Royal College of Paediatrics and Child Health
Professor Sir Roy Meadow 1996-1997
Professor David Baum 1997-1999
Professor Richard Cooke 1999-2000
Professor Sir David Hall 2000-2003
Royal College of Paediatrics and Child Health Annual Report 2007 Copyright © 2008 Royal College of Paediatrics and Child Health Further copies available on request – contact firstname.lastname@example.org 16
Professor Sir Alan Craft 2003-2006
Dr Patricia Hamilton President
Contents President’s report
Chief Executive’s report
Training and assessment
Form of Codicil
From the Collegeâ€™s Royal Charter The objects of the College shall be: (i)
to advance the art and science of Paediatrics;
to raise the standard of medical care provide to children;
(iii) to educate and examine those concerned with the health of children; (iv) to advance the education of the public (and in particular medical practitioners) in child health, which means the protection of children, the prevention of illness and disease in children and safeguarding their optimal development.
“Babies, children and young people receive quality healthcare delivered to an agreed standard as close to home as possible. The RCPCH, in consultation with parents and young people, defines those standards. There is public and political recognition that this means service redesign in order to have the resources and expertise to deliver them.”
Dr Patricia Hamilton President
The annual report gives us an opportunity to see if we are making progress with the Vision
and Values I published at the start of my presidency. We have high ambitions and so I am highlighting those areas where we have made an impact.
“General and specialist children’s health services are effectively commissioned around pathways of care and managed clinical networks.” Our Health Services department, led by Simon Lenton, made a good start with a document on Pathways and Networks which was followed by a major consultation exercise Modelling the Future. We thus were ready when asked to contribute to the emerging debate on reconfiguration of services which coincided with Lord Darzi’s review. We have gone on to contribute to the children’s pathways in this work. The themes have very much reflected those in our vision especially in getting better provision closer to home. This has highlighted the difficulties in access to primary care or first contact doctors which will be a major issue for next year. “…the standards of national service frameworks are implemented locally. The RCPCH uses the findings of regulatory bodies to push for more resources.” We worked with our National Clinical Director, Sheila Shribman, on implementing the NSF standards and made a high profile media response when the healthcare commission identified failings in emergency departments. “There are interventions to reduce obesity at age 11.“ We formed alliances with the Food Standards Agency and lobbied with them for clearer food labelling and we undertook a piece of work with the BBC to raise awareness of childhood obesity. Our obesity adviser Penny Gibson and her group developed an obesity strategy.
“There is a curriculum for generic and specialist training in adolescent medicine which is mainly applicable to paediatricians but also may be adapted for GPs or nurse specialists. The RCPCH and the RCP have agreed on effective transition to adult services.” We obtained £250K from the Department of Heath (DH) to develop such a training programme in adolescent health and also set up an adolescent special interest group. These will both help to define best care. We met with several sister Colleges to discuss transitional care. “Transparency in the family court is managed so that public and press understand the issues without compromising the interests of the child or threatening witnesses.” We actively contributed to the government consultation the result of which was that privacy of the child and witnesses in the family court was maintained. “Trainees, trained doctors and trainers are involved in our Safeguarding training courses. Relevant parts are franchised to others in the UK and abroad. Trainees and trained paediatricians have also undertaken our family justice training.” The Education Department led by Chris Verity and Rosalind Topping ensured that the basic safeguarding course has been undertaken by 1,244 trainees, some on a course in India, and 301 trainers have been trained. The advanced course is well on the way to development. The court skills course has been oversubscribed. “Our Child Protection Officer directs the activity of the Child Protection Committee. He or she works across the College and integrates child protection issues more closely.” Rosalyn Proops has undertaken this new role and has provided leadership and coordination in this difficult area – taking some high profile media challenges in her stride. We have made progress with the GMC in child protection matters. They now have approved lists of expert witnesses in child protection and we have given talks and relevant information to their case examiners.
