Fergal Monsell Presidential Speech BOA Annual Congress 2025

So, it starts.

I was going to do a bit about Mark. He's done an overview of his year but he's someone I've got to know very well over the year and the thing that's stuck me the most is he cannot make a decision. You see, I've known him for a year and I still couldn't tell you if he's an Arsenal supporter or a Leeds United supporter but then I looked at it more carefully and it's actually whoever's winning. So, I think there's great insight and great forethought there. I tend to have a very reactive view to the world. I tend to shoot first, ask questions if necessary later and that is wholly inappropriate for a role like this and I've spent the last two years on the presidential line trying to learn from people who have got a much more mature attitude to this type of work.

Mark's got great insight and imagination but combines that with a very safe pair of hands because he has an ability to listen to all options and then to reflect and then reach the balanced conclusion which are invariably correct and is therefore, as he's demonstrated, delivered consistently throughout the year. He's also presided over a great Congress. It's just really demonstrated the best of what we do as orthopaedic surgeons both in the UK and the wider world and it's been a very great privilege to work alongside him and my only plea to you is don't go anywhere in a hurry.

The other thanks have been given. I'd also like to extend that, you know, my involvement in the BOA has been enormously enjoyable but working with the Secretariat, with the Executive, with the Council, with the specialist societies but most of all with membership. I've had a great week just walking, having conversations with people, learning what it is that animates people, what it is that someone in a position that I now hold, can try and do to make some difference but I'm quite realistic about this.

If you go into a role of this magnitude thinking you're going to make a huge change of course then you are naive and probably stupid. I think the best that I can hope for is to make the ship change a couple of degrees and with a bit of luck it will be in a good direction rather than a bad direction. If there are icebergs ahead of us, if I can just steer it so that we miss them, that'll be good enough for now.

So as in my brief bio, I've been a BOA member for 35 years and it is throughout my professional life and well I was gonna say a big part, a substantial part of my adult life, has been my people, the people who I understand, who I believe understand me and the people who I desperately want to represent in a good way and so it is an absolute privilege to stand in front of you and I promise you that I will do my very best in all aspects of this job. The philosophy really is primus inter pares. I get to you know wear this bit of bling and it's fantastic and I'm gonna get to do some really funky stuff but it's the whole group, the whole organisation that is important, okay.

It's a representative role but I've got to remember at all times who I represent and as Mark said it is team-based and my role is to empower other people to do great things and to do that by fostering collaboration and in so, secure the future of the organisation. So in 12 months time we meet in London Olympia and the theme that I've chosen is the 'changing face of orthopaedics' and it can be looked at in many different ways but the change is the important word obviously because generally as orthopaedic surgeons, as doctors, as adults maybe, we're very poor at managing change. We're naturally resistant and in the current times change is happening both in a geopolitical perspective, a societal perspective and also a clinical perspective and all those elements will influence how we behave.

So the geopolitical change has been in preparing for this talk, has been thinking about it, current affairs have a bit of an end of days feel about them. The political order that we grew up with has been shaken across the western world. If we look at the UK and northern Europe, civic society is restless.

The US have changed the political order and we just don't quite know how to play it and the political certainties that we've relied upon are changing and I guess get the impression that there's a low level anxiety that that all is not well but society is also changing. It evolves, it has to change and we are dealing with the increasing demands of an informed public as clinicians. We're also altering our perceptions of a work-life balance as people and we're doing this in an economy that possibly isn't as good as it was 20 years ago and so all elements of what surrounds us in our waking hours is changing. And healthcare is changing.

Actually it's been in a state of continuous change probably since Hippocrates but nothing is new in the world apart from the history that you don't know. It's Harry Truman and if I think back on my 40-year clinical career there have been 10 prime ministers, been 21 secretaries of state for health, 11 acts of parliament and 13 white papers concerning the provision of healthcare. All these ideas we're going to fundamentally change how we do healthcare in the UK and I'm not sure that I've ever seen that really but it's continuing and the current issues for us as a group, for me in my Presidential year will be the fit for the future - The recent 10-year health plan for England.

And that's going to have wide-ranging impacts on how we think about healthcare, how we deliver healthcare, whether we like it or not and the three pillars being from analogue to digital, from sickness to prevention, and from hospital to community, will all touch how we practice but the details are unclear and as a group we have a choice. We can wave our shrouds and mutter passages from the bible. If we do we will be dictated to.

