Mark Bowditch Presidential Speech BOA Annual Congress 2024

Thank you Simon. I'm humbled and excited to become your new President.

I hope you enjoyed a bit of the Ramones there. A few weeks ago when Charlie, the Congress Queen, asked me what music I'd like to walk out to, that night I woke up in an imposter panic. We've all had them. My chimp brain was saying to me, they found you out at last. You like punk music, you can't play golf, you support Leeds United, not Manchester United, you dream about tractors, I'm from Suffolk, not Porsches, you're different. And I pictured myself walking out to you lot singing 'Anarchy in the BOA', and the only song I could think of was 'Should I Stay or Should I Go Now'.

Well, if you've read The Chimp Paradox by Steve Peters, then you know what I mean. Quickly I switched into the rational human brain. Of course I'm not different at all.

I've never had to break any glass ceilings, and I've been extremely privileged in my surgical career. The reality is that we all have imposter moments with any new job or role, and it's normal and it's okay to talk about it.

In any case, different is good and diversity is better. Equality, diversity and inclusion is and remain centre stage of BOA business. And seriously for a moment, I make no apology for saying the last year has been difficult for surgery and society at large. I'll make it clear that discrimination, racism, sexism, sexual misconduct has absolutely no place in trauma and orthopaedics.

So my first duty is to, as President, is to thank Simon for his stewardship, his leadership over the past year. He has had to navigate the BOA through some choppy waters and has done so with care and due diligence. He's not been afraid to speak up for T&O and speak the truth to power.

With his passion for training future orthopaedic surgeons, he has made it very clear that if we, the BOA, don't shout about it, then there will be no one to treat us in the future. Training will always be front and centre stage of BOA strategy.

Simon is an engaging leader, always courteous, kind and with good humour, as I'm sure the carousel will attest. He's been a true ambassador of British orthopaedics of the highest order. Simon, thank you for your untiring commitment as our President. And whilst we wish you fair winds and following seas in your past President role, I look forward to your wise counsel.

So how did I get here, this once-in-a-lifetime role? Name that song. The short answer, which will please my Medical Secretary Lisa of 20 years, who's here somewhere in the audience, as she would say, “keep it short, Mark”, is I'm truly honoured to have been elected by the trustees of the BOA. But the real answer is a little bit longer.

The real answer is because of Dame Claire Marx. She was mentioned earlier, the first female President of the BOA and the first female President of the Royal College of Surgeons of England. Claire was a colleague and Ipswich of mine for 20 years and became a trusted mentor.

She was my sounding block through the deanery, my SAC chair roles, BOA and leadership roles in the hospital. She had a unique skill to listen with interest, support ideas with enthusiasm and yet challenge compassionately when appropriate. I remember the day when she said to me, “have you thought about the BOA?” Without her suggestion, her encouragement and support, I'd never be here.

Everybody needs a mentor. And I'm delighted that I'm part of the BOMSA-BOTA mentor scheme. And I can even recommend reverse mentoring, something that I hope to bring to the whole Council.

We must listen to our future and diverse generation. Gen Z are different. And remember, different is okay.

Claire would be the first to say, “look back to learn, but look forward to succeed”. So perhaps more importantly than the how is why. Why the BOA? One of my favourite quotes as a training programme director was, “a good surgeon can transform 10,000 patient lives in a 20 year career”.

A good surgical trainer can influence and transform potentially 500,000 lives in that same time period. This is an example of the multiplier effect of population directed activity. For us all to transform individual lives every day, there needs to be someone to speak up for T&O patients and surgeons, drive and develop excellent care and training and to champion innovation and research.

That body or that someone is the BOA and has been doing it for 106 years. Since being involved with the BOA after Claire's suggestion, I've been astonished at the breadth of activities and the importance of the work it does to sustain our daily work. Much of this work is unseen or indirect and perhaps less interesting than the latest way to do an ACL reconstruction or which implant to use.