“Trainees have reasonable working hours and a planned training programme.” PMETB have approved our curriculum and assessment framework. “Paediatricians have a comprehensive training document in which the competence framework is mapped to the assessment framework.” Mary McGraw and Christine Cooper and their teams worked extremely hard and have achieved the above. This was in the context of the deep distress that MTAS and the recruitment process caused. Despite all this, ultimately most posts were filled with good candidates and most people got jobs. Those in programmes will now be assured of a planned pathway through training – balanced in depth and breadth that will lead to a CCT. Trainers can concentrate on training and assessment rather than frequent rounds of recruitment and selection. We have learned from the lessons of 2007 and devised our own recruitment and selection process which was approved by the MMC board for 2008. “Trainers and trainees know how assessment is to be carried out. We have a variety of quality assured assessment tools, including workplacebased and formal examinations.” Whilst this work is not complete, significant progress on developing and piloting e-SPRAT and other workplace based assessment tools was made. Quality assurance improvements were made to the examination.
“Overseas doctors can train in this country on mutually agreed fixed term schemes and there is a fair transition for those already training here and affected by the visa changes.” We agonised over international medical graduates (IMGs) – many of whom have played such an important part in delivering paediatric services in many parts of the UK but who, overall, were contributing to an imbalance in the numbers of posts and the number of applicants. We felt inevitably there must be change but that we must be fair to those who have worked so hard. The outlook is still undecided but we have started work on senior fellowships that could give several years training at a senior level for those who plan to go back to their own countries. “Trainees and others… benefit from the Mastercourse textbook and accompanying DVD from April 2007 and we develop a second edition and website.” Malcolm Levene and his team launched Mastercourse at the Spring meeting and an extremely successful website was developed. Over 1,000 copies have been sold and we have had talks about producing a European edition.
“Paediatricians can access e-learning and website–based facilities for their CPD and specialist credentials or recertification.” “Paediatricians embrace post CCT learning and access College developed or accredited educational modules including training and video assessment of professional skills.” We started to engage with the processes of recertification although this has been slow across the profession generally. Nevertheless more paediatricians are registering their CPD online and some have undertaken our course Paediatricians as Educators. We produced a DVD guide, Giving Difficult Feedback, to be used by assessors as part of the e-SPRAT process.
RCPCH Publication: Vision and Values www.rcpch.ac.uk/doc.aspx?id_Resource=1998
“The research unit… provides the evidence base for College position statements, publications and lobbying and use by paediatricians.” Neil McIntosh and Linda Haines led an extremely important piece of work on establishing the evidence–base in child sexual abuse. This will be the first book of its kind and is due for publication in early 2008. They also won tenders for work on a neonatal service audit and work on urgent care services. BNF for Children was very successful and we saw the development of research networks in medicines for children. “We are working closely and effectively with NICE.” We participated in the production of a large number of guidelines relating to children including fever, urinary tract infection, and infants of diabetic mothers. Our lobbying helped to keep children higher on the agenda for new guidelines.
“Paediatricians, the press and the public use our policy statements as guidance.” We are frequently quoted in the press, and have featured on the Today programme and other radio and television interviews, albeit usually reactively, but are recognised as an authoritative source. “We have more credibility as a result of involving lay representatives and young people in developing College policy.” Our child participation manager has forged useful links with patient and carers organisations and children’s charities. We now have an active reference group of young people who have clearly expressed their views on what the College should be doing. “We reflect and consult on how College activity impacts on all four nations. We are involved in discussions with the relevant Departments of Health in the devolved countries. Databases are accessible from offices in Scotland, Wales and Ireland.” We have made progress in strengthening the physical offices in Wales and Scotland – and perhaps the more virtual one at present in Ireland. The national officers Adrian Margerison, Gwyneth Owen and Denis Gill made huge contributions and we met jointly with the Chief Medical Officer in Scotland and were involved in debates in Wales and Northern Ireland.
“Children in Africa, the Middle East and Asia continue to benefit from the care given by local paediatricians who teach and train on courses originally set up by our College.” Steve Green has worked with the international directors in these areas and we ran courses in Palestine, Jordan, India and East Africa, supported by the David Baum International Foundation. “Paediatricians take up our short course on the rights of the child.” The Advocacy committee organised several of these courses and we also campaigned against the use of dental X-rays in age assessment of asylum seekers.