We can demonstrate clear leadership and a quote that I love which is never miss the opportunity presented by a crisis which is probably a misinterpretation of Machiavellian chapters in The Prince but it does allow us to look at a crisis if we could call it a crisis and see how can we benefit our patients from this. I think we have to think who we are. Are we just technicians that do tasks in which case we'll be irrelevant before we can think of it or are we better than that? I believe we're so much better than that and this crisis gives us the opportunity to do what we do very best.

It's to innovate. It's to be proactive and define the best solutions. We know how to do this.

Walking around this Congress, looking at all the various areas of orthopaedics which are progressing, which are excellent, the brain power of this group is phenomenal and it would be a great shame if that wasn't harnessed and used so that we can do what we're really supposed to be doing which is advocating for our patients but also advocating for our colleagues. But to do this orthopaedic surgery needs to have a voice. If it doesn't it's just going to be a spectator in a changing game.

The British Orthopaedic Association has got 5,000 members. We're the largest surgical specialty and we must use that to provide a cohesive front so that we can properly represent our patients at each other during these changing times. But to have this voice we need to have a strong Association and the topics that I want to spend some time on in the next 12 months are retention of our membership, our relationship with college and special societies.

There is a sandwich in which we seem to be caught in the middle and we need to be very thoughtful about how we manage that situation and also we need to think about the future and the future is those that follow us. So we need to be very mindful about training and particularly workforce planning.

So our membership is stable at about 75% and you can look at that in a number of ways. I look at that as it's only 75% and there is a changing perception certainly in my mind and I may be incorrect that as I've mentioned there have been a change in priorities, the change in work-life balance and a lack of engagement with associations such as ours and ideas that would when I was a baby registrar would be heresy. What do you mean you're not a member of the BOA? It just wouldn't be a conversation that happened. But my concern is that as a subscription-based organisation if we start losing members then we're condemned to a slow death once the tipping point is reached and one of the things that really animates me, concerns me is to ensure that the direction of travel of membership is towards 100% rather than the other direction.

So to do that we need to demonstrate value. One of the things that I have learned and gained being on the inside is just exactly the extent of what goes on within the BOA but we haven't been as good as we might about demonstrating that to everyone else and so we've got to think about everyone who's a constituent member, our medical students, our trainees, our early years consultants and our consultant and SAS colleagues, we've got to be more visible. Now I don't know how to use social media, it's probably a generational thing, it's a bit of a personal choice but I absolutely understand the importance of social media in communication and we've got to be on everybody's feed, I believe that's the word, at all times.

We've got to be so much better at transferring information minute to minute. It's improved enormously over the last five years or so and we just need to be aware of that and in whatever way we need to be visible but also in conventional media, we need to be engaging with people who will promote our message for us and we've been good at that but I think we can be better. The college BOA specialist society sandwich.

Now I don't believe this should ever be a battle and it's not something that we need to win, we've just got to make sure that nobody loses and to do that we've got to define the areas of mutual interest and collaborate and we've got to define the areas of individual interest and support because there's something here for everyone provided we are collaborative in our approach. We've got to improve our communications with the specialist societies and the colleges and we've got to start working on combined initiatives so that we are together, that we're intertwined and enmeshed rather than drifting apart. I don't think there's any agenda, I don't think there's any decisions made, I think there is a danger just of gradual drift towards the smaller associations because that's where people think they will be provided with everything. We've got to reverse that.

And also about training at Next Generation, Mark's alluded to that, there's an awful lot of work in this Congress this week, we value our close links with BOTS our trainees society, we're mindful of working conditions being the hot ticket and last week the Secretary of State for Health came with a 10-point plan about how things should improve, now that's up for discussion but that's something that we should be on top of in supporting. Workforce planning, it's fine in a year's presidency but it's what the world is going to look like in terms of orthopaedic employment in 10 years time. We need to know about trainee numbers, consultant numbers, what infrastructure is required, we've also got to understand finances and how to follow the money because that's where success lies and we have to do this in times that are changing in the ways that I've described to you.

Our five-year strategy does set that course in shaping policy and how we can do that, how we can uphold our standards and then speak up for our patients which actually that's the only important thing and so I'm looking with slight trepidation to the coming year, I'm very much looking forward to it, I understand the responsibility, I'll work as hard as I can and I'll try my very best and I will see you in Olympia in 12 months time.

Thank you very much for your attention.

Fergal Monsell
BOA President 2025-2026