Royal College of
Emergency Medicine
l.K
Annual
Report
and
Accounts
2023
Royal College of Emergency Medicine
## **About the Royal College of Emergency Medicine**
**The Royal College of Emergency Medicine’s objective is to promote excellence in emergency care. Our activities are focused in three key areas:**
- l Delivery of safe high quality emergency care, promotion of best practice and ensuring emergency medicine training is of the highest standard. To achieve these aims we strive to ensure that patient centred care is led and delivered by fully trained Emergency Medicine clinicians, working in and with the wider Emergency Medicine team.
- l Secondly, we advance safe and effective Emergency Medicine by providing expert guidance and advice on Emergency Medicine policy.
- l Thirdly through the development of training, the funding of research and the setting of professional postgraduate examinations we work to educate, train and assess Emergency Medicine doctors to deliver the highest standards of professional competence and practice for the protection and benefit of all the public.
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nual Retx)rt &Accounts 2023
gekn Emergency Medicine
Annual Report & Accounts 2023
## **Contents**
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|---|---|---|
|Foreword by Her Royal Highness|
|The Princess Royal _______________________________________6|Quality ____________________________________________________37|
|President’s Report _______________________________________8|GreenED Accessibility Programme ___________________ 38|
|CEO’s Report ____________________________________________10|Environmental Specialist Interest Group (ESIG) _____ 38|
|Trustee Board ____________________________________________ 12|Committees _____________________________________________ 40|
|Executive Committee ___________________________________ 13|Committee Structure __________________________________ 42|
|Council ____________________________________________________ 13|Membership & Professional Matters Cluster ________ 44|
|National Board for Northern Ireland___________________14|Membership & Professional Matters Cluster ________ 45|
|National Board for Scotland ____________________________15|EMTA _____________________________________________________ 46|
|National Board for Wales _______________________________ 16|EMSAS ___________________________________________________|47|
|Corporate Governance Committee ___________________ 17|Update from current Chair, Dr Immad Qureshi _____|47|
|Emergency Medicine Performance ____________________18|ACP Forum ______________________________________________ 48|
|Our Regions _____________________________________________ 20|Sustainable Working Practices Committee __________ 49|
|East of England _________________________________________ 22|Gender Equity Committee _____________________________ 50|
|North West ______________________________________________ 22|Quality Cluster __________________________________________ 53|
|South East _______________________________________________ 23|QECC ____________________________________________________ 54|
|North East _______________________________________________ 24|Organisational Development Cluster _________________ 56|
|Yorkshire & Humber ___________________________________ 24|Equality, Diversity & Inclusion Committee_____________57|
|West Midlands __________________________________________ 25|Honours Committee ____________________________________ 58|
|South West ______________________________________________ 25|Fundraising Advisory Board ___________________________ 59|
|The College Teams _____________________________________ 26|Academic Cluster ______________________________________ 60|
|International _____________________________________________ 28|Educational Resources Committee ____________________ 61|
|RCEMLearning __________________________________________ 29|Research Committee __________________________________ 62|
|Events ____________________________________________________ 30|International Cluster ___________________________________ 64|
|Membership ______________________________________________ 31|Lay Advisory Group _____________________________________ 66|
|Exams & Training _______________________________________ 32|Financial Report ________________________________________ 68|
|Policy & Communications _____________________________ 34|Acknowledgements ___________________________________ 109|
|Key Statistics ___________________________________________ 36|Annex ____________________________________________________ 110|
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Royal College of Emergency Medicine
## **Foreword by Her Royal Highness The Princess Royal**
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Annual Report & Accounts 2023
Emergency Medicine is one of the most demanding specialties in health care. Those who choose this career path deserve to be looked after and have the finest representation.
During my time as Patron, I have seen The Royal College of Emergency Medicine evolve to become the established, authoritative body that it is today: not only does the College advocate for its members, but for all those who work in Emergency Medicine and for all those patients who may require urgent medical attention. No-one ever knows when they may be calling on your expertise for help, as I am all too well aware!
Challenges in emergency care are vast and ever present. The College continues to be a clear voice for all, striving for fairness and equity. It is essential that those working in clinical practice have the right support and resources to advance their professional development. With the highest number of people joining this year, the College now has 12,000 members, which is testament to its excellent reputation.
The last few years have been particularly challenging as consultants and trainees continue to shoulder the heavy burden of high workloads with the pressures of day-to-day life. Patients place immense confidence and trust in the care provided by those working in Emergency Departments and I extend my gratitude to all emergency service workers for your enduring commitment.
My best wishes to all members and staff at the College.
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Royal College of Emergency Medicine
## **President’s Report**
Dr Adrian Boyle President, The Royal College of Emergency Medicine
In 2023 Emergency Departments (EDs) endured some of the most difficult periods ever recorded in emergency medicine.
Clinicians and staff continued to work tirelessly to cope with the challenges that come when faced with record levels of admissions, long waits, delayed ambulance handovers, corridor care and exit block. Working conditions have been appalling and burn-out a reality with many departments reporting a shortfall of emergency medicine clinicians. The impact on patients and staff cannot be underestimated and it is fair to say that in 2023 we dealt with an emergency admission crisis.
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Patients deserve to be seen quickly, treated with care and in the right place – not in a hospital corridor. Staff should not bear the consequences of having to make things work in a system that is broken. Despite this, ED teams throughout the country have shown remarkable resilience.
But patients and our members deserve much better and we continued to advocate for an emergency care system that is fit for purpose. We are campaigning at the highest levels to press policy makers and those with the power to effect change and we launched our campaign to #ResuscitateEmergencyCare.
Implementing our asks will help the transformation that Emergency Department patients and staff so desperately need. We want:
- An end to ambulance queues and overcrowded Emergency Departments.
- Enough emergency medicine staff to deliver safe and sustainable care.
- A resourced NHS to ensure the emergency care system can provide equitable care to all.
- Transparent ways of measuring how hospitals are performing so we know which ones need to improve.
As a Royal College we will continue to fight for these improvements, while at the same time be agile enough to adapt to serve the best interests of our membership - which during 2023 reached more than 12,000.
In 2023 we also:
- Agreed that from 2024 members on maternity leave could get one year’s membership subscription for free.
- Delivered almost 11,000 exams across the UK last year.
development of global emergency medicine that is clinically excellent, evidence-based, compassionate, and equitable.
We know that 2024 will continue to be a challenging year – with an expected general election meaning that we will be looking at a new Government and new health policies.
I am proud to represent you and work with some incredibly inspiring, dedicated teams and individuals who are committed to keeping emergency medicine alive.
I look forward to continue working with you all towards the vision of being a catalyst for change, ensuring emergency medicine is an inclusive, fair, and equitable speciality for everyone.
Dr Adrian Boyle President, The Royal College of Emergency Medicine **President@rcem.ac.uk**
In 2023 Emergency Departments (EDs) endured some of the most difficult periods ever recorded in emergency medicine.
- Worked with 54 countries around the world to support emergency medicine care.
- Issued a range of grants to fund research in to key areas of emergency medicine.
**Dr Adrian Boyle**
The increased number of global conflicts as well as economic challenges with inflation and a reduction of international funding led to uncertainty across the international health sector. However, we continued to strive to be a world-leader in the
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Royal College of Emergency Medicine
## **Chief Executive Officer’s Report**
Mr Gordon Miles FRCEM (Hons) MBA Chief Executive, The Royal College of Emergency Medicine
I am pleased to be able to present to you our annual report detailing the work of the College in 2023.
We commit to producing a report every year as it gives us the opportunity to summarise and demonstrate the extent of work the College undertakes on your behalf.
Significantly, it allows us to reflect on the progress we are all making collectively as well as marking the year officially for future reference.
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More than 70 employees of the College are aided by countless volunteers from across the UK, and internationally, working collectively to provide support to you to advance the specialty.
We are proud of our achievements in what has been another difficult year for emergency medicine, and we are proud to support you. The pressures in emergency medicine continued unabated, but our hope is that this report provides some reassurance of what we have done, what we are doing and what we are putting in place for the future via our departments and committees with clear remits – all working for you. The report provides a snapshot of national, regional, departmental and committee performance in 2023 as well as aspirations for the year ahead.
There is no immediate respite in sight for the challenges the specialty is facing, and we will remain relentless in representing you and emergency medicine at the highest levels.
In closing I want to thank all our volunteers, those from the specialty and those outside of it, without whom we couldn’t function and to our employees whose extraordinary hard work is much appreciated. One of the most amazing things about the College is that hundreds of you working in emergency medicine and beyond give freely of your time, energy and passion and without your assistance, we would not be able to function as effectively as we do. Thank you.
I have been Chief Executive for the College since 2010 and as each year passes, I have seen our work become more and more complex and the demands on the specialty continue to grow. With it our membership and expertise has also grown.
In January 2023 NHS England published its delivery plan for recovering Urgent and Emergency Care, post COVID and we see ourselves as at the forefront of influencing change in a positive way and continue to offer our advice on the solutions that we can offer to support any recovery. Our own manifesto to Resuscitate Emergency Care was launched during the year and will remain the blueprint for us for the foreseeable future and will continue to be used to influence any new Government in 2024.
As I hope this report demonstrates, we always endeavour to be responsive and adaptable to change, ensuring the College is at the forefront of emergency medicine - in matters such as research, training and professional development. The College needs to be match fit to meet your needs, which relies on a capable team and robust infrastructure. We continue to make investments across the College, setting challenging financial requirements in a wider landscape of a cost-of-living crisis, impacted by international events.
There is no immediate respite in sight for the challenges the specialty is facing, and we will remain relentless in representing you and emergency medicine at the highest levels.
## **Mr Gordon Miles**
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Royal College of Emergency Medicine
## **Trustee Board**
The Trustee Board was formed in 2021 to focus on the strategic agenda for the College, specifically concerned with the delivery of the College’s remit given to us under our Royal Charter. The Board creation allowed the Council to concentrate on specialty matters, whilst the Board is focused on the College delivery of its mandate.
During 2023 the Board, at its quarterly meetings, has continued its focus on the examinations transformation plan which the College is part way through, delivering service and process enhancements to our examinations operations. It has closely reviewed the examinations risk management approach and has supported the management in delivering consistently reliable examinations results throughout the year.
Ensuring that the College budget is well managed is part of the Board’s work. To achieve this it has received and scrutinised regular updates on the financial performance. The Board agreed to run a deficit budget to allow for investment in extra resources for our examinations to support the transformation programme and plans to see the College return to generating more money than it spends in 2025. Reserves have been used to support the examinations development and rebuilding these over time, to ensure the ongoing financial sustainability of your College, remains a goal for the Board in the medium term. The Board considers the pricing strategy of the College regularly and set the subscription framework as part of the College budget setting process.
The Board has reviewed the financial audit performance and was reassured that the financial management of the College remains sound as evidenced by our audit reports.
Risk management has been a continued area of close consideration as the changing landscape has brought new risks to manage.
At a time when the College has had to navigate a period of high inflation retaining and attracting talented employees has been a concern. The Board undertook a review of employee remuneration during the year and agreed a new framework for this, to be implemented in 2024.
To help track progress against our strategic goals the Board agreed to the development of a corporate dashboard which was under development as the year ended, with implementation planned for 2024.
As the year closed, the Board commissioned a governance review of its own performance to ensure it was achieving the goals that were set when it was created: this review reports back to the Board in 2024.
Throughout the year the Board was kept updated by the President on the wider challenges facing the specialty, endorsed the lobbying and manifesto work undertaken to keep emergency medicine a key priority for the NHS during a time of some political turbulence as the country headed towards a general election.
Part of the financial review has been to consider the opportunity to divest of the freehold of 7-9 Breams Buildings in London. This property has not been fully used since the pandemic because the College staff are working at home, attending the office for a minimum of five days a month, or more frequently when the operations demand it. This means that our Octavia House property in Southwark remains sufficient for our needs. Efforts to rent surplus space have been partly successful and a sale is sought. The market in London for commercial property remains difficult however as many organisations are reducing their physical space and so like many others we are trying to divest at a time when the market is over supplied with property.
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Annual Report & Accounts 2023
## **Executive Committee**
The Executive Committee met six times during the year. A core function of this Committee is to support the development and implementation of our emergency medicine policy work and the supporting media and lobbying activities. The Committee were concerned about ambulance off loads, exit block, crowded Emergency Departments and staff wellbeing and worked throughout the year to tackle these issues by lobbying the NHS and MPs for action as you will read elsewhere in this Annual Review. This work included reviewing plans for workforce census projects to establish a clear picture of the resource challenge facing Emergency Departments, holding an emergency care crisis summit in Westminster, and launching its Resuscitate Emergency Care campaign. In addition, the College reviewed and updated guidance and explainers on crowding, workforce and acute care and began work on developing Guidelines for the Provision of Emergency Services.
Other Committee work involved scrutinising clinical guidance and position statements that were in development, responding to consultations, advising on plans for College fundraising activities, considering the progress of our examinations, and ensuring a comprehensive response to the Covid public enquiry. The developing situation with the NHS England plans for expansion of Physicians Associates was a theme of discussion during the year, and a working group was set up to consider this in more detail. Monitoring and reviewing the NHS Urgent and Emergency Care recovery plan, which was published in January, was also a regular topic of discussion.
## **Council**
The College’s governing body met five times during 2023, and considered reports from the National Boards for Scotland, Wales and Northern Ireland and from the 11 Regional Boards in England. It considered carefully the reports of various Committees reporting to Council - these included the quality of emergency medicine practice, new clinical guidance, and the development of the Green ED initiative. We kept costs down by mainly meeting online and only coming together to discuss particularly vexing problems.
Council continued to oversee the performance of College examinations, fundraising and ethical giving guidance, a number of clinical publications, the Emergency Medicine Specialty Forum reports, specialist Doctors Forum and the EMTA trainee survey results. Council debated some difficult problems, conducted with grace and professionalism.
It also reviewed the work of the College, outlined elsewhere in this review, offering guidance to streamline process and ways of working so the College can continue to evolve fit for purpose for the clinicians it represents.
Dr Adrian Boyle President, The Royal College of Emergency Medicine **President@rcem.ac.uk**
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Royal College of Emergency Medicine
## **National Board Reports**
## **National Board for Northern Ireland**
In 2023 EDs in Northern Ireland faced some of the most difficult periods ever recorded. Emergency admission numbers increased in all departments to record levels putting unreasonable strain on employees and risking patients’ safety with unacceptable waiting times.
Ambulance waiting times for response and handovers to EDs by the Northern Ireland Ambulance Service (NIAS) caused serious concern and a plan to enforce a ‘backstop’ of three hours was implemented at a very difficult time without consultation. This was intended to enforce offloading once three hours were reached, regardless of the situation within the EDs.
Associated with a discussion of improving flow from EDs, there were no plans to enforce that, with a typical backstop for ED patients to prevent deterioration in the next stage of the patient journey. Many felt this added unreasonable pressure without firm commitment to improve the number of emergency admissions waiting to leave the department. More corridors were recruited for use, with increased employees in some departments to accommodate the surges caused by this edict.
Widespread media coverage on the emergency admission crisis helped focus minds, but the absence of an Assembly post Brexit prevented a functioning devolved Government from being reformed so there was no Health Minister. We did however successfully engage with health committee members in most parties, who helped relay our concerns independently to the public and health service officials, mostly via media.
With the limited decision-making ability of unelected officials, the Department of Health could not resolve the problems we were facing. This contributed to an ever-deteriorating situation urgently needing systemic reform and budgetary stability.
With employees under substantial pressure, work started on a workforce census for Northern Ireland, replicating that performed in Scotland and Wales - the aim being to look at the current workforce and consider sustainability to identify what will be required over the next decade, considering current vacancies, unit expansions and the expected attrition of employees due to retirement.
We understand emergency medicine in Northern Ireland will face massive technological changes over the next few years with the introduction of Encompass and we have invited stakeholders in this project to update the Northern Ireland board on its introduction, implementation, and anticipated challenges.
Finally, we were delighted to welcome Dr David Purdy and Dr Lauren Pedlow as our emergency medicine trainee representatives on the Board. Dr Brendan Lavery stepped down and we thank him for his contribution. We welcomed his successor Dr Paul Baylis from Altnagelvin Hospital.
Looking ahead to 2024 we are planning an Emergency Care Crisis Summit and there will be a focus on Getting It Right First Tie (GIRFT): Improving data collection, ensuring that it is live, accurate and reliable.
We will continue to represent our specialty at the highest levels in Northern Ireland, consistently engaging with representatives of all political parties, healthcare leadership and other royal colleges.
Dr Russell McLaughlin Vice President, RCEM Northern Ireland **VPNorthernIreland@rcem.ac.uk**
All Royal Colleges therefore co-signed a letter requesting a discussion on the crisis with the Secretary of State for Northern Ireland, to brief him and make appropriate College recommendations.
RCEM published a document on bed occupancy data across the UK, and we shared data for Northern Ireland with all major political parties - some acknowledged the relentless issue of bed capacity, and this is being progressed further.
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## **National Board for Scotland**
Advocacy on behalf of patients and those working in EDs has continued to be the core priority for Scotland’s National Board. This has involved engaging with the Scottish Government, opposition parties and influential stakeholders to keep public health on the agenda, with regular meetings with the Cabinet Secretary for Health and Scottish Government Health teams, attendance at Holyrood’s ‘Health Roundtable’, hosted by the Scottish Conservatives and similar, and ensuring RCEM Scotland is a constant presence, working hard on behalf of members to lobby senior policy decision makers.
We gave evidence to the Scottish Health, Social Care and Sport Select Committee, examining winter planning and resilience issues in September 2023 and a joint visit with Scottish Government representatives to NHS Grampian to review several issues across the health board’s emergency medicines resulted in recommendations being presented to the board, supported with an action plan to improve efficiency and sustainability.
Engagement with NHS Education Scotland has continued, specifically on issues facing trainees, lobbying the Scottish Government to increase funded training posts in emergency medicine in Scotland.
RCEM Scotland was represented at the Scottish Academy of Medical Royal Colleges (AOMRC), and at the Scottish Government’s Operational Performance and Delivery Board, giving an insight into reality and providing compelling evidence on current challenges. With that we discussed what could be achieved by improving ambulance handover delays and integrating ‘attendance alternatives’, such as Flow Navigation Centres.
Quarterly board meetings have been enhanced with input from external speakers and experts with an active interest in our specialty, such as ‘EM at the Deep End’ group.
Media presence has continued to be a priority across print, online, broadcast, and social media: Both the Vice President and Vice Chair for Scotland have been interviewed and quoted extensively in mainstream media.