“Our [new] building reflects our philosophy – modern, outward looking, transparent and flexible. It is accessible for members and in a location where the staff want to work. It has useful space for meetings, space for members and a wireless area for laptop use.” Of all the aims in the Vision and Values document this is the one I thought we would not achieve. But we have. It is accessible by main railway stations and the underground in a pleasant but not over-opulent part of London. The interior is modern and open plan, the few walls we have will be glass, there is a social and a “quiet” space for members on the ground floor and these areas will be wireless.
“A new structure supports College staff in their work and helps if and when help is needed. There is ready communication across departments, with cooperation of effort.”
There is still much to stive for and to achieve, but we hope to build on these foundations to build a better health service for the children and young people of tomorrow.
“Paediatricians meet senior college officers at their regional and national meetings.” We appointed Directors to support the Heads of Department and the Chief Executive. The senior officers and I have tried to get to as many regional and national meetings as we could.
Babies, children and young people receive quality healthcare delivered to an agreed standard as close to home as possible.
Chief Executive’s report on the management of the College Easter 2008 will see the College established in new premises in Theobalds Road. As I write, contracts have been exchanged and completed on; and new internal walls are going up – and carpet is going down – in our future headquarters. Since we identified 5 Theobalds Road as a possible purchase, things have moved fast, but not always smoothly. An (alleged) issue of an established right of way almost lost us our buyer for 50 Hallam Street. The surveyor’s report on Theobalds Road gave us concerns that were allayed only after further investigations. The possibility that we might be liable, as owners of the new building, for chancel repairs to St Paul’s Cathedral was one of the more interesting things that we briefly lost sleep over. (You will be relieved to know that we are not responsible for any chancel, anywhere.) Each step towards ownership seemed to require two trustees’ signatures on yet another document at a few hours notice, and Dr Simon Lenton’s dash across London on his bike to provide the second signature on the contract deserves a small but permanent place in College history. What we have at the end of it all is 23,000 square feet of modern but distinctive office space and meeting rooms. The location, overlooking Gray’s Inn, close to several tube stations and within walking distance of King’s Cross, is good. We have both the College of Surgeons and the College of Anaesthetists as near neighbours. The large floors that the building offers will finally allow us to co-locate related functions such as Education, Training and Assessment, and for them to work efficiently together. The enhanced allocation of meeting room space will enable us to hold events in house that we previously needed to out-source. Everything is on one site again; we are no longer paying rent for half the space we occupy. We have, we hope, made an important investment for the future.
Members and Fellows visiting the building (and we hope that you will) will find that there is a useful amount of public space and a Members’ Room, equipped for working or for taking a break between meetings. We hope that when you see it you will feel that it is a building to be proud of – perhaps not as grand as some medical royal college buildings, but eminently fit for purpose. The project has been a team effort, involving most of the staff and officers, but I should like to thank particularly Debbie Sayers, Jacqueline Fitzgerald, Olly Rice and Mike Poole for their hard work at different stages. I must also give honourable mention to hb Surveyors (who helped find us the building), Hempsons (who handled the vast amount of legal paperwork) and AYH (who are managing the fit-out project). In the meantime all of the other work of the College has continued. It has been another busy year on the press front, and we now have two staff working hard in the press office – Claire Brunert and Ella Wilson. We have operated pro-actively where possible – educating journalists about MMR with the Science Media Centre. We have also been obliged to react to other stories as they occurred – for example the brief furore around Channel 4’s Bringing Up Baby. Child protection issues, as you will have noticed, have also been a regular preoccupation. Bernard Valman retired as Honorary Archivist, having occupied that post as long as there has been a College. His achievements are many, but include editing the Millennium history of the College, capturing on video the stories of a number of pioneers of paediatrics and designing the College coat of arms.
