When Mama Nature throws a hissy of the kind which rocked the countries in the Indian Ocean last month, how heartening to see evidence of the ordinary person's empathy for another's pain thousands of kilometers away, manifested in the substantial private funds raised both here and in other countries.

It strikes one anew, sitting both safe on our cosy, stable island, and helpless to provide real assistance, that without the miracle of effective logistics, financial generosity is simply not enough. Despite all the money pouring into the coffers of various funding agencies, by the time this newsletter hits your doormat, many people who survived the waters of the tsunami will have died because of that simple fact - money is not enough. Without systems and infrastructure to deliver what money can buy, for many, aid will come too late.

Thinking of the critical nature of systems and the teams that run them, I have considered the issue of safety as many of us journey by air, be it for business or pleasure. The complexity of systems that see passengers moved from point A to point B in their millions is both vast and largely hidden supported by thousands of people working in teams, supporting the effort from the moment we enter airport of departure until we leave airport of arrival.

The airline industry has a remarkable safety record in the developed world. A crash of a small commuter plane in Missouri in October 2004 interrupted what had been the safest period for commercial air travel in US history. There had been only one crash in the last three years.

The number of passengers flown is in the tens-of-millions and accidents continue to plummet in number despite the steady increase in flights per year. European statistics, especially in Great Britain, are equally impressive.

Needless to say most passengers who travel are reasonably fit and healthy and having accidents of any kind is very bad for the airline industry, which mostly operates for profit. Clearly the "passengers" with whom we deal as patients are different, as is the configured nature of the National Health Service in business terms.

However a day on call is little like a flight from point A to point B, either 12 or 24 hours long. We witness and participate in the patient journey. The un-masking of the extent of iatrogenic illness is not new, but with a recent focus on the quantity of data now being produced by the Health Service concerning MRSA rates, falls in hospital and drug related errors, which contribute to patient morbidity and mortality, a clinician cannot help but feel that lessons learnt from one industry or business can be translated to another. Those who have engaged themselves in the safety of strands of the patient's journey will recognise that lessons from the airline industry can be embedded in ways of work in the health service (http://81.144.177.110/)

In relation to avionics, improved aircraft design and engineering has helped safety. The same has also been shown for better engineering of systems which oversee the journey of the patient through the hospital with common conditions. The steady improvements in pilot training have also played a role in increased safety, and we have seen similar data produced concerning medical education and training (http://iet.open.ac.uk/oucem/) [open "Publications" and click on "Evaluation of the reforms to Higher Specialist Training 1996-1999, Executive Summary"]. We are about to embark in August 2005 on Foundation Programmes for the most junior of graduate doctors with the core objectives of the Foundation Programme centering on patient safety and a competency to deal expertly with the sickest of patients. (www.mmc.nhs.uk/)

In a phrase, team working, particularly the team learning together with the emphasis on patient safety, "is the only game in town" http://tinyurl.com/3te56

Revalidation
CPD will be the mainstay of revalidation (www.gmc-uk.org/revalidation/index.htm) and I would urge readers to visit the new CPD section of the BGS website (www.bgs.org.uk/CPD/cpdhome.htm). This has been put together by Dr Ian Taylor and covers all aspects of the issue in relation to geriatric medicine. Those of you who were at Harrogate will recall Ian's messianic launch of his CPD tenure and his efforts will continue to help members.

Compendium
The Policy Committee is also working hard to overhaul the whole compendium, which will now include a valuable section on clinical guidelines along with a number of new documents on good practice. This should be published on the BGS website between January and March

Kevin Kelleher