Looking ahead to 2024 we will continue to campaign for improvements in patient safety, better working conditions and quality of care by using performance figures and evidence-based data to maximise media coverage and raise public awareness and support.
This will involve working with professional teams in RCEM to revisit the Scottish census and how we can maximise the data to effect change.
We will continue to develop cases to enhance training experience, increase trainee numbers, and the Less Than Full Time (LTFT) workforce as whole time equivalent rather than based on headcount.
Recognition is a key focus going forward – on the role and number of lead examiners in Scotland, and for our members and fellows who perform crucial College roles on councils, executives, and committees.
Preparations are well underway for RCEM Scotland’s Conference in May 2024, which will take place in Dundee.
More on evidence given to the Scottish Health, Social Care and Sport Select Committee.
Dr JP Loughrey Vice President, RCEM Scotland **VPScotland@RCEM.ac.uk**
A programme of visits to EDs across the country was undertaken to review differing models of service delivery, and to engage with fellows and members working there.
RCEM Scotland’s Conference, held in May 2023 was considered a success, with high quality attendance and abstract submissions.
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Royal College of Emergency Medicine
## **National Board for Wales**
In January 2023, RCEM Wales revealed its workforce census at the Senedd in Cardiff to a large gathering of stakeholders in emergency care, and senior politicians, including then Health Minister, Eluned Morgan.
A major finding in the data was that Wales has a major shortfall of emergency medicine consultants - one consultant per 6,800 attendances, with RCEM’s recommendation being one per 4,000 attendances. We called upon the Welsh Government to fund the appointment of 100 additional emergency medicine consultants in Wales, along with the expansion of training numbers to fill these posts. This resulted in some expansion of emergency medicine training posts, although less than requested.
Junior doctors in Wales held their first strike over a 72hour period (15-17 January 2023). It is understood that all type-one EDs remained open, with cover provided by senior employees. No serious issues relating to the strike were reported. Attendance numbers were not significantly impacted.
Throughout the year we engaged with the Welsh Government’s ‘Six Goals for Emergency Care’ project, including working with the Project Board and Working Group for the Welsh Emergency Care Data Set. We also worked with Welsh Government officials to produce a Quality Statement for Care in Emergency Departments in Wales, as a part of the six goals project.
Board issued a statement on 29 December 2023 advising patients to stay away from the ED if they did not have life-threatening conditions – they had also declared a business continuity incident the previous month. Examples like these reflect the gravity of the current state of urgent and emergency care.
We have been engaging with representatives of the Welsh Ambulance Services Trust (WAST) to discuss the controversial issue of ‘portering’. This followed WAST introducing a policy stating that crews held outside EDs were not permitted to take their patients to X-ray or CT, on the grounds that this encouraged delayed handovers. Although the policy has not yet been fully rescinded, there has been a degree of local relaxation at the discretion of the senior ambulance officer.
In 2024 we endeavour to continue lobbying for Wales to have the Urgent and Emergency Care system healthcare professionals want, and patients deserve.
It is our hope that the Welsh Government will be reinvigorated under new leadership.
Dr Rob Perry Vice President, RCEM Wales **VPWales@rcem.ac.uk**
We challenged, and will continue to challenge, the Welsh Government’s policy of ‘breach exemptions’, on the grounds that this is not a true reflection of the situation in EDs across Wales. Current breach exemptions and lack of transparent reporting is misleading to the public and demoralising for our hardworking employees. Media coverage on this in October 2023 led to meetings with members of the Senedd. Although the Welsh Government initially insisted that all patients were counted in the data and none excluded, they later released a tranche of unadjusted data. Unfortunately, they have not yet acceded to our request to publish this data every month, including bed occupancy numbers, which are also not routinely included as part of the monthly data.
Pressures on the emergency care system led to several incidents reported in the media. Swansea Bay Health
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Annual Report & Accounts 2023
## **Corporate Governance Committee**
The Corporate Governance Committee undertakes a fundamental role within the College in ensuring that there is appropriate oversight and scrutiny of the financial reporting process, the audit process, the College’s system of internal controls, the management of risks and compliance with laws and regulations. It monitors the College HR operations and has a sub committee that deals with staff remuneration.
In undertaking its role, the Committee regularly reviews key aspects of the above areas of business, as well as overall administration and IT and at each meeting the Chief Executive provides a review of organisational wide matters. Often issues arising out of our considerations of these matters triggers in-depth reviews or reports on matters of concern.
The Committee also acts a reviewer of some issues prior to their consideration by the Trustee Board; this is particularly so in relation to budget preparation and other financial issues as well as any matters of concern identified on the risk register.
2023 was a busy year for the Corporate Governance Committee with particular concerns relating to a number of budgetary issues. Early in the New Year it was clear that that the College faced an unprecedented combination of factors impacting on its finances. Given the deficit budget and the asset position it decided to establish a working party, The Property and Income Strategy Working Group (PISWG), to review the situation and provide recommendations for tackling the challenges faced. Importantly the Group would aim to settle the question of our property strategy and approach to pricing our services and our subscriptions in a financial environment that has changed considerably in the past year.
The PISWG quickly got to work and amongst its early recommendations was a tranche of increases to fees for membership, examinations, events and our Quality Improvement Programme (QIPs).
A key role of the Committee is liaison with the College Auditors who in April reported to us that they had successfully completed the audit of the College accounts for the year ended 31 December 2022 and issued an unqualified audit opinion. They commented that of all their clients we were in the top ten from the perspective of how well organised, managed and run our financial systems and processes are.
The year also marked the final year of the current corporate plan 2021 - 2023 and plans for its revision
began early in the year. The College remains ambitious in its objectives and is keen to make a step change in operational delivery, customer service and member engagement. A key aspect of the new plan will be how we monitor effectiveness, efficiency and measure success.
To underpin these objectives the committee also recommended to the Board the establishment of an Internal Audit team.
Giving due attention to the risks facing the organisation is an important feature of our work and during the year we introduced a new format for the risk register which was designed to present the risks in a clearer manner. The committee has access to all of our identified risks and the top ten of these are reviewed at each of our meetings.
Examinations continue to be high on the register and we carefully monitor the implementation of the transformation plan introduced following the recommendations of the internal and external reviews arising out of the problems of the FRCEM SBA examinations in March 2022. Good progress continues to be made in a process that is likely to take a number of years to complete. An on-going concern is when problems occurred as a result of supplier service failure, however, we are able to report that the College has developed systems that have dealt with these in a manner that puts the interests of the candidate above all else.
The year also included major review of a staff salary structure, an external consultancy with considerable experience of working with other Royal Medical Colleges was appointed to undertake this work. In addition the committee received regular reports and a wide range were HR related.
Throughout the year the Committee kept under review the Terms of Reference for all of the College’s committees.
My thanks are due to my fellow committee members and to the Chief Executive and his Directors for all their help and support.
Derek Prentice Chair Corporate Governance Committee
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Royal College of Emergency Medicine
## **Emergency Medicine Performance 2023**
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4 12
Total number of people % of patients seen within the Total number of patients who
attending an ED: four-hour waiting time target: experienced a 12-hour wait
NATIONAL 18,876,114 60.40% (measured from their time of arrival in A&E):
1,795,487
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Annual Report & Accounts 2023
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4 12
Total number of people % of patients seen within the Total number of patients who
attending an ED: four-hour waiting time target: experienced a 12-hour wait
SCOTLAND 1,310,874 66.10% (measured from their time of arrival in A&E):
56,268
4 12
NORTHERN Total number of people attending an ED: four-hour waiting time target:% of patients seen within the Total number of patients who experienced a 12-hour wait
IRELAND 647,185 56.70% (measured from their time of arrival in A&E):
109,084
4 12
Total number of people % of patients seen within the Total number of patients who
attending an ED: four-hour waiting time target: experienced a 12-hour wait
(measured from their time of arrival in A&E):
WALES 775,571 59.90%
109,557
4 12
Total number of people % of patients seen within the Total number of patients who
attending an ED: four-hour waiting time target: experienced a 12-hour wait
(measured from their time of arrival in A&E):
ENGLAND 16,142,484 58.10%
1,520,578
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Royal College of Emergency Medicine
## Our regions
As well as our National Boards, we have a number of other boards representing our different regions. Some boards are more active than others, due to the many constraints and pressures upon the volunteers who run them on our behalf, and many face common issues.
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Royal College of Emergency Medicine
## **East of England Regional Board**
It has been another challenging year in the East of England, with increasing concerns mentioned by trainees about the availability of consultant posts in the region.
More than the year before, the region has been less connected, with increasing service pressures and world-pressures leaving less time for both RCEM work and for connecting with colleagues.
There have been pressures in every area- financial, patient attendance, acuity, training posts, consultant posts and also generally in the NHS, with the effects of long running strikes taking their toll on all parts of the East of England region. And yet, we persist.
The East of England is delivering more care to more patients on a daily basis, with increased ambulance attendances in almost all trusts.
Patients are more complex than ever before, but we continue to adapt and accommodate the changing needs of our patient population.
Over the year to come, we will adapt again to accommodate the dispute between GPs and the NHS; we have shown that we can manage the burdens that industrial action place on Emergency Medicine departments, but there is certainly trepidation about what is to come.
The Regional Board has struggled to meet over 2023; the effects of industrial action and increased service pressures have taken their toll.
We hope, in 2024, to regroup as a region, with a clear plan to re-energise RCEM’s presence and activities.
Dr Nida Yasin Suri Chair East of England **EofEChair@rcem.ac.uk**
## **North West Regional Board**
EDs in the region reported common themes, with exit block, poor flow and crowding seriously affecting efficiency. There was no improvement in the summer months.
Not enough beds were available, and ambulances waited outside to transfer patients. As a result, patients took longer to be processed and overall productivity declined.
Some EDs reported 45-50 patients waiting for a bed at any one time. To address the flow Lancaster and Blackburn started urgent treatment centres (UTCs) with appropriate patients given appointments based on a streaming tool.
North Cumbria reported that they still regularly experienced 24 hour waits for admission.
Workload remained the same without any major spikes for some. Lancaster however saw a 5% increase. Complexity and intensity remained high.
West Cumberland attendances continued to increase with GP provision locally struggling.
Same Day Emergency Care (SDEC) was started in some departments, with positive reports at time of writing.
Senior consultant support for the area remained an issue. Whiston started a reverse boarding approach. Some SDECs opened for limited hours resulting in a high number of patients in ED at night which staff struggled to cope with.
Smaller units had difficulty recruiting CCT consultants and started to recruit non CCT/CESR consultants, supporting them to gain CESR. Lancaster and Blackburn successfully recruited consultants and regional CER leads working with the EDs to support CESR.
Whiston faced a substantial staffing challenge and relied on locums, resulting in staffing overspend. Staffing at nights was occasionally low, resulting in consultants working night shifts by acting down. Overseas nurses were recruited in Lancaster and Blackburn to address staffing numbers and sickness.
North Cumbria reported improvements in staffing, being fully established for nursing staff and having recruited two more substantive ED consultants. The ACP programme remains a success and they now have six credentialed ACPs.
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Annual Report & Accounts 2023
## **South East Coast Regional Board**
EM trainees were lacking on some sites but generally there were no concerns with training. Whiston and Blackburn now delivers an excellent teaching and simulation programme.
The non-medical workforce expanded throughout the region - all helping to address the shortage in medical workforce, especially during strikes.
Some site developments took place with new equipment, expansion plans to increase footfall and the implementation of a hub for local GPs to have a single point of contact with a clinician when referring patients to the Trust, an initiative that was nominated for a National Parliamentary award.
North Cumbria reported that they needed investment as they see twice the number of annual attendances per year than was designed for. They also reported that they are in the design process of a new building, which will initially function as a minor injury unit.
Overall morale remains low, making EDs a challenge to staff.
Looking ahead we plan to increase regional collaboration by holding regular regional meetings virtually, inviting external speakers.
We will elect a Deputy Chair for the region, before establishing a NW Regional Board.
Professor Sanjoy Bhattacharyya Chair North West Regional Board **NWChair@rcem.ac.uk**
EDs in the South East Coast reported increased challenges due to Junior Doctors’ Industrial Action. Poor primary care provision impacted hugely on departments with access to healthcare very challenging for patients, often with complex and timeconsuming pathways.
Mental Health provision in the ED was a serious concern, with a clear need to address the increasingly long stays that these patients have to endure. There continues to be very little appreciation of the risk involved with patients who need to be seen in appropriate environments.
Patient flow throughout EDs in the South East was poor, Minimal Residual Diseases (MRDs) remained high resulting in backlog and bottlenecks in EDs. Lack of social care seriously affected patient flow, particularly in relation to frailty.
Four-hour performance targets proved to be inadequate with most centres, except Minor Injury Units, well below target.
Dr Sarah Honess Chair South East Coast Regional **Chair@rcem.ac.uk**
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Royal College of Emergency Medicine
## **North East Regional Board**
The region has 11 EDs (two MTCs and nine Trauma Units) in seven Trusts. We have 150 consultants, and approximately 118 are under the age of 50.
Over the course of the year, attendances in North East EDs continued to rise. One hospital reported its busiest ever day in July and this was matched by record ambulance delays, with four-hour and 12-hour waits.
A short survey of all clinical leads in the region reported increased footfall, ambulance delays, ambulance waits, four-hour and 12-hour waits – reflecting the picture nationwide.
Recruitment of locally trained colleagues remains high at over 90%, something that has changed little over the years.
The number of substantive consultants per department varies from three-28. A new and increasing trend in this region is cross site working. As Trusts merge and the overall number of Trusts decrease, more consultants are working in more than one department.
The number of consultants working less-than-full-time hours (LTFT) is increasing.
We currently have 71 Higher Specialist Training (HSTs), almost half of whom work LTFT (most commonly at 80%).
Our regional conference took place in January at Spanish City in Whitley Bay - this event has been occurring every January for about twenty years. Originally a small local event attended by Registrars and Consultants from the North East, the event has grown over the years. 18 years ago, there were 35 delegates – organised by four trainees, now more than 100 delegates attend. National and international speakers attend when originally it was considered a forum for local trainees and sometimes consultants to present their work.
Looking ahead I plan to conduct a regional census for activity, workforce structure and workforce planning.
Dr Alex Johnston Chair North East Regional Board **NEChair@rcem.ac.uk**
## **Yorkshire and Humber Regional Board**
The Yorkshire and Humber Regional Board has been busy engaging with board members and departmental clinical leads from across the region.
Regional Higher Specialist Training (HST) took place in February 2023 to increase awareness of some of the non-exam activities of the College. We discussed the region’s 87% RCEM Wellbeing Report, regional EMTA results, and Jayne Hidderley (Lay chair) presented the RespectED campaign.
Some attendees shared insight and personal experience of incivility and bullying in our regional EDs. A pattern appeared that suggested that two Trusts were causing many of the reported incidents. The regional chair met with leads of both departments and has been very encouraged by how open they were to meet, discuss and admit that problems exist.
For the RCEM regional board’s study day in June 2023, we partnered with the Faculty of Emergency Nursing (FEN) to deliver a regional sharing and learning day, with a minor injury and wellness focus. It was open to all ED clinical employees and attended by sixty delegates at the Yorkshire Wildlife Park - the overall feedback was positive.
Looking ahead we will endeavour to recruit new members to the board and continue to link in with local clinical leads.
As the conduit to share information from the College across Yorkshire and Humber, we will continue to ensure the region’s views and experiences are represented and relayed back to RCEM.
For 2024 we aim to increase interaction with local politicians, especially with the General Election approaching and another HST session will be provided to the region, and we plan to host further events, with the first one focusing on Information Sharing to Tackle Violence (ISTV).
Dr Sally-Anne Wilson Chair Yorkshire and Humber **YHChair@rcem.ac.uk**
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Annual Report & Accounts 2023
## **West Midlands Regional Board**
In 2023 West Midlands Regional Board undertook work to increase visibility and engagement with RCEM with members and fellows from the regions participating in RCEM activities and increasing awareness of RCEM’s role and activities.
The board supported the RCEM England Workforce census by liaising with all departments and clinical leads and have hosted a further RCEM supported event in March on Inclusion and Diversity with excellent feedback.
The board are now working on hosting the first regional organised RCEM virtual study day in October 2024 on Minor Injuries and look forward to the Spring 2025 CPD event being hosted in the region also.
Dr Susan Dorrian Chair West Midlands **WMChair@rcem.ac.uk**
## **South West Regional Board**
2023 was a challenging year, with some departments showing an improvement in flow and others continuing to face extreme challenges with ambulance handover delays, crowding and exit block.
These pressures are impacting the delivery of research, but the South West continues to have a strong position in the development and leadership of large clinical trials.
Type one ED performance continued to be challenged, masked by the reporting of organisational performance combining type one and type three data. Type one performance remained much the same as the previous winter.
Waits of one or two days for a bed were the norm in some departments for admitted patients. The South West unfortunately continues to dominate with ambulance handover delays compared to other regions across England. A reduction in bed-base impacted flow out of EDs, providing no respite after the winter period.
Industrial action put significant pressure on consultants to fill strike rotas. Sustainability of this was a huge concern, as was the cost - accumulation of time off in lieu (TOIL) and impact on future rota management.
More Physician Associates (PAs) have been joining ED teams across the South West. A regional survey, to which 16 departments responded, revealed that nine employ PAs and seven do not. PAs not being regulated and unable to prescribe or order radiological investigations continues to be a barrier, but some have reported PAs having a positive impact. We await the RCEM official position on PAs, expected in 2024.
Across the entire workforce, the burden of supervision is growing rapidly – for trainees, ACPs, PAs, and international recruits. Luke Ball took over as chair of the board in January 2024, having previously held the position of deputy chair.
Looking ahead to 2024, the board is looking to develop visibility across the region.
Dr James Gagg Chair South West Board **SWChair@rcem.ac.uk**
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Royal College of Emergency Medicine
## College teams
Around 70 employees work at the College across a number of teams, from front facing delivery of examinations to behind-the-scenes finance and IT. Here we take a look at some of the key headlines for 2023, summarised also in our financial section of this report from page 68.
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## **International**
Our international team works globally to improve the standards and delivery of Emergency Care. In 2023 it:
- Secured £126,000 funding from Health Education England to develop a two-year Emergency Medicine core programme to follow the Emergency Medicine Foundation Programme (EMFP) to support the development of EM in India and began developing plans to create two updated curricula for the programme.
- Secured a £40,000 programme from the European Union/Tropical Health and Education Trust (THET) to support the development of post graduate training of Emergency Medicine in the Northwest of Syria. This initiative aims to address the healthcare challenges in an area still grappling with significant conflict.