Together with Susan Scott, he has been successful in establishing the archives section of the College. He is succeeded by Alan Craft, who (as they say) needs no introduction from me. The archives remain in safe hands. Staff numbers have continued to rise, but only in proportion to the amount of work the College now has to do. During the past year the total number in our three offices finally passed 100. This is inevitable. Each year we take on new functions, funded wherever possible by money from outside the College – there are several potential growth areas for the coming year. In the meantime, the charts on the facing page give some idea of how we are performing against agreed measures. Finally I must record my thanks to the President, officers and staff for their support during the year. We all look forward to a busy, but exciting, year ahead in Theobalds Road.
Len Tyler Chief Executive
Performance measures Financial Reserves
6,000 £5.0m 5,000 £4.0m 4,000 £3.0m
Proportion of ethnic minority members on College committees
No. of doctors sitting College examination
12,000 11,000 10,000
9,000 8,000 15%
7,000 6,000 5,000
4,000 3,000 5% 2,000 1,000 0
Training and assessment Of all areas of the College’s work, Training and Assessment has been one of the most prominent over the last year. This is perhaps inevitable given its importance as part of the College’s statutory functions. However the Government’s implementation of Modernising Medical Careers, and in particular the problems arising from its computerised Medical Training Application Service (MTAS), has meant inevitably that there has been even greater attention this year to the College’s work in this area. As a result, the College’s Training and Assessment functions, led by Dr Mary McGraw as Vice President for Training and Assessment, and supported by Dr Ian Doughty Officer for training, Dr Colin Campbell Officer for Assessment and Dr Tom Lissauer Officer for Exams who has now been succeeded by Dr Simon Newell, has had a large workload, both fighting for the best deal for trainees and continuing to work on longer-term projects to ensure that paediatric training is of as high a standard as possible. A major achievement this year was the approval by the Postgraduate Medical Education and Training Board (PMETB) of the College’s curriculum for postgraduate medical education. This curriculum, covering all levels of training, has now been published on the College’s website, as well as being distributed in print form across the country. The College’s Assessment strategy
has also been approved by PMETB, and published on the website. More than 250 College Tutors have been trained to deliver the Assessment Strategy. The Training and Assessment Department, led by Christine Cooper and Graeme Muir, has undertaken much of the vital underpinning. During 2007, they implemented a programme of work to ensure that all trainees are registered on the College’s database, and have access to their workplace assessments delivered by HcAT. Work continues to ensure that all trainees will soon have access to e-Portfolio for, respectively, managing their assessments and gaining an overview of their training. Existing multisource feedback tools have been redesigned for paediatrics so that they map specifically to the assessment standards the College is now using. This represents a huge step forward in the College’s ability to monitor trainees’ progress. The Department has also been increasingly busy both providing and enhancing its examinations, MRCPCH and DCH. In 2007 more clinical candidates were examined
than ever before with a 10% increase over 2006, 20% over 2005 and 100% more than in 2003. Criterion-referencing and feedback to candidates has been introduced for Part 2. Specialty Based Question groups have been established to increase our database of questions and ensure that they are appropriately mapped to the new curriculum. Training those in assessment is a high priority and examiner training started in Sept 2007. On another side of its work, the College has continued to process and assess CESR applications, (formerly known as the Article 14 route to the specialist register), and has provided a knowledge assessment examination for those who may feel the need to strengthen evidence of their knowledge base before making a CESR application. However, the College’s responsibilities are not limited to those currently training as paediatricians. This year, for the first time, applications were invited for an undergraduate prize to promote interest in Child Health – the Tony Jackson Memorial Prize. In addition, the College is updating its information on “Careers in Paediatrics” in order to build awareness of the benefits and requirements of a career in the field. All of this work would be impossible without the contribution of a large number of College members who give their time to help our work in training. These include those who work as examiners, as College tutors, as Regional Advisers, Article 14 (CESR) assessors, among many others. The College wishes to record its continuing gratitude to all members who do this work, particularly at a time when paediatricians have ever-increasing demands on them.
n Providing training courses for examiners and workplace assessors and quality assure their performance.