But without it we'd be in a mess. The specialist societies are flourishing and clearly the space to learn the detail, but we must not let our love of our societies tear us apart. We have more similarities than we do differences.

Let us have our disagreements internally and agree on a united external front. Chris Whitty described these last week as multiple different medical voices akin to the ancient Britain tribes charging around in different directions whilst the civil service, the Roman legionnaires marched straight through us. Divided we fall.

Together the BOA is much greater than the sum of its parts. We are four and a half thousand members, four times bigger than any other surgical association. We are 45 percent of the surgical workforce, 50 percent of the waiting lists, and with our common training stem, able to provide a comprehensive T&O service. This agency together gives us a stronger and more effective voice when resources are challenged.

So now to the what. What will we do? Last year's presidential guest speaker Kristy Weber told us that we must live by design and not default.

We the BOA must decide on a few strategic objectives with three to five year goals and to some extent we are doing that with our review. We must agree the biggest problems and focus on them with clear metrics. We don't need to do everything if we strengthen our collaboration with partners.

So we've listened and we're putting together our strategy and it's clear we must listen and communicate with all. Tell you why and what we're doing and what progress we're making. We must demonstrate and articulate better the value of membership.

We must speak up for the frontline, campaign for the space, the tools and the staff to deliver timely and productive care, both in the NHS and the independent sector, wherever the work is being done. We must share and support change with the registries, with digital EPR systems and GIRFT, but occasionally dare I say it, push back against unrealistic expectations. We must prevent harm and promote safety and uphold and set high standards.

We must preserve high quality training but make it attractive and relevant to today's world and consider our global responsibilities within that. We must promote and break down barriers to innovation and research. We must make the UK the place, the first place to think about.

Working with grant awarders, industry and regulators to move the dial towards T&O. We must support well-being and challenge poor culture. So to do this we need an Association underpinned by responsible leadership, accountable governance and positive culture.

Whilst I see my role as a president to ensure that our goals, our BOA combined goals are implemented and progressed make a difference. To be effective and successful we must align our agenda to that of the national agenda. As we have all heard from the new Government, there is no more money. It's time to change the emphasis from treatment to prevention. So this actually fits quite well into my presidential year's theme, preventing harm, improving or transforming lives. We plan to look at this in terms of firstly primary prevention.

We have plenty of work, so what can we do to reduce the injury and disease burden before the problem occurs? This could be effective hip screening, a national ACL injury prevention programme, changing the fireworks laws and reducing hand injuries, a universal fracture liaison services across the country. All of these are preventative actions that we could align to.

Then there's secondary prevention. How can we prevent harm when we do intervene with our life restoring surgeries? Perhaps a focus more on human factors, focus on preventing infection rather than tackling it once it's occurred, making better use of data, standards and innovation to make value-based interventions.

And finally tertiary prevention, a focus on the individual and the team well-being. Prevent poor leadership, toxic work cultures, turn blue Mondays into rainbow days, communicate and collaborate with but not against the wider team and that includes the management.

So to finish trauma and orthopaedic surgery is the best specialty by far. It's been good to me. Next month my trust opens a 70 million pound new elective orthopaedic centre named after Dame Claire Marx.

She demonstrated that meaningful leadership and collaborating can deliver. Good can happen in the right environment and the right culture. We are fixers, replacers, trainers, innovators, researchers and leaders.

But we can also be compassionate to patients, treat the patient not just the disease and show respect and kindness to our colleagues even if we have disagreements. The BOA is the arms, the legs and the backbone of British trauma and orthopaedics and we aim to be your voice helping you transform lives every day and rise to the challenges together. So whilst I can't necessarily promise to bounce around the country as much as Deborah Eastwood did during her presidential year, I hope to meet as many of you as I can and maybe if there's a space eight months after my own tibial plateau fracture, yes skiing again, I'm hoping to run the marathon and I dare you to join me.

I'm honoured and privileged to serve you as your President this year and I look forward to hosting you all in Liverpool next year.

Thank you.

Mark Bowditch
BOA President 2024-2025