- Continued a small-scale £10,000 Departmental of Health and Social Care (DHSC)/THET partnership with the Ghana College of Physicians and Surgeons which also saw RCEM sponsor the African Conference of Emergency Medicine in Accra, Ghana.
- In December 2023 RCEM secured £155,000 from the DHSC/UK AID/THET. This funding was for a programme to be delivered in 2024 to play a pivotal role in advancing post-graduate medical education in Ghana through our collaboration with the Ghana College of Physicians and Surgeons. www.thet.org/announ…ramme/
- Helped to ensure generous donations from the College’s Syria appeal fund reach selected hospitals impacted by the earthquake in February 2023, making a tangible impact on healthcare facilities in need.
- Continued the delivery of the EMFP programme in India and Pakistan into its fifth year and saw the Kerela Institute of Medical Sciences sign up as a new site.
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Annual Report & Accounts 2023
## **RCEMLearning**
Our RCEMLearning team manages RCEM’s online educational platform and resource for the Emergency Medicine community. Providing a wide range of educational materials, which are all mapped to the RCEM curriculum, learning content includes blogs, clinical cases, EM quizzes, iBooks, learning sessions, Podcasts, references, short answer questions (SAQs), and single best answer questions (SBAs). The CPD diary is also a feature of RCEMLearning so that members can record CPD activity.
**Number of items published**
**New pieces of content**
320
149
> **Podcast Downloads** 58,324
> **RCEMLearning** 3,917,700 **website page views**
**Reviewed pieces of content**
171
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Royal College of Emergency Medicine
## **Events**
Our events team delivers conferences, study days and diploma ceremonies across the UK, supporting the education curriculum and beyond. With changes in audience behaviours post COVID, we continued to adapt the way we delivered our activity, but very pleased to be able to return to face-to-face events. We were delighted to welcome our Patron HRH The Princess Royal to three of our events in 2023.
|**Attendees:**|**Types of event:**|
|---|---|
|5,715
**Total number of people**
**registered to attend an**
**event**
5,598
**Those registered for**
**live events**
117
**Those registered for**
**content on-demand**
**Event stats:**|2
**Flagship conferences**
3
**Pre-conference**
**workshops**
2
**Multi-disciplinary**
**group conferences**
27
**Number of study days**
1
**On demand only**
**study days**|
|39
**Events overall**
19
**Face-to-face events**
11
**In London**
8
**In the regions**|2
**Practical workshops**
2
**Diploma ceremonies**
17
**Virtual events**
3
**Hybrid events**
427
**Abstracts received**
**across eight events**|
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Annual Report & Accounts 2023
## **Membership**
Our membership continues to grow with the highest number of members joining in a year – 1,949 - reaching 12,000 members.
We also:
- Launched no cost membership for members on new parents leave.
- Implemented new subscription members completing FRCEM but who are pre CCT.
- Launched more items in our merchandise range and increased sales to over £6,000.
- Launched our customer service standards project and vision, to help be more responsive to our members, launching LiveChat across every page on the website.
- Answered on average 253 LiveChats a month with an average satisfaction survey of 95% and dealt with on average 782 calls a month.
- Started working with Medics Money to communicate with members the tax relief available and how to easily claim this.
- Revamped our wellbeing newsletter, increasing our open rates to 58%.
- Relaunched our partnership with Royal Society of Medicine (RSM) providing discounted RSM membership to RCEM members.
We were also delighted to support fundraisers to take part in two national events - the London Landmarks Half Marathon and The Royal Parks Half Marathon - raising £2,300; and supported the ‘Together for Northwest Syria Medical Aid’ appeal which raised over £8,000. Our legacy campaign – to encourage members to consider donating to us in their will was also launched.
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Royal College of Emergency Medicine
## **Exams and Training**
Providing examinations and training is at the heart of the College and we increased our numbers again in 2023. We:
- Facilitated 11,976 exams candidates across 14 exams and 71 exam days across 54 countries, supported by 627 examiners using 400 OSCE scenarios and 1,080 theory exam questions.
- Awarded 220+ CCT, over 100 CESR registrations and 123 ACPs credentials since the pilot in 2016.
- Reduced the risk rating attributed to exams from red to amber for the first time in recent years.
The second diet of the MRCEM Primary exam, and both diets of the MRCEM SBA exam are three of the largest exams that RCEM has ever delivered and an additional 200 OSCE spaces were added in the UK in 2023. The 1,548 additional exam sittings in 2023 represent a 16.5% increase compared with 2022.
In response to growing demand for our exams, we are hugely grateful to all our examiners who volunteered their time to support these exams, including more than 300 new examiners that have been recruited and trained in the last two years.
**----- Start of picture text -----**
2022 - 2023
Exam 2020 2021 2022 2023
Difference
MRCEM Primary 2,629 3,272 3,515 3,997 482
MRCEM SBA 2,083 2,559 3,193 4,048 855
MRCEM OSCE 104 667 979 1,156 177
FRCEM SBA 574 1,025 1,190 1,102 -88
FRCEM OSCE 370 538 501 623 122
Intermediate SJP* 894 497
Critical Appraisal* 440 199
QIP* 393 277
Total 7,487 9,034 9,378 10,926 1,548
**----- End of picture text -----**
*Withdrawn from the programme of assessment following the introduction of the current RCEM Curriculum in August 2021.
Alongside our business-as-usual activity, the department continued to deliver its extensive and complex Exams Transformation Plan, completing phase one of this plan a month ahead of schedule. This transformation plan spans the full exam cycle and has identified 500 process improvements across four phases, with phase two to be completed in September 2024. The Exams department completed 35% of this project by the end of 2023.
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Royal College of Emergency Medicine
## **Policy and Communications**
Our Policy and Communications teams provide insights and analysis to the issues facing the specialty of emergency medicine, generating evidence to help illustrate the issues and influence policymakers by raising the profile externally.
The teams develop briefings and reports with which to lobby Governments, NHS England and devolved equivalents, and other stakeholders, to ensure the pressures facing urgent and emergency care remain top of the health policy agenda.
Members’ views are gathered through census work, surveys, and projects jointly undertaken with Regional Boards and Committees.
Freedom of Information Requests (FOIs) are undertaken on a regular basis throughout England, Northern Ireland, Scotland and Wales. More than 50 FOI requests were sent to NHS England and individual Trusts throughout 2023 to gather vital information such as waiting times in A&E based on age, and primary diagnosis, excess deaths, virtual beds and corridor care.
Impact monitoring allows us to help track where, when and how often our work is gaining traction. This includes references to RCEM and our work in reports/ briefings, research, policy, campaigns, and press/media. We also closely monitor what key stakeholders are taking note of – specifically if we are being listened to and supported by Members of Parliament in the House of Commons and/or House of Lords.
We were able to land our key points to an influential audience which set the tone for the year, and we continued with lots of discussions with Ministers and the Department of Health and Social Care, urging for attention on key areas.
As a result, NHS England agreed to publish 12-hour (from arrival) length of stay data routinely alongside all performance statistics – this was a great step forward.
NHS England and the Government’s Urgent and Emergency Care Recovery Plan was published and we have been watching with close interest the impact of this, urging that it must be reviewed and assessed.
We held a crisis summit at the House of Lords to discuss the crisis facing the emergency care system. The aim of the event was to build political will to address problems that will take more than an election cycle to fix, and the panel included Wes Streeting MP, Shadow Secretary of State for Health and Social Care, Lord Allan of Hallam, Liberal Democrat Lords Spokesperson (Health), Anita Charlesworth, Director of Research and the REAL Centre, Health Foundation and colleagues from other Royal Colleges.
Working with Ministers in the UK and devolved governments, questions of impact are tabled via the main political parties. In 2023, we tabled more than 20 questions on various issues that need addressed to improve Urgent and Emergency Care.
In addition to this, we ensure members’ voices and that of RCEM are heard by submitting evidence on a range of consultations. In 2023, RCEM President Dr Adrian Boyle gave evidence to the Health and Social Care Select Committee as part of their A&E Departments Enquiry.
We started 2023 with a bang with high profile media coverage swiftly followed by a visit to Downing Street.
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Annual Report & Accounts 2023
**We also set out our manifesto in anticipation of a new Government in 2024 and promoted our key policy asks:**
**End overcrowding in Emergency Departments and ambulance queues outside hospitals**
**Resource the NHS to ensure the emergency care system can provide equitable care to all**
**Provide the UK with enough emergency medicine staff to deliver safe and sustainable care**
**Introduce transparent ways of measuring how hospitals are performing so we know which ones to improve**
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Royal College of Emergency Medicine
## **Key statistics**
101 news pieces issued, which included press releases, member newsletters (College News) and blogs
15,142 mentions of the Royal College of Emergency Medicine in print, online and broadcast media
65%+ Email Open Rate
in line with our strategy to increase engagement streamlined our member newsletters with an average 65.78% open rate on our email communications
4,348,662 page views of www.rcem.ac.uk with a total of **506,142 unique users**
## Increase of 2,825 followers
on our main social media account X, formerly Twitter
59 meetings with stakeholders /policymakers
Cited 34 times in Parliament
11 reports briefings, and consultation responses
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Annual Report & Accounts 2023
## **Quality**
Our Quality Improvement Programmes (QiPs) enhance and promote quality in EDs across the UK, ultimately leading to improved patient care.
In 2023, data was gathered on three QIP topics: Mental Health, Infection Prevention & Control, and Care of Older People.
**----- Start of picture text -----**
Total patient records Number of ED sites which Number of consultant
submitted for the QIPs: registered for the QIPs: posts supported:
51,972 176 47
**----- End of picture text -----**
Support was given to the 17 specialist clinical committees which help to shape RCEM quality and service delivery work, 14 toolkits and guidance documents were developed and published, and three national safety alerts were issued and promoted.
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Royal College of Emergency Medicine
## **GreenED Accreditation Programme**
Following the successful pilot of the GreenED sustainability accreditation programme in 2021-22, the College made significant strides in advancing its sustainability efforts. In March 2023, a comprehensive pilot report was published, marking the conclusion of the trial phase. By August 2023, GreenED was officially launched as a fully accredited programme.
Between August and December 2023, 12 UK-based Emergency Departments (EDs) registered to participate, beginning their journey towards accreditation, with the goal of completing the process by August 2024. The programme also expanded its international presence, presenting at the ACEM Scientific Conference in Australia in November 2023, where discussions began on a potential pilot programme for Australasia.
The GreenED initiative was made possible through the support of the Environmental Special Interest Group (ESIG) and the RCEM Quality team. Together, they promoted the programme’s sustainability framework, collaborated with other medical institutions to develop similar frameworks for other specialties, and championed the integration of sustainable practices as a means to enhance both patient care and planetary health.
## **Environmental Specialist Interest Group (ESIG)**
The environmental specialist interest group has had a busy year in 2023. Along with the quality team our members have helped to create and launch the GreenED accreditation programme.
We held our second RCEM study day on environmental sustainability and the health effects of climate change with expert speakers from around the world. We were honoured to have our patron HRH The Princess Royal attend the study day and address our audience.
Throughout 2023 we ran free evening webinars on various topics related to the climate crisis and sustainability in partnership with the centre for sustainable healthcare network.
Our team helped RCEM to respond to the Climate and Health scorecard initiative, with RCEM scoring well on advocacy and education. We have continued to work closely with the UK health alliance on climate change, to raise awareness of the health effects of climate change.
Our team have presented our work at the ICEM conference in Amsterdam, the spring CPD conference and the EMTA conference.
Thanks to everyone at the college for their ongoing support of our work.
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Royal College of Emergency Medicine
Committees
**40**
nual Retx)rt &Accounts 2023
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Royal College of Emergency Medicine
## **Committee Structure**
**----- Start of picture text -----**
Trustee
Nominations & Guidelines for Provisions Executive
Appointments Committee of Emergency Medicine Committee
Services GPEMS Project
Steering Group
Cou
Regional & National Boards The Quality Cluster Lay Group
N ational Board: Northern Ireland Invited Service Review Committee (formed as required)
N ational Board: Scotland Informatics Committee
N ational Board: Wales Service Design & Configuration Committee
R egional Board: East of England Environmental Committee
R egional Board: East Midlands Green ED Working Group
R egional Board: London Same Day Emergency Care SIG
R egional Board: North East Quality in Emergency Care Committee
R egional Board: North West Best Practice Sub Committee
R egional Board: South Central Older People in Emergency Medicine SIG
R egional Board: South East Coast Public Health SIG
R egional Board: South West Toxicology SIG
R egional Board: West Midlands Mental Health Sub Committee
Regional Board: Yorkshire & Humber Paediatric Emergency Care PAG
Pre Hospital Emergency Care PAG
Quality Assurance &
Improvement Sub Committee
Safer Care Sub Committee
**----- End of picture text -----**
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Annual Report & Accounts 2023
**----- Start of picture text -----**
e Board
Corporate Governance Remuneration
Committee Sub Committee
uncil
Membership & Organisational
Academic Cluster Professional Development
Matters Cluster Cluster
Academic Committee Consultant Forum (Not Yet Formed
Honours Committee
Careers Committee EMTA
Fundraising Advisory Board
Education Rsources & Committee EMSAS
Equity, Diversity &
E-learning Sub Committee ACP Forum Inclusions Committee
Ultrasound Education & EM Physicians Associates Forum RespectED Working Group
Training Sub Committee
Sustainable Working Practices
Examinations Committee Committee
Global Emergency Medicine Committee Gender Equity Committee
Research Committee
Training Standards Committee
Advanced Clinical Practitioners
Credentialing Committee
CESR Sub Committee
Curriculum Sub Committee
Recruitment Sub Committee
**----- End of picture text -----**
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Royal College of Emergency Medicine
## Membership & Professional Matters Cluster
Our membership and professional matters group of committees has responsibility for everything we do to support membership, including our EMTA, EMSAS and ACP specialist groups.
**44**
Annual Report & Accounts 2023
This year (2023) was an opportunity for the team to continue to build on improving membership engagement to focus on transparency and fairness for all. There was ongoing work to address historical anomalies in the membership fee structure – prompted by some members, particularly post graduate doctors in training, who pointed out the relative fairness of fees compared to the earnings of members concerned in a category. We therefore wanted to ensure a fair and transparent fee structure across different cohorts, categories and professions.
We created a Membership Decision Tree, to map out each category and found some anomalies and considerations that had not been accounted for before, such as subspecialty trainees or dual trainees, those not working towards a CCT but had passed FRCEM, those LTFT etc and set about making changes.
Difficult decisions were taken, including making reductions in some areas and increases in others - specifically in ACP and PA associate member categories. The first change to the ACP fee was met with serious concerns from our ACPs and resulted in some of our ACP community leaving RCEM altogether. Even though we know the change was the fairest thing to do, we absolutely appreciate and recognise that the increase could have been established in a better way. Learning from this, for the PA fee increase, we have asked that any new PAs joining now pay the new membership fee, and current PA members have been given notice that their subscription will increase from next year.
Following feedback from members and from EMTA we reconsidered the current fee structure for members going on maternity leave and in 2023 agreed that from 2024, there would be no cost for a year when someone was on maternity leave. This will be the year in which their maternity leave falls or members can select which year they would like to have this applied to if their maternity leave spans across years. This approach allows us to accommodate members during what can be a challenging time and brings us in line with practices from other Royal Colleges.
Trainee membership reported frustrations of not knowing their CCT date or having to constantly call us to find this out for their Annual Review of Competency Progression (ARCP). We listened and uploaded a CCT calculator on our website - it still requires some fine tuning, but trainees are finding this useful.
We are seeing some great work and projects ongoing in the different membership committees – Emergency Medicine Trainee Association (EMTA), Emergency Medicine Specialty and Specialist Doctors (EMSAS), Advance Clinical Practitioner (ACP) Forum, Equality Diversity and Inclusion Committee, Gender Equity Committee and our Sustainable Working Practices Committee.
We continue to look at ways to improve membership engagement and add value, particularly for Fellows, which will be the focus of 2024.
Work will continue on the Membership Decision Tree, and we are looking to improve services to overseas members and create a simpler e-portfolio package for our Registered Healthcare Practitioners (RHP) category.
Watch out for the new EMSAS handbook, Back to Basics guidance, and specific membership conferences and study days throughout 2024.
Dr Salma Malik Vice President Membership **VPresident@rcem.ac.uk**
For those members already on maternity leave during 2023 when the decision was made, we retrospectively honoured this arrangement for that year and refunded or credited the fee. We are proud to advocate for this change, demonstrating RCEM’s progression in development and transformation.
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Royal College of Emergency Medicine
## **Emergency Medicine Trainee Association (EMTA)**
EMTA representatives each contribute to the work of various committees across the College, representing trainees at all levels. Their work is reported in each committee’s section and will not be repeated here.
## **Committee and Members**
There are 40 members of the committee covering most regions in England, Wales, and Scotland. We do not currently have a representative in Northern Ireland and are actively trying to resolve this.
We have an even split between those in earlier stages of training and HST, and a diverse team in respect to gender, race, sexuality, and FT vs LTFT status. A new role of EM-ICM dual training representative has been established on the committee.
Quarterly recruitment rounds will continue and will include RCEMLearning, Research and ACCS representative posts.
Active dialogue and feedback with local regional reps - appointed through regional school processes is proving beneficial in highlighting and resolving issues.
Engagement from committee members is often difficult, and members of council have reported similar. We recognise that trainees on the panel undertake this work in their own time and that EM is becoming increasingly demanding. By continuing to demonstrate the improvements EMTA is capable of instigating, we are hopeful to reinvigorate interest and participation.
## **Meetings**
We have had a total of four meetings, one of which was in person at Octavia House and involved several members of the RCEM team. This was gratefully received by the committee and is something we wish to replicate in future.
## **Social Media/Website**
Tom Ludlow stepped down as social media representative after 18 months of fantastic work. His successor is Ashna Aggarwal and we continue to see positive levels engagement.
## **Survey**
Results were discussed at council in November; presented to individual committees on request; and findings specific to each subcommittee were shared directly.
This is a valuable, yet intense piece of work and we must safeguard its future by expanding the team responsible and believe turnaround time for data analysis may also be reduced with this intervention.
## **Key Objectives for 2024**
- Continue to work collaboratively with RCEM.
- Develop the website with examples of good practice.
- Continue to assist with improving trainee trust and confidence in exam processes.
- Work with RCEM on the PA working group.
- Continue to work on promoting a reduction in incivility in departments and taking part in the ‘Improving culture in Emergency Departments working group’.