RCPCH Assessment Road Map Assessment of competence MRCPCH part 1
MRCPCH part 2 written
ST4 ST5 ST6 ST7
Structured paediatric assessment
Portfolio and trainers reports DOPS as required
Assessment of performance
n Continuing to develop and enhance our training and assessment functions overseas in line with the Overseas strategy.
Multi-source feedback annually Mini Cex CBD Multi-source feedback annually CBD Mini Cex SAIL
This is clearly an ambitious agenda, and fulfilling it will require careful planning and hard work. But it is also essential for maintaining the Collegeâ€™s central role in training paediatricians to the highest possible standards.
Multi-source feedback annually CBD (with external validation) SAIL SHEFFPAT
The future There is much work currently in progress to be completed over the course of the next year and includes:
n Providing standards for trainees for general paediatric and all paediatric subspecialties for use by Deans to evaluate the training provided.
n Providing modular curricula for those training to lead responsibility for subspecialty area of paediatrics, for example diabetes and epilepsy.
n Working with Deaneries and Department of Health to design and implement and appropriate recruitment process for entering paediatrics.
n Obtaining subspecialty accreditation for metabolic medicine, palliative care and secondary cardiology.
n Providing Quality Assurance for the first year of the of the assessment strategy.
Dr Mary McGraw Vice President for Training and Assessment
...to ensure that paediatric training is of as high a standard as possible.
1 Dr Tom Lissauer, Officer for Examinations (to February 2008).
2 Dr Simon Newell, Officer for Examinations (Current post-holder).
3 Graeme Muir, Head of Assessment.
Education The College’s education function has been led by Dr Chris Verity, Vice President for Education and Chair of the Academic Board. The Education staff at the College are led by Rosalind Topping, Head of Education. Dr Alistair Thomson takes over from Dr Verity in April, after the Spring Meeting 2008.
returns in the new online diary. One of the College’s major decisions this year has been to begin work on training-the-trainers courses for career-grade paediatricians. This work is led by Dr Ian Spillman, Senior College Tutor, and future developments will be announced on the College website.
Its purpose is to provide high-quality and robust educational materials for those working in the field of paediatrics. This includes conferences, continuing professional development, one-day courses and, increasingly, e-learning initiatives.
Education Projects Perhaps the greatest area of expansion in the College’s education work recently has been the development of courses aimed at improving standards in core areas of paediatric expertise. There is not space here to cover all of them, but some of the most important are:
The College’s flagship educational event is the Spring Meeting, which takes place at the University of York each year. It comprises plenary sessions, specialty group meetings, the College’s Annual General Meeting, as well as a range of social functions. The cost is kept as low as possible in order to maximise the number of people who are able to attend. Attendance can be anything up to 2,000 across the four days of the meeting. This year, the Spring Meeting focussed especially on presenting a programme that met the CPD needs of those attending. Highlights are on the website. The response was very positive overall, and the Academic Board hosted a follow-up session in October 2007 to seek a wide range of views on future improvements to the meeting. Continuing Professional Development CPD is an area of increasing focus for the College. The Government’s plans for revalidation/recertification of doctors emphasise the central role CPD will have. The College’s CPD scheme has now been running for a decade, providing a framework for members to demonstrate that their practice is up to date. Members are required to obtain an average of 50 CPD credits each year, ie 250 across each five-year period. Most members now submit CPD
n Child in Mind. This project aims to give a comprehensive grounding in child mental health, and is currently aimed at trainee paediatricians. The course material has been developed over the last few years by Dr Quentin Spender and Dr Avril Washington, and the College is now working to ensure that the course is rolled out as fully as possible to those who need it. At present, this includes College-run “Training the Trainers” workshops backed up by a website that gives trainees access to course materials. n Court skills programme. In the light of many paediatricians’ concerns about giving expert witness evidence, especially in child protection cases, the College has developed a course giving a grounding in family and civil law in England and Wales, and covering skills in report-writing and evidence-giving. A corresponding programme is being developed for Scotland. n Diploma in Paediatric Nutrition. This project, a joint venture between the College and the University of Southampton, has been running for several years. It aims to give paediatricians an understanding of what nutrition is and how it impacts on their work, especially in the context of growth and development.
