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Welcome to the autumn edition of the Bulletin. As I write this, there is a sombre atmosphere as the funeral arrangements for Queen Elizabeth II proceed, and I want to take the opportunity to pay my respect to her and to her devotion to duty in this editorial. Although it was not unexpected, I was surprised how deeply her death affected me – I felt keenly what a historic moment the death of the longest-serving monarch in British history, and the second-longest in world history, was.

A new year signals a new Editor for the Bulletin, and it gives me immense pleasure to welcome you to the January 2023 edition. As I write this, the UK’s NHS is experiencing winter pressures, nurse strike action seems imminent, purple seems the new black in terms of hospital bed status, and elective surgical recovery targets seem an insurmountable challenge.

Mrs Shivalkar was a 78-year-old patient with debilitating co-morbidities scheduled for elective revision hip surgery at a stand-alone surgical unit without Level 2 or 3 care facilities. The surgical procedure was prolonged, and intraoperatively there was prolonged significant hypotension. In recovery this hypotension continued, but despite this the patient was discharged to the ward, where she sustained cardiac arrest. 

Here is the latest data from the CPD event-accreditation scheme. During 2022 we received more than 900 applications for CPD event accreditation. Around two-thirds of these gained the accreditation applied for without condition, although for the remainder this approval only became available when further information or clarification was provided.

Dr Kirstin May and Dr Ashwini Keshkamat, RCoA SAS Members of Council, introduce us to our first SAS-themed issue, celebrating our SAS colleagues' contribution to the specialty and NHS.

Dr Harry Craven, ST6 Anaesthetics talks through his journey and how he overcame self-consciousness and self-doubt during his anaesthetic management training.

Dr Ramai Santhirapala, Editor of the Bulletin, welcomes you to April 2023's anaesthetist in training (AiT) issue of the Bulletin and looks at why this year's theme 'Adapting to change' is very apt in these uncertain times.

Dr Aaron Lavin, HSRC QI Fellow, ST4 in Anaesthetics tells us about the College’s Quality Network which was formed to share learning, develop knowledge, and encourage local improvement work.

Dr Elisa Bertoja, Chair of the RCoA CQ&R Board, takes on the role of guest editor and introduces us to this year's research-themed issue.

At the time of writing this article we can be fairly confident that we have left the worst of the pandemic behind us. However, the NHS now faces the challenge of tackling spiralling waiting times for elective surgery.