- Plan 2025 conference and improve accessibility for all.
- Succession plan for when we step down as cochairs in summer 2024.
Dr Hannah Baird
Co-Chair, Emergency Medicine Trainees’ Association
Dr Lara Somerset Co-Chair, Emergency Medicine Trainees’ Association
EMTA’s website remains a solid resource and will continue to be updated with fresh content.
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Annual Report & Accounts 2023
## **Emergency Medicine Specialty and Specialist Doctors (EMSAS)**
Our Spring meeting in May 2023 was held virtually due to industrial action on the railways but we were able to meet in person at Glasgow at the Annual Scientific Conference where our sessions with varied topics were well received. Our November 2023 conference took place on the Isle of Man, with a huge amount of valuable continuous professional development.
Our network continues to grow, with new members in London, Northern Ireland, Wales, the South West and the South East. Our WhatsApp groups for EMSAS Executive and representatives - generic EMSAS (275 members) and EMSAS CESR groups - allow us to share resources including courses, clinical updates, and other issues pertinent to our members.
Going forward it was agreed to meet face-face twice a year to improve communication and productivity and agreed that it would be better to stagger any changes so that not all our representatives and executives change at the same time, so a staggered transition will be implemented to help retain institutional memory which should also have a less disruptive effect on our function.
Regular executive and representative meetings take place prior to each Council meeting and allow us to keep up to date and present EMSAS issues in a timely fashion. We plan to improve communication with our CEO, President, and other members of Council by inviting them to join us.
We have continued to have an excellent relationship with the exams team, allowing us to assist CESR applicants with exam issues.
Immad and I were part of the College task force that developed and published the revised speciality specific guidance for the new portfolio pathway (previously CESR) to ensure that it remained fair to SAS doctors of all grades including those applying for registration from outside the UK.
## **Update from current Chair, Dr Immad Qureshi**
I started as chair on 17 November 2023 and have already attended one diploma ceremony, three council meetings, been part of an exam supplier process representing EMSAS and examiners, and appointed as RCEM Trustee.
Looking ahead, EMSAS will produce a handbook for SAS Doctors, taking inspiration from the Anaesthetists Association SAS handbook.
There are plans to engage with the EMSAS membership via surveys, questionnaires, and direct mail.
We plan to start an email forum, hosted by the College and new EMSAS pins are being planned to reflect the new logo.
A dedicated EMSAS social media account will increase visibility and engagement, and we will be continuing our work on the Adel Aziz legacy project.
The 2024 EMSAS conference will take place in Scarborough in November, and planning for this will be a key priority, with our Spring Meeting due to be held in May as a hybrid event.
## More on EMSAS.
Dr Immad Qureshi Chair Emergency Medicine Specialty and Specialist Doctors Forum EMSAS@rcem.ac.uk
It has been a productive three years as chair of EMSAS. I stepped down in November at our Annual Conference 2023 but look forward to remaining involved with the executive team.
Dr Steve Black Immediate Past Chair Emergency Medicine Specialty and Specialist Doctors Forum
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Royal College of Emergency Medicine
## **ACP Forum**
The last 12 months have been a challenge for Advanced Clinical Practitioner (ACP) members of the College in similar ways to other college members but there have also been some unique challenges to this group.
The UK has seen an unprecedented amount of industrial action affecting all employee groups in healthcare, one of the themes emerging from BMA actions has been centered around Medical Associate Professional (MAP) roles which is an umbrella term thought to encompass AAs/PAS/ANPs/ACPs/ENPs. This has had a national effect on ACPs working in all specialties. Positively, RCEM remains one of the few organisations to have created a specific pathway for EM ACPs which is extremely helpful in justifying the scope of clinical practice. However, this is a real threat to the role and looking forward will continue to be one of the biggest challenges. RCEM does not view ACPs in the MAP category and there was discussion with RCEM council that this term is used to describe AA/PAs only.
RCEM’s ACP forum has grown to mirror the RCEM regional boards, however there is some work to do to integrate ACPs in each regional board.
We are almost in a position of having an ACP on every committee within RCEM where the voice of the EM ACP is of value - this has been powerful in highlighting membership benefits. There are now 122 RCEM credentialed ACPs in practice.
## **Looking ahead:**
- The next 18 months will be the final 18 months of my tenure and in 18 months the other forum members will come to the end of their tenures. Staggering the change of ACP forum representatives may avoid any loss of corporate knowledge and allow important ongoing work to continue at pace, we have some ideas of what the next ACP forum might look like, and this is work in progress.
- The 2017 curriculum will be permanently replaced by the 2022 curriculum, and the new curriculum will be reviewed.
- We hope to finalise and start processing the initial phase of the post credentialing portfolio work.
Ashleigh Lowther Chair Advanced Clinical Practitioners’ Forum ACPChair@rcem.ac.uk
Some of the most important ongoing projects for the ACP workforce is around ‘Post Credentialing’ work - the Dean and some of the ACP Forum are working on this which has the potential to be a particularly important offering to credentialed ACPs who are questioning the benefits to post credentialing membership.
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## **Sustainable Working Practices Committee**
Our main aim as a committee during 2023 has been developing a document called Back-to-Basics, which includes suggestions and recommendations on how to improve the working environment, employee experience and wellbeing within Emergency Departments. We reviewed the current guidelines and collated evidence based on our wellbeing assessment tools and 87% reports.
We are currently working on writing a business case for the next year on creating a mentoring programme for the College, which would include recruiting a team of mentors, training them using the existing resources and then matching them with mentees. Nancy Redfern from the Royal College of Physicians (RCP), who currently runs mentorship programmes and training, has kindly agreed to support this project.
As a committee, we managed to successfully secure a study day entitled ‘Are you Thriving or Surviving’ to be delivered next year with the aim to talk about the current evidence on wellbeing and what are the current support programmes and guidelines provided by the College, including examples of good practice.
We created a new special interest group - Older EM Clinicians Working Group - to create guidance and recommendations for older EM Physicians and employees. VP Ian Higginson, will be chairing the group, supported by the Sustainable Working Practices Committee.
## **Looking ahead:**
Our key projects for the year ahead are:
- To launch the Back-to-Basics campaign, recruit sites to test the efficacy with the aim of releasing the final document in September/October 2024.
- To finalise and submit the business case for the Mentoring program.
- To deliver the Study Day on the 5 September 2024.
- To share recommendations from the Older EM Clinicians working group.
- To stay up to date with our webpage and fill current vacancies for Welsh and Scottish representatives.
Dr Saurav Bhardwaj Chair, Sustainable Working Practices Committee SWPC SWPC.Chair@rcem.ac.uk
I submitted the draft for GPEMS - Wellbeing last year and awaiting further correspondence.
There is ongoing work to update the committee page and resources on our website.
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## **Gender Equity Committee**
Last year marked the end of the first term of the inaugural committee members whose commitment and energy helped make considerable progress in addressing gender equity, changing culture and behaviours.
In line with our goals of defining the issues of gender equity and changing the culture in RCEM and the wider emergency medicine community we have:
- Co-developed with the EDI committee a minimum set of metrics for RCEM to maintain focus on gender equity; this information is beginning to flow.
- Contributed to the RCEM ‘Improving culture in EDs’ work programme.
## **Looking ahead we will:**
- Recruit to vacant committee posts, with specific representation from Emergency Medicine Specialty and Specialist Doctors (EMSAS), the devolved nations and non-female College members.
- Publish first analysis of RCEM metrics.
- Support the EDI committee in delivering ‘Change begins with me’ study day in May 2024.
- Provide gender equity input into the Guidelines for Provision of Emergency Medicine Services (GPEMS) project.
- Develop the ‘Improving culture in EDs’ project with the EDI committee and wider RCEM stakeholders.
- Contributed to local and regional events.
- Represented RCEM at national events on ending sexism in medicine.
- Continued to work with the LeadersPlus Fellowship to offer RCEM part-sponsored places; supported the development of the first NHS-specific fellowships.
- Championed and welcomed the RCEM policy change of offering reduced fees to those on parental leave.
- Useful links – LeadersPlus, Emergency Medicine Continuing Education Forum
Dr Kirsty Challen Chair Gender Equity Committee GECChair@rcem.ac.uk
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Quality Cluster Our quality cluster of committees has responsibility for standards of quality and care, best practice and advice, providing clinical guidance on a range of issues relating to emergency care and patient wellbeing.
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## **Quality Cluster**
One of the most important things RCEM does is set standards for the practice of Emergency Medicine within the UK. This is also one of the areas of our activity that our members value most.
Behind the scenes we’ve been quietly reorganising ourselves, to try and bring together the committees, and more importantly the people, who are actively contributing to this field within our College. We hope this will pay dividends down the line.
The chairs of the committees, the colleagues who sit on those committees, and the college staff who support them, work really hard to produce meaningful output that can be used in practice. They are also involved in a lot of activity that is never visible, such as contributing to the work of other organisations, and influencing policies and guidelines that are being developed elsewhere. Keeping everything up to date is a real challenge. There’s been so much good work in the past, but we all know how quickly, and frequently, things change. Finally we know it can be hard to find the information we need to, and our College team are looking at how we can improve the website so that our work can be found easily.
RCEM work is voluntary, and unpaid. Many colleagues are not given time to support their participation by their host Trusts. We want to ensure that RCEM is the voice of quality in EM, and that we have the capability and capacity to deliver on that aspiration. One of our
challenges is convincing busy people, leading busy lives, to make themselves even busier by choosing to support the work of College. Their expertise is in demand, including from organisations who can pay for their time and brain power. There’s not an easy answer to this complex dynamic.
We get many requests to lend our support to work from other organisations. I like to think this is because RCEM is respected, and its support is valued. This year we’ve started being more forceful around what we will put our badge to, and what we won’t. We aim to continue in this vein, even though it can be difficult at times.
For all these reasons I am grateful to the talented people who are working within the sphere of quality within RCEM. If you want to get involved, I am sure we can find a place for you. Keep an eye out for opportunities. You are the experts in EM. Quality at RCEM can only ever be the result of your expertise being applied.
Dr Ian Higginson Vice-President, RCEM
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## **Quality in Emergency Care Committee (QECC)**
In 2023 our QECC developed and reviewed several new clinical guidelines for the speciality of emergency medicine. Notably these included, ‘Suspected nitrous oxide toxicity in the ED’, ‘Acute Behavioural Disturbance in Emergency Departments’, and ‘Invasive Procedures in the Emergency Department’. These guidelines are now integral in clinical settings and serve as resources for various professional bodies ensuring best practices are widely adopted.
QECC continued to monitor and promote high standards of clinical care throughout the UK, including keeping clinicians and patient safety leads updated on important time sensitive information. This includes publishing safety flashes for Time Critical Medications, and Cortico Steroid Dependency as well as promoting World Patient Safety Day.
The committee continues to work closely with other medical organisations including other royal colleges and NHS England. It provides RCEM representation across a variety of external committees focusing on a breadth of work from guideline development groups to providing an emergency medicine perspective on training materials.
QECC reviews and endorses work of other professional bodies as a leading voice in the emergency medicine speciality. In 2023 the committee was asked to consider endorsement of 14 items with only four of these gaining endorsement, highlighting the rigorous standards the committee upholds.
The committee has continued its work on RCEM’s Quality Improvement Projects (QIPs) encouraging Emergency Departments to improve clinical practice in 149 EDs across the UK. The national reports for ‘Pain in Children’, ‘Infection Prevention and Control’, and ‘Consultant Sign Off’ were published and presented at RCEM’s Annual Scientific Conference in Glasgow.
## **Looking ahead to 2024 we will:**
- Review previously published RCEM guidelines to continue to uphold the rigorous standards expected from our clinical guidance, expecting all current guidance published by the College to be up to date, accurate, and at the forefront of new research and evidence. This includes reviewing the current pain management guidance in the ED and guidance on patients who abscond.
- Develop various new guidelines and toolkits for clinical use including a Learning Disability in the ED toolkit as well as Frequent Attendance in the ED, and Screening in the ED guidance.
- Continue to develop consensus-based position statements for the speciality of emergency medicine on behalf of RCEM including positions on the PEWS, the increase in measles and vaccinations for ED employees, and the National Cauda Equina Syndrome pathway.
- Continue to collect data and monitor standards of clinical care using RCEM QIPs, publishing both local and national reports on Care of Older People, Mental Health: Self Harm, and Infection, Prevention, and Control for 2022/23.
- Continue the development and dissemination of patient safety strategies for the speciality of emergency medicine to safety leads nationwide by publishing safety flashes.
- Provide input into RCEM’s Guidelines for the Provision of Emergency Medical Services (GPEMS).
- Consider requests for RCEM endorsement from other organisations.
- Continue to represent RCEM on various external bodies and committees including those hosted by NHS England, National Confidential Enquiry into Patient Outcome and Death (NCEPOD), and the Faculty of Intensive Care Medicine (FICM).
Useful links – RCEM Clinical Guidance, Safety Resource Centre, Quality Improvement
Dr James France Chair Quality in Emergency Care Committee QECChair@rcem.ac.uk
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## Organisational Development Cluster
Our organisational development group of committees is aimed at improving and developing the cultures and environments within which emergency medics work, and for rewarding and honouring innovation and contribution to the sector.
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## **Equity, Diversity and Inclusion (EDI) Committee**
The EDI Committee’s focus is to identify and address EDI issues that align with our vision and strategy for 2023-2025: to be a catalyst for change and to ensure emergency medicine is an inclusive, fair, and equitable speciality for everyone.
The year started with an enthusiastic in-person strategy planning event in March, where we reinvigorated our vision and workplan. This has reaped the rewards of an industrious year for the committee during which we have significantly accelerated several work streams.
We successfully created and publicised our first EDI Calendar, supported with educational blogs to raise awareness of specific events, and shared a link to an electronic version that enables these events to pop up as reminders on members’ personal calendars. In due course we hope to add some ‘inclusion tips’ to these celebration and awareness days, so members can take immediate action to become more inclusive in their day-to-day interactions with minoritised colleagues and patients. We have also shared a series of blogs written by committee and RCEM members.
We continue to publicise and collect ‘Count Me In’ data and are reviewing the survey questionnaire to improve the interface with respondents.
We are striving to make EDI a core clinical competency for emergency medicine training by improving EDI knowledge and stamina of our educators and trainers. We presented virtually and in person to national emergency medicine leaders, regional training boards at the Training Standards Committee’s educators’ day, where our session received the highest scores across all three areas (content, usefulness, speakers).
To reduce blind spots and mitigate bias within the College we have been signposting employees, leadership, and volunteers to training - such as Active Bystander Training, which we hope to lobby the NHS to roll out nationally. We have continued to contribute in an advisory capacity to several College committees.
Looking ahead we will continue to deliver actions from the 2023-2025 workplan. This includes sustaining workstreams started in 2023.
In 2024 we plan to do more work on improving the culture of emergency medicine, creating a working group focused on this to support our membership in their working life deal with the pressures of inappropriate behaviour they can experience from colleagues in the workplace, as evidenced by a range of survey data.
Dr David Chung Co-Chair, Equity, Diversity and Inclusion Committee edichairs@rcem.ac.uk
Dr Sivanthi Sivanadarajah Co-Chair, Equity, Diversity and Inclusion Committee edichairs@rcem.ac.uk
We have continued to raise awareness about Differential Attainment (DA) and are confident that many of our trainers have now gained a much better understanding of the issues.
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## **Honours Committee**
The Honours Committee reviews nominations for College and National Honours. It is a privilege to have the opportunity to ensure that those who have made an outstanding commitment to the specialty and the College have their work recognised.
This report reflects the work of the Honours Committee during 2023 under the chairmanship of Derek Prentice who concluded his term as Chair in December 2023 and was succeeded by John Heyworth. The Honours Committee wishes to acknowledge Derek’s great work as Chair and thank Derek for his excellent contribution.
We know that RCEM colleagues are undertaking incredible work but this is often under the radar and therefore not widely known, so our work can sometimes be hampered by a lack of nominations. Among the highest honours the College can bestow is the Dr Cliff Mann President’s Medal, an honour in the gift of the President. In 2023 it was awarded to Dr Chris Moulton, a former Vice President of the College, who has made an outstanding contribution to emergency medicine, including in recent years his important work on GIRFT.
The Honours Committee welcomes nominations for future honours to be sent to honours@rcem.ac.uk.
## **In 2023 RCEM medals were also bestowed upon the following members.**
**----- Start of picture text -----**
|||
|---|---|
|Hoddon Abi|Equity, Diversity, and Inclusion Committee Chair|
|Mark Buchanan|For outstanding contribution to the RCEM|
|Simon Carley|CPD and Conference Committee Chair|
|Daniel Darbyshire|EMTA Chair|
|Sarah J Evans|East of England Regional Chair|
|Jayne Hidderley|Chair Lay Advisory Group|
|Ian Higginson|Pre-Hospital Care Committee Chair|
|Jason Long|International Education Sub Committee Chair|
|Sohom Maitra|North East Chair (Council & AAC)|
|Shashank Patil|London Regional Chair|
|In recognition of her service to emergency medicine and in particular her interna-|
|Gillian Park|
|tional work for the specialty and the College|
|Emma Redfern|Safer Care Chair|
|Alexander Robertson|Environment SIG Chair|
|Emma Rowland|London Regional Chair|
|Timothy Spruell|Environment SIG Vice Chair|
**----- End of picture text -----**
The Committee also had the pleasure of recommending to the College Council the award of an Honorary Fellowship to Professor Jonathan Benger.
Dr John Heyworth Chair Fundraising Advisory Board FoundationChair@rcem.ac.uk
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## **Fundraising Advisory Board**
RCEM’s fundraising group continued to explore all opportunities to build on successes from previous years and to support activities contributing to our fundraising aims.
Key areas of work included:
- Inviting senior Fellows and Members to consider leaving a legacy gift in their will
- Developing a strategy to attract high net worth individuals and businesses to partner with RCEM
- Highlighting donation opportunities at RCEM diploma ceremonies
- Encouraging individual fundraising events
- Reviewing the annual appeal to ensure awareness amongst the public by inviting household names with an association to emergency medicine to be the face of the campaign
## **The current priorities for fundraising initiatives are:**
- Wellbeing projects for emergency medicine clinicians
In April, three RCEM runners took part in the London Landmarks Half Marathon, raising over £2,300.
We renewed efforts to engage members with legacy giving which started with a well-received message to relevant RCEM members in the summer.
In late 2023 the decision was made to disband the Fundraising Advisory Board as part of the College’s restructuring of committees. However, the fundraising work will continue and will now be taken forward by a core group within the Engagement and External Affairs directorate.