1 RCPCH Publication: Child Protection Reader. 2 Child In Mind logo.
n Paediatricians as Educators. Paediatricians are increasingly being called upon to work as educators, but many feel that they have not been trained in the necessary skills; this course aims to address that gap. It is aimed especially at paediatricians whose jobs have educational components, and its goal is to enhance skills in communication and working with those being trained. n Safeguarding Children. In conjunction with the NSPCC and the ALSG, and under the leadership of Dr Neela Shabde, the College has developed a comprehensive programme to educate trainee paediatricians in this sensitive area. The course currently comprises a comprehensive Child Protection Reader, an accompanying DVD, and regular one-day training programmes advertised on the College website. Details of all these courses can be obtained from www.rcpch.ac.uk/Education/ Education-Courses-and-Programmes. In all of these projects, the College is also looking at additional means of delivery, especially e-learning. The College’s Education Projects Leader, Chris Mason, has wide experience in the field, and the College is aiming to deliver many of these courses via web-based platforms in the future. Further education projects take place as part of the College’s International programme, detailed on page 18.
Dr Chris Verity
...to provide high-quality and robust educational materials for those working in the field of paediatrics.
3 RCPCH Spring Meeting 2007 Annual Dinner.
4 Child In Mind Workshop. 5 RCPCH Spring Meeting 2007
College orchestra and choir conducted by James Ross.
Policy In 2006 the RCPCH created a new RCPCH Policy and Standards Directorate and Health Services Department. The aim was to prioritise the following RCPCH requirements for the advancement of paediatrics and child health: n Promotion of high-quality, modernised services. n Developing effective policy and ensuring quality standards. n Providing platforms for public opinion and participation. n Advocating for the rights of children in health care. n Ensuring good communications between health care professionals and the public. These new departments will ensure the development and co-ordination of effective policies and quality standards with a strong focus on public participation in college activity. For health services, it provides resources to support the challenging issues associated with delivery of services and also to encourage a culture of improvement and innovation. For further details of RCPCH activities in Scotland, Wales, and Northern Ireland see page 19 in this report.
A major new RCPCH project, Modelling the Future, was initiated to develop a vision for the future provision of child health services. Proposals for new models of service delivery were laid out in a consultation document – Modelling the Future: a consultation paper for the future of children’s service delivery. This document was produced in print and web versions to provide a basis for feedback from paediatricians.
Health Services The RCPCH Health Services Department is managed by Susan Mitchell and overseen by the Vice-President for Health Services, Dr Simon Lenton. It serves to: n Support the RCPCH vision for high quality and sustainable services for children n Address the impact of Government reforms and reconfiguration of child health services, including the consequent demands on the workforce. n Encompass the changes in provision of care and increasing numbers of children with complex healthcare needs. n Develop, share and influence policy n Support paediatricians in improving their services.
In April 2007 the RCPCH published an intercollegiate report on the standards of care for children in emergency departments. Created by an intercollegiate group for children’s emergency care, Services for Children in Emergency Departments contained over 60 recommendations encompassing service design, assessment, treatment, staffing and training, child protection, sudden and unexpected deaths in infants (SUDI), children in major incidents and information systems. Supported by this publication, the RCPCH was awarded a tender by the Health Care commission to develop a toolkit to audit the quality of children’s care in Emergency Departments.
To carry out these objectives a number of initiatives were put into action during 2006/7. Dr Simon Lenton led a project on effective pathway and network commissioning, which culminated in the production of a report, A Guide to Understanding Pathways and Implementing Networks. This document complimented existing Department of Health policy and the National Service Framework with particular relevance to the development of managed clinical networks.
1 RCPCH Publication: Modelling the Future. 2 RCPCH Publication: A Guide to Understanding Pathways and Implementing Networks. 3 RCPCH Publication: Services for Children in Emergency Departments.
