could do much more travel and learning from our international colleagues. Um So um it's also good for us in terms of having a large global presence in, in terms of our impact in the government um here as we for a larger and more global organization, we have a bit more, we pack a bigger punch. So that is really good. Uh There is a hierarchy of the Royal College so of the royal colleges. So the big ones are C S R C P R C GPS. They, they sort of top tier. They're the ones that people go to. Uh there is a sort of second rank which is R C O G, R C psych. Um They are also big R C O G have got there because they have a massive global presence. They are really huge and we are sort of teetering between the third and the second rank. And so we need, if we're going to get our voice heard, if we're going to represent us, we need to push ourselves up there. Not that I've got an idea of world domination or anything like that. So we got 14,000 members worldwide. Um We have a sort of certain special relationships with certain country. You can't do the whole world all at once. Uh There are some places that we, we have a good connection with India, Malaysia, Nigeria, Egypt, Pakistan. Um And also, of course, Malaysia Hong Kong um and Australia. Um and we're expanding that all the time. We had our first Global Congress last year. Um And we will be having another one next year. Um And so uh first Global Congress in Dubai, which had a sort of mixed faculty from Dubai and from the UK. And that was really helpful. We all learned so much from each other. Um So that was very, very interesting. Um And in oncology, we're doing quite a lot of Malaysia. We're also going to other people's conferences, other Radiological societies conferences. So I went to the Indian Conference in AM Ritzer. Um And we're doing a lot more of the RCR Act. So we will run a session at an international conference. So, and we really want as many people as possible to get involved in that, develop an interest, develop a good talk or something you can do and we will snap you up, people will snap you up. People want good education and you can have an awful lot of fun, learn a lot more, the more, you know, the more you present, the more you get learning from other people. And it can be a really great way of, of developing your career. Where are we now? We're also launching exam hubs abroad. Uh So it's easier for candidates to take their exams. Um International applicants for our exams have had a terrible time actually waiting and trying to get the place on the exams because we haven't had enough capacity particularly to be as you know, is quite sort of time consuming well for everyone on both ends. Um And so, um yes, so people have waited a long time, but we're trying to do what we can, there, we have a lot of people coming to work with us, as I've said, 60% of our applicants um from uh from uh international medical graduates at ST one. We also have opportunities now to join S T three. I don't know if we've got any S T three join us here today, have we? Yeah. Um because uh which is an expanding program. So a lot of people, a lot of countries, they, they'll do like a three year training program, unlike five years. And then, but if you have um up to your, to a of the FRC, are you can then apply to join as an S T three trainee and do the last bit of our training and then get an A C C T. Um and it's a great, it's a great way forward for a lot of people. And uh and certainly in Nottingham where I work, we've got some absolutely fantastic S T three trainees. And again, we'll all learn from each other. There's also the global radiologist scheme where people come from mainly from India at the moment. But we want to expand that who come over to the UK for three years as a consultant and get some specialist um experience because quite a lot of places you have really to be a general radiologist, but a lot of people want to get a bit more specialist experience. So they become work as a general radiologist. But get some specialist experience. Uh But now we're talking about the future. So let's just talk a little bit about our work on A I um we're pretty active in this area at the moment. Um It's huge. There are so many players talking about A I, every department of government has an AI person and you can see it in the paper all the time. Can't you all the, all the discussion? But actually, in terms of the Medical Royal colleges, in terms of the medical specialties, we are right up at the front of this because as you know, uh there are far more A I algorithms for radiology than for anything else. Um And so we are the ones who need to be setting the agenda there. It's interesting because there are so many companies that are developing things. We need to have a bit more influence on the market. You know, we need to say, well, this is what we need rather than this is what you've got, how can we use it? We need to be influencing that we also need, although there's so much activity going on, actually application in, in on the ground, there isn't that much A I being used at all and it's poorly integrated where it is. And so what we need to do is to make it easier for people to, to do it, to implement it. Um And so we need to reassure them about how it works that we're doing regular Q A that it'll work with your system, all that sort of thing. And we're working on that a great deal and also trying to position ourselves with the government in terms of, um, being the A I lied, you know, the people to come to being the experts. Um, so I won't talk much more about this because I've just about run out of time, computerized decision support. You know, we have, I refer, which is now being rolled out to GPS. And so it comes up when you're requesting things that should help us and she should help us make sure that people ask for the right, um, investigations should do. I mean, it does help it just saying and that's all I'm going to say with the whole 20 seconds left. And does anybody have any questions or comments or thoughts, comments? So, it's regarding this, uh, international, uh, Junior Junior's, uh, you're not applying for rescue one's what are the bizarre regulations? I'm not sure, I'm not sure somebody sitting in this country or somebody sitting, yes, somebody sitting from outside can apply. Yes. And they will get, I think, I think that once you have a post, you get a visa, I think, but I'm not the best person to talk about that same. I'm really not, but we can certainly advise on that. Somebody who does know more about it, making advice it. Uh, so just check the chat, you I have a quick question. Do you see our curriculum changing to reflect the focus on A B CS in the future or do you think that that focus needs to come through on a local level within the departments in, in our hospitals? So in terms of the curriculum, I'm not sure that, that, that it will be focusing on ABC, I think we'll definitely be focusing on A, I definitely be focusing on A I and that, that work is going on in terms of ABC. I think it's a bit more about professional practice guidance, I think and increasing awareness and also increasing our um our connection is a community. I think that there is still not that much connection between clinical directors and network leads and each other to understand what good work they're doing. And so we're trying to create fora for clinical directors to be able to learn good practice from each other. Um That's very informal at the moment trying to make it much more formal. Thank you so much.