RCEM now has an infrastructure which will optimise future fundraising opportunities. We will continue to work hard to drive the fundraising agenda and would welcome all suggestions from colleagues.
My sincere thanks to all our members who have supported our work and to the Fundraising Advisory Board for their outstanding contributions over the years.
- International work to support training and education initiatives
In early 2023 we were pleased to support RCEM member Dr Tirej Brimo in his fundraising efforts, alongside the Cambridge Global Health Partnership (CGHP), to provide direct support to healthcare workers and hospitals based in Northwest Syria following the catastrophic earthquake. As well as providing administrative support, we were able to donate to this campaign, with over £8,000 raised.
Dr John Heyworth Chair Fundraising Advisory Board fundraising.chair@rcem.ac.uk
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## Academic Cluster
Our academic committees ensure our training, education, credentialling and examinations programmes align with a structured curriculum and are delivered to a high standard and that we fund relevant research to benefit our emergency medicine sector.
During the past year we have redesigned the academic cluster to deliver strategic and operational roles to facilitate much better communication between the committees within the cluster. There has been a focus on developing strategic collaborative thinking across the cluster and we are already seeing benefits from this through better coordination and communication between the various elements.
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## **Academic Committee**
The academic strategy for the next three years was devised and will focus academic activities across the college. There are five themes:
1. Ensure that RCEM has a robust governance model across the academic cluster.
2. Ensure all educational activities and services do not perpetuate unnecessary barriers for success leading to differential attainment and strive towards fairer training for all.
3. Engage constructively with advances in technology to ensure educational products and services remain innovative and are sector-leading.
4. Ensure that RCEM delivers a workforce that is educationally fit for purpose, both now and in the future.
5. Advance emergency medicine globally.
The new portfolio (Kaizen/RIRS: Advance) has been a step forward in functionality but required a period of embedding and review/revision which the academic cluster has been overseeing. It is now embedding into practice.
We worked with the General Medical Council (GMC) to develop and revise the CESR route to CCT, to make it more streamlined whilst maintaining a high standard approach (now known as the portfolio pathway).
## **In addition, we will:**
- Ensure that exam capacity meets demand.
- Further develop learning opportunities for trainees and trainers. We will also work with all relevant parties to ensure that education is prioritised within the clinical environment and that we continue to produce highly qualified and effective doctors in practice.
- Complete the next phase of the Exams Transformation Plan that will ensure that RCEM maintains the high standards expected by trainers, trainees and the public.
- Begin work to transform the operations across the Training and International Team in line with improvements and enhancements being made in the Exams Team.
- Continue to work with partners across RCEM and the wider learning environment to promote fairer cultures for all.
Professor Simon Carley Dean, RCEM Dean@rcem.ac.uk
Developing close working relationships with key partners has remained a key strategic priority throughout the year and includes relations with the General Medical Council (GMC), Royal College of Paediatrics and Child Health (RCPCH) - for Paediatric Emergency Medicine (PEM) training and the Intercollegiate Board for Training in Pre-Hospital Emergency Medicine (IBTPHEM).
Looking ahead to 2024 we will embed the academic strategy into all areas of work within the cluster. This will mean aligning current workstreams to the strategy and ensuring that new projects support our mediumand long-term goals.
We will select and deliver a new exams management system (EMS) for the College theory exams. This will be a bold project that will embrace new technologies in exam delivery and quality control.
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## **Research Committee**
The Research Committee aims to increase research capacity and activity in the specialty and 2023 was another very successful year. We saw the launch of further highprofile emergency care funded studies to answer some of the most pressing research questions in emergency medicine and the highlight of the year was the Annual Scientific Conference, held in Glasgow in September 2023.
Other key activities in 2023 included:
- The award of six college research grants in Spring 2023 and two in Autumn 2023.
- The award of two Low and Middle-Income Country (LMIC) grants to support research internationally.
- The appointment of Dr Virginia Newcombe as one of the two RCEM professors. Dr Ed Carlton will continue in post as the other RCEM professor until April 2025.
- The appointment of Dr Edward Barnard and Dr Alex Novak in April 2023 as RCEM Associate Professors with Dr Sarah Wilson and Dr Darryl Wood to take up their appointments in January 2024.
- The award of two RCEM Pre-Doctoral Research Fellowships to Dr Cieran McKiernan and Dr Dale Kirkwood.
- The award of two RCEM Undergraduate prizes to Cellan Liiv (QI prize) and Jacob Wilks (Research prize).
- The work of the Trainee Emergency Research Network (TERN), which continued to deliver high-quality multicentre research studies under the leadership of Dr Fraser Birse and presented some of its work at a dedicated session at the Annual Scientific Conference.
- The work of the National Institute for Health and Care Research (NIHR) Emergency Care Incubator, which continued to flourish under the leadership of Professors Heather Jarman and Edd Carlton, with funding secured from the NIHR until 2025. The incubator has continued annual awards co-badged with the NIHR which highlight success and excellence in emergency medicine research and continues to focus on the development of academic careers in emergency care. Another excellent two-day event was held in Bristol in November 2023. Further details, including a list of research mentors, can be found at https://www.rcemlearning.co.uk/ecincubator-new-menu
## **Looking ahead:**
The Research Committee will continue to increase research capacity and activity in emergency medicine and aim to improve the quality and relevance of our research. In 2024 we will:
- Continue to be guided by the James Lind Alliance research Priority Setting Partnership refresh in 2022.
- Continue to strive to integrate research into clinical care and address the questions that are most important to patients and clinicians daily.
- Aim to make research and research opportunities accessible to all RCEM members and continue to promote and celebrate emergency medicine research at all levels, with the aim to make research part of usual clinical care.
- See the awarding of the RCEM three-year funded PhD fellowships which will thereafter be an annual award.
- Continue to support TERN, now an integral part of the emergency medicine research landscape, in the form of 50% of the TERN fellow’s salary costs, and a part-time TERN administrator to facilitate the set up and running of complex multi-centre TERN studies.
- Continue to refresh the committee. In 2023, Dr Etimbuk Edet Umana joined as the RCEM PhD representative and Dr Ed Barnard as lead for the Academic Department of Military Emergency Medicine (ADMEM).
Useful links - RCEM Research Committee research priorities, RCEM Research Grants, Trainee Emergency Research Network (TERN)
Professor Matt Reed Chair RCEM Research Committee Research@rcem.ac.uk
- The Clinical Studies Group hosted popular Research Engagement Days in January and June 2023, the latter building on the successful James Lind Alliance research priority setting partnership refresh in 2022, taking forwards the delivery of the selected research priorities for emergency medicine.
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## **Training Standards Committee (TSC)**
During 2023 the RCEM curriculum continued its work to ensure fair and consistent training, assessment and recruitment standards are maintained across the UK. This is enabled by an enthusiastic team of leaders in medical education and EM training including heads of school, trainee representatives, college professionals and lay members. Examples include the following.
Setting standards for EM training and assessment within the GMC framework
- Work with exam committee to ensure transparency, consistency, fairness and quality of exam questions and marking.
- Work with curriculum committee to develop ARCP decision aids for intermediate and higher training.
- Development of Portfolio Pathway to specialist registration which replaced the longstanding CESR route.
Providing advice to trainees and trainers in the UK on training and assessment
- Responsive approach to direct queries from trainees and trainers to the TSC.
Working with the UK medical education bodies to set standards for entry to training and recruitment to training posts
- Continuous development and improvement of the ACCS EM, DREEM and HST recruitment process.
- Quality management and survey of training programmes
- Survey and data analysis then production and publication of TSC Quality Review
- Working with EMTA and trainee reps to understand the trainee perspective of EM training quality across the UK
Some of these activities require a significant voluntary time commitment from TSC committee members and leads, for this we are extremely grateful.
Dr Russell A Duncan Chair Training Standards Committee
- RCEM Trainers study day in Manchester to share information, guidance and receive feedback.
- Development of TSC guidance on PHEM, PEM, early CCT and LTFT working.
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International Cluster
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Our international cluster supports the development of emergency medicine education for our international members. We continue to strive to be a world-leader in the development of global emergency medicine that is clinically excellent, evidence-based, compassionate, and equitable.
In 2023 we:
- Secured £155,000 from the Tropical Health Education Trust, Department for Health, and Social Care/UK AID. This funding will play a pivotal role in advancing post graduate medical education in Ghana through our collaboration with the Ghana College of Physicians and Surgeons. www.thet.org/announ… ramme/
- A four-year extension from the EU to support the development of emergency medicine in the Northwest of Syria. This initiative aims to address the healthcare challenges in an area still grappling with significant conflict.
- A £10,000 grant from the Tropical Health and Education Trust (THET), NHS England, is dedicated to supporting the development of Gulu Regional Referral Hospital in Uganda.
- Generous donations of over £12,000 from the RCEM Syria appeal fund, which have now reached selected hospitals following the earthquake to support identified healthcare facilities in need.
- Sponsored part of the African Conference of Emergency Medicine in Accra, Ghana
- Hosted three visiting observer fellows from Ethiopia, Ghana, and Uganda who spent a month’s placement at Northwick Park Hospital and Chelsea and Westminster Hospital
• Continued the delivery of the EMFP programme in India and Pakistan into its fifth year and saw the Kerela Institute of Medical Sciences sign up as a new site.
There continues to be challenges regarding capacity in delivering the wide breadth of international work with an extremely small team and meeting the demand and requests from various international partners. The increased number of global conflicts as well as the economic challenges with inflation and a reduction of international funding has led to uncertainty across the international health sector.
Looking ahead, RCEM’s International Cluster will continue to support the development of emergency medicine globally. There has been an increase in programmatic work in countries who are at the early stages of developing emergency medicine and who have developed a small cohort of EM Consultants and are now looking to scale up and expand their post graduate training.
RCEM has helped forge strong health partnerships by using the skill set of our membership to support developments in the education and training in emergency medicine to ensure high standard quality health care is delivered to patients in these settings.
Dr Jason Long Vice President International VPresident@rcem.ac.uk
- Held our first Medical Training Initiative Day which brought together 26 of our current applicants from the Caribbean, Africa, and Asia to help guide them through the process, and prepare them for life and work in the UK.
- Secured funding to develop a two-year EM core programme to follow the Emergency Medicine Foundation Programme (EMFP) to support the development of EM in India
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Lay Advisory Group
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Members of the Lay Group provide an all-important lay/patient perspective to the work of the College, and in this role can ensure that this key aspect is taken account of in the development of College policies.
During 2023, 10 members of the Lay Advisory Group sat on approximately 36 College Committees, Special Interest Groups, and regional boards, as well as examinations appeals. Lay members were also represented on the Scottish and Welsh Boards. In addition, several of the Group held related committee and board roles at the Academy of Medical Royal Colleges and the NHS.
Lay members have made a particular contribution to the work of the Research, Training Standards, Academic, Quality in Emergency Care, Mental Health and Governance Committees. We are also actively engaged in the Guidelines for the Provision of Emergency Medical Services (GPEMS) project. The work of our colleagues on the Scottish and Welsh Boards is also worthy of note.
Despite our limited numbers we have also started to attend regional board meetings and we have benefited from several visits to EM departments.
The latter half of the year was particularly challenging with members leaving the Lay Group or coming to the end of their term of office and recruitment is underway so in 2024 we expect to welcome new members.
Former Chair Jayne Hidderley left office in January at the end of her term and our thanks to Jayne for her work in what has been a difficult period. Dennis Franklin, who has served on the Lay Group since its inception and was also Chair of the Governance Committee until 2020 also left the Committee, as did Joan Aitken and Martin Rolf who represented the Lay Group on the Scottish and Welsh Boards - all have made notable contributions to the work of the College.
Derek Prentice Chair Lay Advisory Group LayChair@rcem.ac.uk
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## Financial Report
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## **Report of Trustees**
**Trustees submit their annual report together with financial statements of the College for the year ended 31 December 2023.**
## **Reference and administrative details of the charity, its trustees and advisors**
**----- Start of picture text -----**
|||
|---|---|
|Status|The College is a charitable body incorporated by Royal Charter on|
|12 December 2007. The College is registered with the Charity’s|
|Commission (charity no. 1122689) and the Scottish Charity|
|Regulator (number SC044373).|
|Registered office|Octavia House, 54 Ayres Street, London, SE1 1EU|
|Bankers|Handelsbanken|
|1 Kingsway, London, WC2B 6AN|
|Solicitors|Hempsons|
|Hempsons House, 100 Wood Street, Barbican, London, EC2V 7AN|
|Auditors|Moore Kingston Smith LLP|
|9 Appold Street, London, EC2A 2AP|
|Investment Managers|Flagstone Investment Management Ltd,|
|1st Floor, Clareville House , 26-27 Oxendon, London, SW1Y 4EL|
|Senior Leadership Team|
|Chief Executive|Gordon Miles|
|Director of Corporate Services|Nigel Pinamang|
|Director of Education|Romana Moss|
|Director of Engagement|Catherine Feast|
|& External Affairs|
**----- End of picture text -----**
**----- Start of picture text -----**
Board of Trustees From To
President Dr Adrian Boyle 2022 2025
Dean Professor Simon Carley 04/01/2023 2026
Treasurer Dr Scott Hepburn 2021 2024
Vice President (Treasurer) Dr James Gagg 2024 2027
Vice President for Memberships Dr Salwa Malik 2022 2025
Council Trustee Dr Maya Naravi 2021 2024
Council Trustee Dr Anne E Weaver 2021 2026
Member Trustee Dr Mahamed Javid Abdelmoneim 2021 01/08/2023
Member Trustee Dr Fiona Burton 2024 2027
Member Trustee Dr Stephen Jones 2021 2026
Lay Trustee Ian Ailes 2021 2024
Lay Trustee Mary Hockaday 2021 2024
Lay Trustee Palvi Shah 2021 2026
Lay Group Chair Miss Karen Jayne Hidderley 2021 09/12/2023
Lay Group Chair Mr Derek Prentice 2024 2025
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## **Structure, governance and management**
The Royal College of Emergency Medicine was constituted by Royal Charter in 2008. The registered Charity Number is 1122689. The College is also registered with the Office of the Scottish Charity Regulator. The registered Charity Number is SC044373.
The charity is governed by its trustees. The Trustee Board comprises the President, Dean, Vice President Membership, and the Vice President Treasurer who are Fellows of the College. In addition, two Members of Council, two Membership Trustees and three independent Lay Members are appointed in accordance with the College’s Charter and Ordinances.
The Board has additional support in undertaking its functions from the College Council and those involved in the standing committees. The Council and Board aims to make decisions by developing a consensus but voting by members (simple majority) is the final decision-making process. The Council is constituted by the College Role Holders (formerly known as Officers), elected members, Co-Chairs of the Emergency Medicine Trainees Association (EMTA), and Chairs of some standing committees, Chair of the College Lay Group, Chair of the Forum for Emergency Medicine Specialty and Specialist Doctors (EMSAS), Chair of Advanced Clinical Practitioners Forum and representatives from other Royal Colleges.
The Executive Committee of the College meet regularly during the periods between each Board and Council meeting.
The day to day running of the College is undertaken by the Chief Executive and a team of employees supported by the College Role Holders.
The Trustees receive a training programme to ensure they can discharge their duties effectively. Further training is available to meet individual needs. Arrangements are in place for the induction of all newly appointed trustees who receive a formal induction from the President and CEO of the College relating to their role and responsibilities as a trustee, prior to their first meeting. The Trustees additionally receive information about their role and responsibilities from a range of sources, including the Charity Commission and professional advisors to the College.
The election of Role Holders and other elected members of the Council are undertaken in accordance with the governing documents of the College. The Board and Council is chaired by the President, Dr Adrian Boyle. The Role Holders of the College have been involved in many national and international initiatives relating to the functions of the College and do so with no remuneration for their roles, they are also leading groups of College Committees helping deliver the objectives of the College. They are released by their employers to undertake this work in the wider interests of the NHS and use their own time to assist the College.
We and our membership are honoured that The Princess Royal is our Royal Patron.
The College has standing committees relating to Education and Examinations, Training Standards, Professional Standards, Corporate Governance, International aspects of College work, Research, Clinical Effectiveness and Standards, Fellowship and Membership.
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## **Report of Trustees (continued)**
## **Employee policy & remuneration of senior employees**
In relation to its employees, it is the policy of the College to observe equality of opportunity in their recruitment, development, treatment and promotion, to provide benefits superior to the statutory minimum entitlement, to recognise meritorious performance and to encourage development of individual potential by the provision of formal training. The College consults its employees on significant employment matters via our Employee Forum.
With regards to senior employees, the Board has a Remuneration Committee which reviews their remuneration arrangements periodically. In determining employee remuneration, the College undertook a review of its grading and remuneration arrangements during the year with the assistance of an expert in employee remuneration arrangements. This has resulted in some minor changes made to the pay policy.
## **Objectives**
The objectives for the Royal College of Emergency Medicine are described in our Royal Charter. To implement these our Corporate Plan sets out our corporate strategy. The strategy document is available on our website. The Corporate Plan was reviewed during 2023. The latest iteration covers the period 2024-2027.
During 2023, the Royal College of Emergency Medicine continued to promote excellence in emergency care. Our activities were focused in four key areas:
- i. Improving patient care
- ii. Support our membership to achieve sustainable satisfying careers
- iii. Advancing the practice of Emergency Medicine through research and engagement in Global Health
- iv. Support our membership with the delivery of high-quality day to day care in Emergency Departments
To achieve our objectives, we undertake a range of activities including:
- l setting the curriculum and standard of training for doctors in Emergency Medicine;
- l providing Continuing Professional Development (CPD) including through an eLearning hub, known as RCEMLearning;
- l delivering the specialty examinations for doctors pursuing a career in Emergency Medicine and making recommendations relating to the completion of specialist training to the General Medical Council;
- l working with the General Medical Council and the NHS to deliver training pathway for those developing a career in Emergency Medicine;
- l supporting our Members and Fellows including supporting Trainees, Staff Grade and Associate Specialist (SAS) doctors in Emergency Medicine.
- l providing a credentialing process for Advanced Clinical Practitioners and commenced work during 2023 to form a Working Group to establish what the role of Emergency Medicine Physician Associates, as well as any necessary training and training pathways, could be;
- l supporting and giving advice on research within the specialty;
- l working with other healthcare organisations and governments to implement the College’s campaign improve the provision of Emergency Medicine for the benefit of patients, centring this on our Resuscitate Emergency Care campaign. This campaign provides solutions to address the pressing issues in Emergency Medicine in the UK and forms the general election manifesto set out by the College. A full description of this campaign is available on our website.