Child Protection continues to be a major area of work for the college. Although an emotive and controversial issue the college has striven to provide support for both clinicians and families. In the reporting year, the RCPCH Health Services Department developed online child protection information pages for the health services area of the College website. Information included an online survey for Named and Designated doctors to obtain information on demographics, workload and support needs. Model job descriptions were also made available to ensure a clear understanding of the role. These web pages also provide a full list of related documents, policies, events, and external links (www.rcpch.ac.uk/Health-Services/ Child-Protection).
Workforce As part of College health services policy, the RCPCH collects a range of data about the paediatric medical workforce. Recent work has centered around the impact of policies such as the Working Time Directive and changes to the Consultant contract, informing workforce modelling and annual reviews with the NHS. Information from a biannual census of career grade paediatricians is supported by regular surveys of the numbers and career intentions of paediatric trainees. Some of the new and regular activities carried out in 2006/7 consisted of: n The Working Time Solutions project ‘Children and Maternity Services in 2009’. Funded by NHS National Workforce Projects and undertaken jointly with RCOG. Begun in May 2007. n Workforce Census 2005 results published in August 2006. n SpR follow up survey undertaken in Autumn 2007, with a report issued in June 2007. n 2007 RCPCH and RCN Nursing Workforce Survey of all NHS organisations employing children’s nurses (via the Director of Nursing). n Publication of the 2005 census ‘A Changing Workforce’ highlighting a slowdown in the growth of the paediatric workforce.
Policy and standards The new Policy and Standards Directorate, led by David Ennis, serves to: n Co-ordinate and manage the development of College policy. n Ensure adherence to College procedures, rules and regulations. n Promote paediatric standards of practice. n Advocate on important paediatric issues as well as children’s access to health and health care. n Promote the rights of children and young people according to the UN Convention on the rights of the child. n Encourage the participation of children, parents and carers within college activity and practice. The College continues to address standards of practice for paediatricians by working with NHS bodies such as the National Clinical Assessment Service, the National Patient Safety Agency and Council for Healthcare Regulatory Excellence. The CMO’s report “Good Doctors, Safer Patients” proposed an increasing role for Medical Colleges on revalidation. In response to this and other recommendations outlined in the report, the RCPCH began to investigate model proposals for the recertification process and the provision of revalidation opportunities for paediatricians. In addition, the 2007 RCPCH Policy Conference theme, “The Career Continuum: From Foundation to Senior Fellow”, considered how to integrate RCPCH work to provide a training, assessment and professional support and development service for paediatricians throughout their professional careers. In these ways the College continues to ensure the highest standards of healthcare practice.
A number of consultations were issued by the Department for Health, Nuffield Council on Bioethics, Parliamentary Office on Science and Technology, Home Office, National Institute for Clinical Excellence and Ministers among others. The College consulted widely on the CMO’s report on medical expert witnesses: ‘Bearing Good Witness – Proposals for reforming the delivery of medical expert evidence in family law cases’. Two other important consultations that the College responded to were: n GMC document ‘Children and Young People: Doctors’ Roles and Responsibilities’. n Home Office document ‘Planning Better Outcomes and Support for Unaccompanied Asylum Seeking Children’.
Advocacy The College continues to build on the good work already achieved for child advocacy awareness in strategy and practice. Overseen by the Advocacy Committee led by Dr Tony Waterston, the RCPCH have kept advocacy at the centre of College work in 2006/7 in the following ways: n Contributing to College responses to consultations relating to child advocacy. n Developing a guide to the processes for advocating for children’s rights. n Working with over 20 UK charities to feed in evidence to the Children’s Rights Alliance for England enquiry into UK compliance with the UN Convention on the Rights of the Child. n UNCRC Training day, for members, staff and lay representatives, to understand how the UNCRC is relevant to paediatricians work. The session also incorporated Article 12 – the child’s right to be heard – as a regular feature for this and future training days. n Presentation to raise College staff awareness of the UNCRC .