- l setting, monitoring and auditing clinical standards, and preparing and disseminating guidelines for Emergency Department patient care and safety;
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- l improving data quality and the ensuring the effective integration of information technology within Emergency Medicine;
- l providing advice to other bodies relating to Emergency Medicine, including accident prevention. These bodies include the Departments of Health, other Royal Colleges and Faculties, the Royal Society for the Prevention of Accidents and many other organisations;
- l encouraging new roles in Emergency Medicine as additions to the medical team;
- l dealing with enquiries from the general public concerning Emergency Medicine and acting as an advocate for Emergency Medicine patients;
- l developing the employee structure to deliver our operations;
- l improving our information systems to reduce risk and enhance our service performance;
- l continuing to develop our risk management systems, budgeting and business planning.
## **Public Benefit**
The College provides public benefit under the Charities Act in two main ways:
- 1) for the Advancement of Education for the Public Benefit to a section of the public and
- 2) a wider benefit to the public.
In terms of public benefit our Royal Charter empowers us to:
- l advance education and research in Emergency Medicine and to publish the useful results of such research; and
- l preserve and protect good health and to relieve sickness by improving standards of health care and providing expert guidance and advice on policy to appropriate bodies on matters relating to Emergency Medicine
It also defines what constitutes Emergency Medicine as follows:
“Emergency Medicine: means the branch of medical science which is based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development. Within such definition, the day-to-day practice of Emergency Medicine in the United Kingdom encompasses the reception, resuscitation, initial assessment and management of undifferentiated urgent and emergency cases and the timely onward referral of those patients who are considered to require admission under the in-patient specialist teams or further specialist assessment and/or follow up.”
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## **Report of Trustees (continued)**
## **Public Benefit (continued)**
## **Fundraising**
As can be seen from the preceding explanation of our activities a significant amount of our resources are directed for the advancement of education and research in Emergency Medicine and to publish the useful results of such research.
In terms of a wider public benefit, taking from our Charter again: we “preserve and protect good health and to relieve sickness by improving standards of health care and providing expert guidance and advice on policy to appropriate bodies on matters relating to Emergency Medicine”.
Our Members and Fellows working with their NHS colleagues provide a clear benefit to well over 16.7 million people through Major Emergency Departments in the UK1, we also take part in a wide range of other initiatives to support the public; for example, our work on the effects of alcohol amongst others. The College also deals with enquiries from the general public concerning Emergency Medicine and acts as an advocate for Emergency Medicine patients.
During 2023 the College continued to develop its fundraising capabilities. Our engagement with a firm of professional fundraising consultants working alongside a dedicated employee focused on the implementation of our fundraising strategy. Our fundraising was overseen by a Fundraising Advisory Board who ensure that we adhere to the tenets of the Charity Commission guidance. We continue to comply with the requirements of the Charities (Protection and Social Investment) Act 2016 and no complaints were received in respect of fundraising activity. Furthermore, the College does not fundraise in any way that could be expected to unreasonably intrude or place undue pressure on vulnerable people and other members of the public to give money or other property to the College. Our approach to fundraising is to approach contacts, stakeholders and our membership for specific appeals, and we also have a Just Giving page. We are registered with the Fundraising Regulator.
The Trustees confirm in accordance with section 17 of the Charities Act 2011 that they have had due regard to guidance issued by the Charity Commission in determining the activities of the charity.
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## **Achievements and Performance**
During 2023 our work to enhance the reliability of our examinations continued with the first phase of the Examinations Transformation Plan being delivered ahead of target. We continued to deliver our examination results effectively.
Our events team successfully delivered a programme of online study days and conferences, including a hybrid Scientific Conference and CPD conferences where delegates were present in person and online. Significant work has been undertaken communicating RCEM Learning content. We continued to provide clinical guidance and through our Emergency Medicine Journal, study days, scientific conference, research programme and Continuing Professional Development programme support the development of the emergency medicine profession.
Our Clinical Quality Audits have continued. We launched our Green ED initiative which helps emergency departments work on their environmental performance. Our Research programme continues to gain strength and we have a vibrant research community growing in the specialty.
The Policy Team launched our Resuscitate Emergency Care campaign and undertook associated engagement in the political arena to set out our case for more support for the specialty. This campaign provides solutions to address these pressing issues so that Emergency Department employees can deliver safe and timely care for patients.
The campaign focuses on the following key areas to:
- l End ambulance queues and overcrowded Emergency Departments
- l Provide the UK with enough Emergency Medicine employees to deliver safe and sustainable care
Our Membership team continued to make significant progress on automating and streamlining membership processes to make it easier for our membership. They are also developing our approach to adding more member value to our services.
Internationally the MTI programme continued. The Emergency Medicine Foundation Programme continued to build on its earlier successes. We have no capacity for further expansion of our examinations overseas at this time. However, we will continue to work with our partners abroad to deliver existing commitments but for the foreseeable future we shall not be in a position to offer further examination centres overseas as we work to implement the process and systems improvements that support our examinations.
Our internal support arrangements were consolidated as our Corporate Services function developed. Our HR team have continued to work to improve employee recruitment, retention, development, engagement and wellbeing notwithstanding the fact that for most of the year our employees were working from home.
Our operations remain concentrated on our building at Octavia House as a hot desking and examinations centre. Our Breams Buildings property is partly let with additional space there being offered for rent on a short-term basis the space which we are not using.
The work of the College is a collaborative team effort from our employees and emergency medicine professionals, to our membership: “We help those who help the sick and injured.” We continue to provide information, guidance, re-engineer our operations and make sure our services continue.
- l Resource the NHS to ensure the emergency care system can provide equitable care to all
- l Introduce transparent ways of measuring how hospitals are performing so we know which ones need to improve
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## **Financial Review**
The Trustees are pleased to report that total incoming resources for 2023 were £10.945m (2022: £9.646m).
**----- Start of picture text -----**
Incoming resources 2023 % 2022 %
Donations & Grants 220,910 2% 111,434 1%
Other Income 214,453 2% 185,949 2%
Investment Income 118,649 1% 20,108 0.2%
Emergency Medicine Journal 462,500 4% 395,217 4%
Subscriptions 4,296,859 39% 4,048,288 42%
Conferences & CPD 1,043,680 10% 981,498 10%
Examinations 4,113,953 38% 3,571,117 37%
Training 229,021 2% 203,364 2%
Clinical Audit 245,083 2% 128,706 1.3%
(Quality Improvement Program)
Total 10,945,109 100% 9,645,680 100%
**----- End of picture text -----**
The principal funding sources for the College remain membership subscriptions and examinations income. These funding sources are in line with the main educational activities and charitable aims of the College.
At the end of 2023 the total membership rose to 12,177 (11,507), an increase of 5.8% from 2022. For 2023 the numbers of Fellows and Members both increased by 15% reflecting the increase take up in examinations.
Total resources expended during 2023 were £11.196m (2022: £9.810m). An increase of 14% and includes key expenditure outlined on page 73 in this report.
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## **Financial Review (continued)**
Major areas of expenditure were as follows:
**----- Start of picture text -----**
Resources Expended 2023 % 2022 %
Raising funds 5,099 0% 3,851 0%
Emergency Medicine Journal 666,910 6% 643,178 7%
Research & Publications 343,270 3% 408,690 4%
Education & Examinations 4,867,308 43% 4,403,933 45%
Training Standards Committee and 1,622,701 14% 1,285,720 13%
general training
Conferences & CPD 1,385,668 12% 1,156,600 12%
Membership Services 711,839 6% 635,309 6%
Quality In Emergency Care 655,056 6% 510,732 5%
Policy & Professional Affairs 803,323 7% 663,094 7%
NHS Project Expenditure 14,250 0% 40,345 0.4%
RCEM Foundation 106,037 1% 59,014 0.6%
Home Office 12,850 0% 0 0.%
Total 11,196,310 100% 9,810,466 100%
**----- End of picture text -----**
## **Investment policies and returns:**
The Trustees have the power to invest funds and can use this power to invest in a range of ethical areas where reasonably possible.
The College has £1,141,499 on deposit with Flagstone Investment Management Limited on their cash Investment platform. The Trustees keep this investment under review periodically.
## **Risk Statement**
The trustees of the College are responsible for ensuring that procedures are in place to identify risks that the organisation may be exposed to. Trustees ensure risks are considered as an integral element of all decision making and identify appropriate procedures to ensure that risk levels are acceptable in each case.
The College’s Risk Register sets out the most significant risks classified by governance, operation (business continuity), finance, environment, regulatory compliance and reputation. Each risk is scored against a matrix of impact and likelihood. The College then puts in place steps that monitor, manage and mitigate these risks.
The risk register maintained by the Director of Corporate Services on behalf of trustees. The register is reviewed on a regular basis at the meetings of the Corporate Governance Committee and the Board. The key risks are reviewed by the Board regularly.
Our risk management process complies with the best practice as set out in the latest guidance from the Charity Commission.
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## **Financial Review (continued)**
## **Significant risks for the College include:**
- l Operational, Reputational, Financial and Governance - Examinations: The College is one year into a three year change programme for our examinations operations. It is anticipated that this will improve operational performance in this area. The examinations delivery has significantly improved during 2023 and no issues were identified in the accuracy of our results. This improvement led to the Board downgrading of the risk in this area at the year end recognising the progress made.
- l Operational and Reputational – Training: We experienced some unexpected costs in relation to our ePortfolio platform during the year. We have worked closely with our suppliers to establish a system to ensure that billing is done accurately in future.
- l Financial – Inflation and interest rates: Description: The prevailing macroeconomic uncertainty continues to pose financial challenges for the College. This raises the potential risk of the College facing a budget deficit exceeding the initially projected estimate and timeline. This risk is influenced by both external and internal factors that may hinder our ability to increase income while witnessing escalating costs. To recognise the increasing inflation impact on our operations we have introduced price increases to return our budget to breakeven in 2024 with surpluses projected in 2025 and 2026.
- l Business Continuity – Cyber incidents: Cyber-attacks, cyber enabled crime, IT failure/ outage, data breaches, fines and penalties. With cyber-attacks and cyber enabled crime on the rise there is a risk of cyber and data security breach. The College is now a cyber essentials accredited organisation, and we are working to achieve the cyber essentials plus accreditation. Furthermore, we dedicate a section of our business continuity plan to managing IT outages, security breaches and have physical and virtual infrastructure in place to minimise the possibility of this.
## **Reserves policy**
As of 31 December 2023, the total funds of the College amounted to £10,334,014, compared to £10,585,215 in 2022. Of this total, £456,650 (2022: £466,483) is restricted and not available for the general purpose of the College. Unrestricted funds totalled £9,877,364 (2022: £10,118,732), of which £8,595,550 (2022: £8,089,705) is designated funds. Designated funds represent amounts ‘ring fenced’ by the trustees from unrestricted funds for particular use by the College. As at 31 December 2023, there are two designated funds, tangible fixed assets fund and organisational development fund. Most of the designated amount pertains to tangible fixed assets of the College, net of a related bank loan, reflecting that these funds cannot be realised without disposing of the assets. The organisational development fund is designated to support restructuring, digital transformation, operational and service delivery improvements, and process reengineering over the next 2 years. The Trustees, considering the College’s risk position, have determined that the College should maintain a minimum reserve target equivalent of six months’ overhead cost for the following financial year, thus this target is £2.9m for the year ending 31 December 2023. Despite efforts to maintain adequate reserves, the College was unable to meet this target during the year as it focused on reducing the bank loan and made significant investments in operations. The free reserve held at 31 December 2023 is £1,281,814 (2022: £2,029,027). The Trustees have agreed on plans to strengthen reserve levels in the future. The Treasurer will be responsible for deciding how to hold the reserves, whether in interest-bearing accounts or investments, considering the overall financial position of the College. The reserves policy will be subject to review in the coming year to ensure its continued effectiveness and alignment with the College’s financial goals and strategic objectives.
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## **Future Plans**
Our Corporate Plan 2020 – 2023 sets our current strategic aims, this plan is currently under review. Subject to that review our strategic aims remain as follows:
1. Improving patient care
2. Support our membership to achieve sustainable satisfying careers
3. Advancing the practice of Emergency Medicine through research and engagement in Global Health
4. Support our membership with the delivery of high quality day to day care in Emergency Departments
The Trustees are developing a new Corporate Plan to take effect in 2024.
## **Statement of Trustees’ responsibilities**
The Trustees are responsible for preparing the Trustee Report and the financial statements in accordance with applicable law and regulations. Charity law requires the Trustees to prepare financial statements for each financial year in accordance with United Kingdom Generally Accepted Accounting Practice (United Kingdom Accounting Standards) and applicable law. Under charity law the Trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the charity and the group and of the charity’s net incoming/outgoing resources for that period. In preparing these financial statements, the Trustees are required to:
The Trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the charity’s transactions and disclose with reasonable accuracy at any time the financial position of the charity and enable them to ensure that the financial statements comply with the Charities Act 2011, the Charity (Accounts and Reports) Regulations 2008, the Charities and Trustee Investment (Scotland) Act 2005 and Charities Accounts (Scotland) Regulations 2006 (as amended) and the provisions of the charity’s constitution. They are also responsible for safeguarding the assets of the charity and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
## **Appreciation**
The trustees wish to thank the College employees for their unstinting hard work during 2023 and their on-going efforts in the daily administration of numerous areas of College activity.
The trustees wish to acknowledge the immense quantity of high quality work undertaken by College employees, Officers, Committee members and College members to deliver the charitable objectives of the College. Approved by the Board of Trustees on 27/06/2024 and signed on their behalf by:
- l select suitable accounting policies and then apply them consistently;
- l observe the methods and principles in the Charities SORP;
- l make judgments and estimates that are reasonable and prudent;
- l state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the financial statements;
- l prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charity will continue to operate.
Dr Adrian Boyle President
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## **Independent Auditor’s Report to the Trustees of The Royal College of Emergency Medicine**
## **Opinion**
We have audited the financial statements of The Royal College of Emergency Medicine for the year ended 31 December 2023 which comprise the Statement of Financial Activities, the Balance Sheet, the Cash Flow Statement and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including FRS 102 ‘The Financial Reporting Standard Applicable in the UK and Republic of Ireland’ (United Kingdom Generally Accepted Accounting Practice).
In our opinion the financial statements:
- l give a true and fair view of the state of the charity’s affairs as at 31 December 2023, and of its incoming resources and application of resources, for the year then ended;
- l have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and
- l have been prepared in accordance with the requirements of the Charities and Trustee Investment (Scotland) Act 2005 (as amended), regulations 6 and 8 of the Charities Accounts (Scotland) Regulations 2006 (as amended) and the Charities Act 2011.
## **Basis for opinion**
We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s Responsibilities for the audit of the financial statements section of our report. We are independent of the charity in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.
## **Conclusions relating to going concern**
In auditing the financial statements, we have concluded that the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate.
Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charity’s ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue.
Our responsibilities and the responsibilities of the trustees with respect to going concern are described in the relevant sections of this report
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## **Independent Auditor’s Report to the Trustees of The Royal College of Emergency Medicine**
## **Other information**
The other information comprises the information included in the annual report, other than the financial statements and our auditor’s report thereon. The trustees are responsible for the other information contained within the annual report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon.
Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.
We have nothing to report in this regard.
## **Matters on which we are required to report by exception**
We have nothing to report in respect of the following matters where the Charities Accounts (Scotland) Regulations 2006 (as amended) and the Charities Act 2011 requires us to report to you if, in our opinion:
- l the information given in the Trustees’ Annual Report is inconsistent in any material respect with the financial statements; or
- l the charity has not kept adequate accounting records; or
- l the financial statements are not in agreement with the accounting records and returns; or
- l we have not received all the information and explanations we required for our audit.
## **Responsibilities of trustees**
As explained more fully in the trustees’ responsibilities statement set out on page 13, the trustees are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.
In preparing the financial statements, the trustees are responsible for assessing the charity’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the charity or to cease operations, or have no realistic alternative but to do so.
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## **Independent Auditor’s Report to the Trustees of The Royal College of Emergency Medicine (continued)**
## **Auditor’s responsibilities for the audit of the financial statements**
We have been appointed as auditor under section 44(1)(c) of the Charities and Trustee Investment (Scotland) Act 2005 and Section 144 and 154 of the Charities Act 2011 and report in accordance with those regulations.
Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.
As part of an audit in accordance with ISAs (UK) we exercise professional judgement and maintain professional scepticism throughout the audit. We also:
- l Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control.
expressing an opinion on the effectiveness of the charity’s internal control.
- l Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the trustees.
- l Conclude on the appropriateness of the trustees’ use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the charity’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the charity to cease to continue as a going concern.
- l Evaluate the overall presentation, structure and content of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions and events in a manner that achieves fair presentation.
We communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit.
- l Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purposes of
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## **Explanation as to what extent the audit was considered capable of detecting irregularities, including fraud**
Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below.
The objectives of our audit in respect of fraud, are; to identify and assess the risks of material misstatement of the financial statements due to fraud; to obtain sufficient appropriate audit evidence regarding the assessed risks of material misstatement due to fraud, through designing and implementing appropriate responses to those assessed risks; and to respond appropriately to instances of fraud or suspected fraud identified during the audit. However, the primary responsibility for the prevention and detection of fraud rests with both management and those charged with governance of the charity.
Our approach was as follows
- l We obtained an understanding of the legal and regulatory requirements applicable to the charity and considered that the most significant are the Charities Act 2011, the Charity SORP, the Charities and Trustee Investment (Scotland) Act 2005 (as amended), regulations 6 and 8 of the Charities Accounts (Scotland) Regulations 2006 (as amended) and UK financial reporting standards as issued by the Financial Reporting Council.
- l We assessed the risk of material misstatement of the financial statements, including the risk of material misstatement due to fraud and how it might occur, by holding discussions with management and those charged with governance.
- l We inquired of management and those charged with governance as to any known instances of non-compliance or suspected non-compliance with laws and regulations.
- l Based on this understanding, we designed specific appropriate audit procedures to identify instances of non-compliance with laws and regulations. This included making enquiries of management and those charged with governance and obtaining additional corroborative evidence as required.
There are inherent limitations in the audit procedures described above. We are less likely to become aware of instances of noncompliance with laws and regulations that are not closely related to events and transactions reflected in the financial statements. Also, the risk of not detecting a material misstatement due to fraud is higher than the risk of not detecting one resulting from error, as fraud may involve deliberate concealment by, for example, forgery or intentional misrepresentations, or through collusion.
- l We obtained an understanding of how the charity complies with these requirements by discussions with management and those charged with governance.
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## **Independent Auditor’s Report to the Trustees of The Royal College of Emergency Medicine (continued)**
## **Use of our Report**
This report is made solely to the charity’s trustees, as a body, in accordance with Section 44(1)(c ) of the Charities and Trustee Investment (Scotland) Act 2005 and Chapter 3 of Part 8 of the Charities Act 2011. Our audit work has been undertaken so that we might state to the charity’s trustees those matters we are required to state to them in an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to any party other than the charity and charity’s trustees as a body, for our audit work, for this report, or for the opinion we have formed.
Date: 18/07/2024
Moore Kingston Smith LLP, Statutory auditor
9 Appold Street London EC2A 2AP
Moore Kingston Smith LLP is eligible to act as auditor in terms of Section 1212 of the Companies Act 2006.
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## **Statement Of Financial Activities**
**(Incorporating Income And Expenditure Account) For The Year Ended 31 December 2023**
**----- Start of picture text -----**
Notes Unrestricted Restricted Total Total
Funds Funds 2023 2022
2023 2023
£
£ £ £
INCOME FROM
Donations and grants 2 86,290 134,620 220,910 111,434
Income from charitable activities 3 10,391,096 - 10,391,096 9,328,189
Investment income 4 118,649 - 118,649 20,108
Other Income 5 214,453 - 214,453 185,949
Total Income 10,810,489 134,620 10,945,109 9,645,680
EXPENDITURE ON
-
Raising funds 5,099 5,099 3,851
Charitable activities 6 11,064,975 126,236 11,191,211 9,806,615
Total resources expended 11,070,074 126,236 11,196,310 9,810,466
Net (Expenditure)/ income for the year (259,585) 8,384 (251,201) (164,786)
Transfer between funds 13,14 18,217 (18,217) - -
Net movement of funds (241,369) (9,833) (251,201) (164,786)
Total funds brought forward 10,118,732 466,483 10,585,215 10,750,001
Total funds carried forward 13,14 9,877,364 456,650 10,334,014 10,585,215
**----- End of picture text -----**
All incoming and outgoing resources are attributable to continuing activities. The accompanying notes form part of these financial statements.
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## **Balance Sheet as at 31 December 2023**
**----- Start of picture text -----**
2023 2022 Re-stated
Notes £ £ £ £
Fixed assets
Tangible assets 9 13,360,808 13,538,062
13, 360,808 13,538,062
Current assets
Debtors 10 1,047,923 1,061,492
Current asset Investment (90 days and under) 968,508 950,866
Current asset Investment (Over 90 days) 172,991 168,902
Cash at bank and in hand 2,303,364 2,067,053
4,492,787 4,248,312
Creditors: amounts falling due within one year 11 (2,419,580) (1,411,159)
Net current assets 2,073,206 2,837,153
Total assets less current liabilities 15,434,014 16,375,215
Creditors: amounts falling due after one year 12 (5,100,000) (5,790,000)
NET ASSETS 10,334,014 10,585,215
Represented by:
Unrestricted funds: 13
Designated funds 8,595,550 8,089,705
General funds 1,281,814 2,029,027
9,877,364 10,118,732
Restricted funds 14 456,650 466,483
TOTAL FUNDS 10,334,014 10,585,215
**----- End of picture text -----**
These financial statements were approved by the Tustees and authorised for issue on 27/06/2024 and signed on their behalf by:
Dr Adrian Boyle (President)
Dr James Gagg, Vice President (Treasurer)
The accompanying notes form part of these financial statements.
**87**
Royal College of Emergency Medicine
## **Statement of Cash Flows for the Year Ended 31 December 2023**
**----- Start of picture text -----**
2023 2022 Re-stated
Notes £ £ £ £
Cash flows from operating activities
Net cash generated by operating activities 17 861,795 (1,077,714)
Cash flows from investing activities
Investment income 114,560 191,206
Purchase of tangible fixed asset (28,313) (5,652)
Movement on over – 90 days current asset (4,089) 171,098
investment
Net cash provided by investing activities 82,159 356,652
Cash flow from financing activities
Repayment of bank loan (690,000) (1,210,000)
Net cash used in financing activities (690,000) (1,210,000)
Change in cash and cash equivalents in the year 253,954 (1,931,062)
Cash and cash equivalents at the beginning of the 3,017,919 4,948,981
year
Cash and cash equivalents at the end of the year 3,271,872 3,017,919
Analysis of cash and cash equivalents
Current asset investment (Under 90 Days) 879,429 950,866
Cash at bank and in hand 2,303,364 2,067,053
3,271,872 3,017,919
**----- End of picture text -----**
The accompanying notes form part of these financial statements.
**88**
Annual Report & Accounts 2023
**----- Start of picture text -----**
At start of Cash-flows Other non- At end of
year cash changes year
Analysis of changes in net debt 2023 £ £ £ £
Cash 3,017,989 253,883 - 3,271,872
253,883
Loans falling within one year (200,000) 200,000 (200,000) (200,000)
Loans falling due after more than one year (5,790,000) 490,000 200,000 (5,100,000)
Total (2,972,011) 943,883 - (2,028,128)
Analysis of changes in net debt 2022
Cash 5,033,981 (2,015,992) - 3,017,989
(2,015,992)
Loans falling within one year (200,000) 200,000 (200,000) (200,000)
Loans falling due after more than one year (7,000,000) 1,010,000 200,000 (5,790,000)
Total (2,166,019) (807,992) - (2,972,011)
**----- End of picture text -----**
The accompanying notes form part of these financial statements.
**89**
Troyal College of Emergency Medl
00
Annual Report & Accounts 2023
## **Notes To The Financial Statements for the year ended 31 December 2023**
## **1. Accounting Policies**
## **Basis of accounting**
The financial statements are prepared in sterling which is the functional currency of the charity, and rounded to the nearest pound in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective 1 January 2019) - (Charities SORP (FRS 102) second edition - October 2019)), and with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102).
The Royal College of Emergency Medicine meets the definition of a public benefit entity under FRS 102. Assets and liabilities are initially recognised at historical cost or transaction value unless otherwise stated in the relevant accounting policy note(s).
Initially recognised at historical cost or transaction value unless otherwise stated in the relevant accounting policy note(s).
## **Going concern**
The trustees undertook their annual review of going concern in December 2023 and considered several factors in concluding that the adoption of a going concern basis in the preparation of these financial statements is appropriate. They have reviewed reserves, cashflow projections and business plans, for a period of 36 months from the date of approval of these financial statements which demonstrates that the College has enough resources to meets its obligations as they fall due. Furthermore, having developed digital solutions for our examinations and conferences, trustees are content that the College has robust income streams in these areas as well as subscriptions. Our Medium-Term Financial Strategy (MTFS) 2024 – 2026 has been developed in line with our corporate aims and continues to focus on balancing our commitment to invest in improved service delivery, operational delivery and member value whilst managing our financial sustainability with respect to income generation and costs. The plan is to ensure the College exceeds breakeven budgets in each of the next 3 financial years following two deficit years in 2022 and 2023. Furthermore, the College has free reserves of approximately £1.3m at the balance sheet date, and this further affirms the conclusion to adopt the going concern basis in the preparation of the financial statements
## **Judgements and estimates**
Judgments made in the preparation of the financial statements are based on a combination of historical experience, and considered assumptions that are believed to be reasonable under the circumstances. These estimates serve as the foundation for making informed judgments regarding the
carrying values of assets and liabilities that may not be readily apparent from other sources. Trustees recognise that actual results may differ from these estimates. Estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised.
## **Income**
All income is recognised once the College has entitlement to the income, it is probable that the income will be received, and the amount of income receivable can be measured reliably. Income comprises amounts receivable during the year except for investment income which is accounted for in the period in which it is received on the basis that this is not materially different to a receivable basis. Grants are recognised when receivable and subscriptions for life membership are recognised when received. Payments received in advance of the related income being receivable are treated as deferred income within creditors.
## **Expenditure**
Expenditure is recognised on an accruals basis in the period in which the College receives the benefit from the supplies or services. Raising funds are costs of investment management, costs of merchandise and costs incurred in publicising the name of the charity. Charitable activities comprise all expenditure directly relating to the objects of the charity and, in addition, support costs which are costs which are common to a number of activities and are charged to those activities on the basis of office space used by respective employees. Support costs include governance costs which are the costs of compliance with constitutional and statutory requirements and costs related to the strategic management of the organisation.
## **Tangible fixed assets and depreciation**
Tangible and Intangible fixed assets are recorded at cost or, in cases where fixed assets have been donated to the College, at valuation at the time of donation. All items of expenditure over £1,000 regarded as fixed assets are capitalised. Depreciation and amortisation are charged at the following rates in order to write down the cost or valuation, less estimated residual value, of all fixed assets, over their expected useful lives:
||Freehold land|nil|
|---|---|---|
||Freehold building
Fixtures and fttings|2%
25%|
||Computer equipment|25%|
||Database systems|50%|
**91**
Royal College of Emergency Medicine
## **Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
The Coat of Arms and Presidential Chain of Office have not been depreciated in view of their nature. The Council believe that their current value is at least equal to their book values.
## **Investments and investment gains and losses**
Current short term Investments are stated at nominal value at the close of business at the year end. Any changes in nominal value are recognised in the statement of financial activities.
## **Pension costs**
The charity makes contributions towards employees’ personal pension schemes which are accounted for as the payments fall due.
## **Employee benefits**
- l Short term benefits Short term benefits including holiday pay are recognised as an expense in the period in which the service is received.
- l Employee termination benefits Termination benefits are accounted for on an accrual basis and in line with FRS 102.
## **Operating leases**
Rentals applicable to operating leases are charged to the SOFA over the period in which the cost is incurred.
## **Taxation**
No provision has been made for corporation tax or deferred tax as the charity is exempt.
## **Funds**
General funds are unrestricted funds which are available for use at the discretion of the trustees in furtherance of the general objects of the charity and which have not been designated for other purposes.
Basic financial instruments are initially recognised at transaction value and subsequently measured at amortised except for investments which are held at fair value. Financial assets held at amortised cost comprise cash at bank and in hand, together with trade and other debtors. A specific provision is made for debts for which recoverability is in doubt. Cash at bank and in hand is defined as all cash held in instant access bank accounts and used as working capital. Financial liabilities held at amortised cost comprise all creditors except social security and other taxes and provisions.
## **Debtors**
Trade and other debtors are recognised at the settlement amount due after any trade discount offered. Prepayments are valued at the amount prepaid net of any trade discounts due.
## **Cash and cash equivalents**
Cash and cash equivalents include cash in hand, deposits held at call with banks and other short-term liquid investments with original maturities of 90 days or less.
## **Creditors and provisions**
Creditors and provisions are recognised where the charity has a present obligation resulting from a past event that will probably result in the transfer of funds to a third party and the amount due to settle the obligation can be measured or estimated reliably. Creditors and provisions are normally recognised at their settlement amount after allowing for any trade discounts due.
## **Prior Year Adjustment**
£89,079 was removed from prior year long term current asset investments to short term, to align with the charity’s accounting policy for cash and cash equivalents. There is no impact to reserves in the previous financial year. Brought forward cash in the cash flow statement has therefore increased by this same amount.
Designated funds comprise funds which have been set aside by the trustees for specific purposes. The purpose of each designated fund is set out in note 14.
Restricted funds relate to non-contractual income which is to be used in accordance with restrictions imposed by the donors or which have been raised by the charity for specific purposes. The purpose of each restricted fund is set out in note 15.
## **Financial instruments**
**92**
Annual Report & Accounts 2023
## **2. Grants and Donations**
**----- Start of picture text -----**
Total Total
2023 2022
Restricted Funds £ £
-
NHS Health Education England Projects 59,626
Beth Christian Memorial Fund 5,000 -
RCEM Fundraising 98,553 51,808
Unrestricted Funds £ £
Grants and Donations 117,357 -
220,910 111,434
**----- End of picture text -----**
## **3. Income from Charitable Activities**
**----- Start of picture text -----**
Total Total
2023 2022
Unrestricted Funds £ £
Emergency Medicine Journal 462,500 395,217
Conferences & CPD 1,043,680 981,498
Subscription 4,296,859 4,048,288
Examination fees 4,113,953 3,571,117
Training 229,021 203,364
Clinical Audit (Quality Improvement Programme) 245,083 128,706
10,391,096 9,328,190
**----- End of picture text -----**
**93**
Royal College of Emergency Medicine
## **Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
## **4. Investment Income**
**----- Start of picture text -----**
Total Total
2023 2022
Unrestricted Funds £ £
-
Interest received on short term deposit 23,410
Interest received 95,240 20,108
118,649 20,108
**----- End of picture text -----**
Interest received in both years were from unrestricted sources.
## **5.Other Income**
**----- Start of picture text -----**
Total Total
2023 2022
Unrestricted Funds £ £
Sale of Merchandise 2,989 2,855
Rental and Room Hire Income 211,465 183,094
214,453 185,949
**----- End of picture text -----**
**94**
Annual Report & Accounts 2023
## **6.Expenditure**
**----- Start of picture text -----**
Direct Support Total
Costs Costs 2023
Raising Funds £ £ £
Website costs 3,420 - 3,420
RCEM Merchandise - - -
-
Investment broker charges 1,679 1,679
5,099 - 5,099
Charitable Activities £ £ £
-
Emergency Medicine Journal 666,910 666,910
Research & publications 292,807 50,463 343,270
Education and examinations 3,272,890 1,143,647 4,416,537
RCEM learning 307,319 145,452 452,771
Training 950,510 672,191 1,622,701
Conferences & CPD 1,062,151 323,517 1,385,668
Membership services 360,194 351,645 711,839
Quality in emergency care 412,101 242,955 655,056
Policy and professional affairs 467,892 335,431 803,323
-
RCEM Fundraising 106,037 106,037
-
NHS project expenditure (Restricted) 14,250 14,250
-
Home Office (Restricted) 12,850 12,850
7,925,911 3,265,301 11,191,211
7,931,010 3,265,301 11,196,310
**----- End of picture text -----**
**95**
Royal College of Emergency Medicine
## **Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
## **6. Expenditure (continued)**
**----- Start of picture text -----**
Direct Support Total
Costs Costs 2022
Raising Funds £ £ £
Website costs 2,170 - 2,170
RCEM Merchandise - -
-
Investment broker charges 1,681 1,681
-
3,851 3,851
Charitable Activities £ £ £
-
Emergency Medicine Journal 643,178 643,178
Research & publications 312,520 96,170 408,690
Education and examinations 3,098,568 960,299 4,058,867
RCEM learning 202,269 142,797 345,066
Training 721,141 564,579 1,285,720
Conferences & CPD 814,315 342,285 1,156,600
Membership services 356,771 278,538 635,309
Quality in emergency care 273,500 237,232 510,732
Policy and professional affairs 380,102 282,992 663,094
-
RCEM Fundraising 59,014 59,014
-
NHS project expenditure (Restricted) 40,345 40,345
6,901,723 2,904,892 9,806,615
6,905.574 2,904,892 9,810,466
**----- End of picture text -----**
During the financial period we spent in total £ 11,196,310 (2022: £9,810,466) broken into restricted funds £144,453 (2022: £76,888), designated funds £6,901 (2022: £22,471) and general funds £11,063,173 (2022: £9,711,108).
**96**
Annual Report & Accounts 2023
**----- Start of picture text -----**
Total Total
2023 2022
Employee costs comprise: £ £
Wages and salaries 3,101,581 2,882,892
Social security costs 328,170 323,227
Other pension costs 306,754 269,183
Total Employee costs 3,736,505 3,475,302
Casual employees 141,585 56,321
3,878,090 3,531,624
**----- End of picture text -----**
Wages and salaries reported above includes termination payments for 3 individuals totalling £69,912 (2022: £63,082).
The average number of permanent employees during the period was 74 (2022: 70). These were supplemented by several casual employees who assisted primarily with examinations and training.
**----- Start of picture text -----**
Total Total
2023 2022
Employee numbers as analysed by category: No. No.
Exams & Education 18 17
Training 14 12
Policy & Professional Affairs and Quality in Emergency Care 13 13
Membership 6 5
Research & Publications and Events 5 6
Other 18 17
74 70
**----- End of picture text -----**
**97**
Royal College of Emergency Medicine
## **Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
## **6. Expenditure (continued)**
During the period the numbers of employees whose emoluments (defined as salary and taxable benefits) exceeded £60,000 were:
**----- Start of picture text -----**
Total Total
2023 2022
£60,000 to £70,000 1 1
£70,001 to £80,000 1 1
£80,001 to £90,000 - 1
£90,001 to £100,000 2 1
£150,001 to £160,000 - 1
£160,001 to £170,000 1 0
**----- End of picture text -----**
The aggregate emoluments of the key management personnel which comprises of Trustees, Chief Executive Officer, Director of Corporate Services, Director of Education and Director of Engagement and External Affairs amounted to £543,488 (2022: £411,090).
The pension amounts paid to the above employees amounted to £60,825
**98**
Annual Report & Accounts 2023
## **6A. Support and Governance Costs**
**----- Start of picture text -----**
Total Total
2023 2022
Employee costs 1,304,733 1,135,623
Rates, service charges and electricity 272,818 296,781
Office expenses 182,415 218,861
Printing, postage, stationery & telephone 63,857 78,899
Website & information technology 383,779 332,172
Insurance 68,095 50,617
Depreciation & loss on disposal of assets 205,567 214,857
Irrecoverable VAT 218,994 217,069
Sundry expenses 32,715 21,355
Bank interest on loan 348,820 181,518
Bank & credit card charges 138,943 88,540
Governance
Audit remuneration 24,450 22,450
Board meeting and travel costs 20,115 46,149
3,265,301 2,904,892
**----- End of picture text -----**
Support costs are allocated to activities on a basis consistent with the use of these resources. The allocation method of apportionment adopted by The Royal College of Emergency Medicine is as follows, headcount, i.e. based on the number of people employed within an activity, square foot, i.e. based on floor area occupied by an activity and time, i.e. where employee duties span more than one activity.
**99**
Royal College of Emergency Medicine
## **Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
## **7. Charitable Activities – Grant Payable**
Research grants awarded by the Royal College of Emergency Medicine in the year to 31 December 2023 were paid to 23 individuals totalling £204,120 (2022: 16 individuals £181,664).
## **8. Trustees**
The trustees received no remuneration from the charity in respect of acting as Trustees. No trustee provided services to the charity for which they were paid.
During the year, we had 12 trustees, 7 trustees received reimbursement for costs for attending meetings and for travelling expenses, amounting to £2,416 (2022: 10 trustees, £1,012). In addition, expenses paid directly by the College, mainly in the form of hotel bills, amounted to £3,359 (2022: £4,766).
## **9. Tangible Fixed Assets**
**----- Start of picture text -----**
Building Office College Coat of Chain of Total
Costs Equipment Database Arms office
£ £ £ £ £ £
**----- End of picture text -----**
|**Cost or valuation**|**Cost or valuation**||||
|---|---|---|---|---|
|At 1 January 2023||14,418,138|759,022|528,864
6,534
428
15,712,987|
|Additions||11,823|16,490|-
-
-
28,313|
|At 31 December 2023||14,429,961|775,512|528,864
6,534
428
15,741,299|
||||||
|**Depreciation**|||||
|At 1 January 2023||980,256|723,500|471,168
-
-
2,174,924|
|Charge for the year||124,721|23,150|57,696
-
-
205,567|
|At 31 December 2023||1,104,977|746,650|528,864
-
-
2,380,491|
||||||
|**Net Book Value**|||||
|At 31 December 2023||13,324,984|28,862|-
6,534
428
13,360,808|
||||||
|At 31 December 2022||13,437,882|35,522|57,696
6,534
428
13,538,062|
**100**
Annual Report & Accounts 2023
## **10. Debtors**
**----- Start of picture text -----**
Total Total
2023 2022
£. £.
Trade debtors 146,638 141,145
Prepayments 382,870 515,828
Accrued income 511,775 402,436
Other Debtors 6,640 83
1,047,923 1,061,492
**----- End of picture text -----**
## **11. Creditors: amounts falling due within one year**
**----- Start of picture text -----**
Total Total
2023 2022
£. £.
Bank loan (see note 12) 200,000 200,000
Trade creditors 555,258 111,532
Taxes and social security - 92,208
Accruals 376,183 283,293
Deferred income 1,120,577 465,100
Other Creditors 167,562 259,026
2,419,580 1,411,159
**----- End of picture text -----**
Included within Other Creditors is an amount of £29,981 (2022: £28,854) in respect of pension contributions.
Deferred income at 31 December 2023 reported above relates to income for exams, events and course fees as all previously held deferred income at 31 December 2022 has been released and recognised in the year.
**101**
Royal College of Emergency Medicine
**Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
## **12. CREDITORS: amounts falling due after more than one year**
**----- Start of picture text -----**
Total Total
2023 2022
£. £.
Bank loan 5,100,000 5,790,000
5,100,000 5,790,000
Bank loan maturity analysis
Due less than 1 year 200,000 200,000
Due 1 – 2 years 200,000 200,000
Due 2 – 5 years 4,900,000 5,590,000
Total loan value 5,300,000 5,990,000
Included in current liabilities (see note 11) (200,000) (200,000)
Included in long term liabilities 5,100,000 5,790,000
**----- End of picture text -----**
The bank loan is secured by a first legal charge over the land and buildings owned by the charity. Interest is calculated at Bank of England Base Rate plus 1.60%.
**102**
Annual Report & Accounts 2023
## **13. Unrestricted Funds**
**----- Start of picture text -----**
At Income Expenditure Transfers At 31
1 January December
2023 2023
£ £ £ £ £
Designated Fund
- -
Tangible fixed Assets 7,548,062 512,746 8,060,808
- -
Organisational Development 541,643 (6,901) 534,741
General fund 2,029,027 10,810,489 (11,063,173) (494.529) 1,281,814
10,118,732 10,810,489 (11,070,074) 18,217 9,877,364
At Income Expenditure Transfers At 31
1 January December
2022 2022
£ £ £ £ £
Designated Fund
- -
Tangible fixed Assets 6,547,266 1,000,796 7,548,062
- -
Organisational Development 564,113 (22,471) 541,643
General fund 3,206,685 9,534,247 (9711,108) (1,000,796) 2,029,027
-
10,318,064 9,534,247 (9,733,579) 10,118,732
**----- End of picture text -----**
The Tangible Fixed Assets fund represents the value of these assets less a related loan and are not free reserves. The Organisational development fund has been designated to support our plans for restructuring, digital transformation, operational and service delivery improvements, and process reengineering over the next 3 years.
**103**
Royal College of Emergency Medicine
**Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
## **14. Restricted Funds**
**----- Start of picture text -----**
At Income Expenditure Transfer At 31
1 January 2023 December
2023 2023
£ £ £ £ £
Alison Gourdie Memorial Fund 43,832 - - - 43,832
E-learning for Health Fund 157,622 157,622
ENACT 3,348 - - - 3,348
Beth Christian Memorial Fund 6,050 5,000 - - 11,050
- - -
Emergency Care Data Set Project 12,273 12,273
- -
Health Education England Projects 194,728 (14,250) 180,477
-
RCEM Fundraising 48,630 98,553 (99,136) 48,047
- -
Home Office 31,067 (12,850) (18,217)
466,483 134,620 (126,236) (18,217) 456,650
**----- End of picture text -----**
**104**
Annual Report & Accounts 2023
**----- Start of picture text -----**
At Income Expenditure Transfer At 31
1 January 2022 December
2022 2022
£ £ £ £ £
Alison Gourdie Memorial Fund 43,832 - - - 43,832
E-learning for Health Fund 157,622 157,622
ENACT 3,348 - - - 3,348
Beth Christian Memorial Fund 6,050 - - - 6,050
- - -
Emergency Care Data Set Project 12,273 12,273
-
Health Education England Projects 175,447 59,626 (40,345) 194,728
-
RCEM Fundraising 33,365 51,808 (36,543) 48,630
-
431,937 111,434 (76,888) 466,483
**----- End of picture text -----**
**The Alison Gourdie Memorial Fund** was established to award prizes to doctors and nurses for projects that benefit the provision of high quality care in the field of Accident and Emergency Medicine.
**The Beth Christian Memorial Fund** was established in her memory.
**Elearning for Health Fund (** previously known as the EnlightenMe Grant) is a project funded by the Department of Health to improve e-learning for Healthcare by covering the costs of Content Authors, Module Editors and Clinical Leads.
**ENACT** is a fund set up to help develop emergency medicine learning overseas.
**The Emergency Care Data Set Project** is a funded by the Department of Health to change the data set collected by the NHS relating to emergency medicine.
**The Health Education Projects fund** is to fund a series of joint projects focused on the development of the emergency medicine workforce with NHS Health Education England.
**RCEM Fundraising** is to support further improvements in patient care, to support groundbreaking research and help low-income countries establish emergency care and clinical training.
**Home Office** Information Sharing to Tackle Violence Project is a funded project to help establish a Standard Operating Procedure to assist Emergency Departments in improving their recording and sharing of information, which in turn will help tackle violence.
**105**
Royal College of Emergency Medicine
## **Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
## **15. Analysis of net assets between funds**
Fund balances at 31 December 2023 represented by:
**----- Start of picture text -----**
General Designated Restricted Total Funds
Funds Funds Funds
£ £ £ £
- -
Tangible fixed assets 13,360,808 13,360,808
Current assets 3,501,395 534,741 456,650 4,492,787
-
Creditors falling due within one year (2,219,580) (200,000) (2,419,580)
- -
Creditors falling due after one year (5,100,000) (5,100,000)
Total net assets 1,281,815 8,595,549 456,650 10,334,014
**----- End of picture text -----**
Fund balances at 31 December 2022 represented by:
**----- Start of picture text -----**
General Designated Restricted Total Funds
Funds Funds Funds
£ £ £ £
- -
Tangible fixed assets 13,538,062 13,538,062
Current assets 3,240,186 541,643 466,483 4,248,312
-
Creditors falling due within one year (1,211,159) (200,000) (1,411,159)
- -
Creditors falling due after one year (5,790,000) (5,790,000
Total net assets 2,029,027 8,089,705 466,483 10,585,215
**----- End of picture text -----**
**106**
Annual Report & Accounts 2023
## **16. Operating lease commitments**
**----- Start of picture text -----**
Total Total
2023 2022
Lessee Equipment Equipment
Operating leases which expire within: £ £
Less than one year 20,215 29,572
Between one and two years 20,215 6,124
Between two and five years 29,529 15,310
-
Over five years 4,450
74,409 51,006
**----- End of picture text -----**
As at 31 December 2023, the future minimum lease receipts due from lessees in respect of office space under non-cancellable operating leases are as follow
**----- Start of picture text -----**
Total Total
2023 2022
Lessor Rental Rental
Operating leases which expire within: £ £
Not later than one year 92,805 90,495
92,805 90,495
**----- End of picture text -----**
**107**
Royal College of Emergency Medicine
**Notes To The Financial Statements for the year ended 31 December 2023 (continued)**
## **17. Reconciliation Of Net (Expenditure) to Net Cash Flows Provided by Operations**
**----- Start of picture text -----**
Total Total
2023 2022
£ £
Net income before other gains and losses (251,201) (164,786)
Depreciation charges 205,567 214,856
Investment income (118,649) (20,108)-
-
Movement in investment portfolio cash 170,000
Decrease/(increase) in debtors 20,639 (38,971)
Increase/(decrease) in creditors 1,008,421 (982,608)
Net cash used in operating activities 864,777 (821,617)
**----- End of picture text -----**
## **18. Related Party Transactions**
There are no related party transactions
“The Royal College of Emergency Medicine objective is to promote excellence in emergency care. Our activities are focused in three key areas:
Delivery of safe high quality emergency care, promotion of best practice and ensuring emergency medicine training is of the highest standard. To achieve these aims we strive to ensure that patient centred care is led and delivered by fully trained Emergency Medicine Consultants, working in and with the wider Emergency Medicine team.
Secondly, we advance safe and effective Emergency Medicine by providing expert guidance and advice on Emergency Medicine policy.
Thirdly through the development of training, the funding of research and the setting of professional postgraduate examinations we work to educate, train and assess Emergency Medicine doctors to deliver the highest standards of professional competence and practice for the protection and benefit of all the public.”
## **This report covers activity of the year to 31 December 2023**
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## **Acknowledgements**
So many people invest time, energy and commitment to make the College what it is today and for that we are extremely grateful. Many give their time, often on a voluntary basis, juggling demanding roles in emergency departments throughout the UK and internationally. To those who do, we are in awe. We understand the relentless pressures you are under which makes your commitment to the speciality even more remarkable.
Collectively we strive to make the lives of those who work in emergency medicine as fulfilled as possible, with patient care front and centre.
We rely on numerous emergency medicine doctors and consultants, academic, quality, research, policy, communications and many other professionals to ensure the College delivers for the membership.
We are also fortunate to have the support and input from a number of external stakeholders, including organisations from across the healthcare sector and NHS, fellow Colleges, partners, patient groups and sponsors to name a few.
To everyone who has contributed to what we have achieved in the past year, thank you.
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Royal College of Emergency Medicine
## **Annex**
## **College representatives work with several organisations, including:**
- l Academy of Medical Royal Colleges
- l Academy of Medical Royal Colleges and Faculties in Scotland
- l Australasian College for Emergency Medic (ACEM)
- l All Party Parliamentary Group – Tobacco
- l All Party Parliamentary Group – Coronavirus
- l Apollo Hospitals, India
- l Aster Medicity, India
- l British Medical Association Scotland
- l British Medical Journal
- l British Orthopaedic Association
- l British Red Cross
- l Cambridge Global Health Partnership
- l Care Quality Commission
- l College of Emergency Physicians, Malaysia
- l College of Paramedics
- l Committee for Health, NI assembly
- l Compassion in Dying
- l Department of Health and Social Care
- l Department of Health Northern Ireland
- l Devices Expert Advisory Committee
- l Edith Murphy Foundation
- l Egyptian Ministry of Health and Population
- l Emergency Care Society of Uganda
- l Emergency Medicine Specialist And Staff (EMSAS) - old name of the Forum of Associate & Staff Grade Emergency Medicine (FASSGEM)
- l Emergency Medicine Trainees’ Association (EMTA)
- l European Society For Emergency Medicine (EuSEM)
- l Faculty of Forensic and Legal Medicine (FFLM)
- l Faculty of Intensive Care Medicine (FICM)
- l Faculty of Sport and Exercise Medicine (UK)
- l General Practitioners at the Deep End (Scotland)
- l Getting It Right First Time (GIRFT)
- l Hospital Saturday Fund
## Group (CAG)
- l Healthcare Improvement Scotland
- l Healthcare Inspectorate Wales (HIW) - Patient Discharge Thematic Review Stakeholder Group
- l Home Affairs Committee’s inquiry into Spiking
- l Home Office – Modern Slavery Campaign
- l House of Commons - Health and Care Bill
- l HSC Public Health Agency (Northern Ireland)
- l Independent Inquiry into Child Sexual Abuse - Prevention of child sexual abuse in healthcare settings
- l Institute of Hepatology - Lancet Commission for Liver Disease
- l Intercollegiate Board for Training in Intensive Care Medicine
- l Intercollegiate Board for Training in Pre-Hospital Emergency Medicine (IBTPHEM)
- l Intercollegiate Committee for Acute Care Common Stem Training (ICACCST)
- l Inter- Collegiate and national Agency Domestic Violence and Abuse forum (INCADVA)
- l Inclusive Health
- l Infected Blood Inquiry
- l Intercollegiate Committee for Standards for Children and Young People in Emergency Care Settings
- l International Federation for Emergency Medicine (IFEM)
- l James Lind Alliance
- l Joint Colleges Hospital Visiting Committee
- l Joint Royal College Ambulance Service Liaison Committee
- l Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, India
- l Landspitali – The National University Hospital of Iceland, Iceland
- l Law commission
- l Leeds Comprehensive Care Haemophilia Centre
- l Manchester University NHSFT
- l Max Healthcare, India
- l MBRRACE
- l HCA Healthcare UK
- l Healthcare Safety Investigation Branch (HSIB)
- l Health and Social Care Committee, Welsh Parliament
- l Health Select Committee - Children and young people’s mental health inquiry
- l Health Select Committee – White paper
- l Health and Sport Committee, Scottish Parliament
- l Health Education and Improvement Wales (HEIW)
- l Health Education England (HEE)
- l Health Research Authority (HRA) – Confidentiality Advisory
- l Medicines and Healthcare products Regulatory Agency
- l Medical Council on Alcohol – Advisory Committee
- l Myanmar Emergency Medicine Society
- l National Confidential Enquiry into Patient Outcome and Death (NCEPOD)
- l National Co-ordinating Centre for Health Technology Assessment (NHS R&D)
- l National Electronic Library for Health – Emergency Care branch
- l National Horizon Scanning Centre expert database
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Annual Report & Accounts 2023
- l National Institute for Health and Clinical Excellence (NICE) – Rapid guideline for the ‘management of the long-term effects of COVID-19
- l National Institute for Health and Clinical Excellence (NICE) – Medical technology evaluation of: GID-MT554 KardiaMobile for the ambulatory detection of atrial fibrillation
- l National Police Chiefs Council (NPCC)
- l National Safeguarding Delivery Unit – Partnership Network
- l National Workforce Skills Development Unit - Enhancing the management of psychological trauma and resilience experienced by staff working in the NHS
- l NHS Blood and Transplant (NHSBT) - National Organ Donation Committee
- l NHS Commissioning Board Special Health Authority
- l NHS Education for Scotland
- l NHS England & NHS Improvement
- l NHS England - Clinical Review of Standards Consultation
- l NHS England North Regional team - Liaison Mental Health Task & Finish Group
- l NHS Health Education England
- l NHS Infrastructure
- l NHS National Services Scotland
- l NHS Pathways - National Clinical Governance Group of NHS Pathways
- l National Institute for Health and Care Excellence (NICE)
- l National Institute for Health Research (NIHR)
- l Nuffield
- l Northern Ireland Ambulance Service
- l Office for Health Improvement and Disparities
- l Oman Medical Specialty Board, Oman
- l Paediatric Intensive Care Society (PICS)
- l Pakistan Institute of Medical Sciences
- l Patient and Client Council (Northern Ireland)
- l Psychiatric Liaison Accreditation Network (PLAN)
- l Professional Record Standards Body (PRSB)
- l Public Accounts Committee inquiry on NHS Backlogs and Waiting Times
- l Public Health England (PHE)
- l Public Health Wales (PHW)
- l Qimet International
- l Rawalpindi Medical University, Pakistan
- l Regulation and Quality Improvement Authority (RQIA) Northern Ireland
- l Royal College of Anaesthetists
- l Royal College of General Practitioners
- l Royal College of Pathologists
- l Royal College of Physicians and Surgeons of Glasgow
- l Royal College of Physicians of Edinburgh
- l Royal College of Physicians of London
- l Royal College of Psychiatrists
- l Royal College of Radiologists
- l Health Innovation Network
- l Royal College of Surgeons of Edinburgh
- l Royal College of Surgeons of England
- l Safe Lives
- l Scottish Ambulance Service
- l Scottish Government’s 6 Essential Actions for Unscheduled Care National Programme
- l Scottish Government’s Ministerial Strategic Group forHealth and Community Care
- l Scottish Government’s Unscheduled Care Advisory Group
- l Scottish Health Action for Alcohol Problems (SHAAP)
- l Senedd Health Select Committee - Priorities for Sixth Senedd
- l Serious Hazards of Transfusion Steering Group (SHOT)
- l Sickle Cell society
- l Scottish Health and Sport Committee
- l Scottish Intercollegiate Guidelines Network (SIGN)
- l Society for Acute Medicine
- l St John Ambulance
- l The Emergency Medical Retrieval and Transfer Service Cymru (EMRTS) Wales
- l Uganda UK Health Alliance
- l UK Advisory Panel for Healthcare Workers Infected with Blood borne Viruses
- l UK Clinical Research Collaboration (UKCRC) – Clinical Research Collaboration (NRES –
- l UK Clinical Research Network (UKCRN) – National Institute for Health Research – specialty groups
- l UK Government - Women’s Health Strategy
- l UK Health Alliance on Climate Change (UKHACC)
- l UK Health Security Agency (UKHSA)
- l UK Treasury – Spending Review
- l University of Medicine 1, Yangon
- l University of Medicine 2, Yangon
- l University of Medicine, Mandalay
- l Warwick Advisory Group
- l Welsh Ambulance Service
- l Welsh NHS Confederation
- l Welsh Parliament
- l Royal College of Paediatrics and Child Health
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Octavia House 54 Ayres Street, London SE1 1EU
Tel: +44 (0)20 7400 1999 **www.rcem.ac.uk**
**Incorporated by Royal Charter, 2008 Registered Charity number 1122689**