Participation Children and young people’s (CAYP) participation in RCPCH activity and practice continues to be overseen by the CAYP Participation Manager, Sophie Auckland, with 2006/7 witnessing further activities in this area. The response to the RCPCH’s children’s drawing competition on the theme of ‘Me and My Doctor’ was hugely successful with an unprecedented number of entries received by the deadline in September 2006. The competition culminated in a very enjoyable awards ceremony for the winners in October 2006, which was well attended by families, college staff and RCPCH officers. Thanks go to all the College representatives who helped out on the day. The new RCPCH website was launched in March 2007 along with a CAYP area for children and young people. The site provides a platform for children and young persons to share their views and experiences of health related issues. There is a Youth journalist monthly competition, Paediatric careers information area and the opportunity to respond to consultations such as passive smoking and obesity. Consequently, the CAYP site has attracted a great deal of interest from outside the College as a useful communication tool for participation activity.
The 2007 Spring Meeting witnessed the groundbreaking attendance and active participation of children and young persons, offering their views and perspectives, on a number of issues concerning health and health care. Children from the Young Experts Patients programme held workshops looking at the significance of communication skills between paediatrician and patient. Sophie Auckland also facilitated a symposium on communication. To ensure that participation is developed throughout College activity the CAYP Manager conducted well-attended College staff training sessions about participation and how to incorporate participation activity into project planning. Aided by the RCPCH Assistant to the Registrar, Dr Eddy Estlin, and Sophie Auckland, plans for the formation of a CAYP Participation Advisory Group took hold in Summer 2007. The aim was to create a youth advisory panel UK network to inform College policy development and practice, respond to consultations and help implement our strategy for CAYP participation. The College’s Patients’ and Carers’ Advisory Group (PCAG) serves to promote the opinions of children, parents and carers in college activity. This group continues to play an important role in providing lay advice to College Committees led by its chair, Mrs Sally Sweeney Carroll. A handbook has been developed to advise new members
on the purpose of the PCAG role. Last year the PCAG held a coffee morning for all public members to meet and share their experiences of being involved in College work. Feedback from this session has helped to develop policies and practice guides for lay involvement. Members visited Northern Ireland, Scotland and Wales as well as many places in England to promote the benefits of this work to clinicians. The PCAG had a stall at the RCPCH Spring Meeting, helped to review documents for the public, supported key meetings at the College and consolidated the group’s function to support paediatricians in their role. In conclusion, significant progress has been made during the past year in policy development, setting standards, health services, advocacy and participation.
Dr Simon Lenton Vice-President for Health Services
David Ennis Director of Policy and Standards
The competition culminated in a very enjoyable awards ceremony for the winners in October 2006. 3
1 RCPCH Draw to Win Competition awards ceremony.
2 Young Expert Patients Programme workshop at the RCPCH Spring Meeting 2007.
3 RCPCH Draw to Win Competition entry.
Research Research continues to be a vital part of College activity . The aims of the College specifically include the promotion of scholarship and research in child life and health and the provision of information, evidence and advice on selected aspects of the health care of children and young people. Overseen by the Vice President for Science and Research, Professor Neil McIntosh (to July 2007) and Professor Terence Stephenson (the present post-holder), the Research Department have been hard at work in 2006/7 with new evidencebased initiatives, workforce planning and current projects. Clinical Guidelines and Audit The RCPCH Research Department promotes the implementation of evidence-based guidance. In 2006/7 data collection for the National Neonatal Audit Project (NNAP) was rolled out throughout England and towards the end of the reporting year the College was also commissioned to scope two further evidence-based initiatives, a national audit on emergency care and evidence-based care pathways for children with allergy. The RCPCH programme of guideline development and appraisal is conducted by the College’s Research Department and overseen by the RCPCH Quality of Practice Committee. It is designed to support paediatricians to practise evidence based medicine. The following appraisals of paediatric guidelines were completed in the reporting year: n Decreased Consciousness (Paediatric A&E research group) n Depression in children (NICE) Mouth Care for children and young people with cancer (UKCCSG-PONF Mouth Care Group). All appraisals conducted by the RCPCH can be viewed from the College website at: www.rcpch.ac.uk/Research/CE/ Guidelines/appraisal-and-endorsement. This site also includes information on how to submit a guideline or appraisal for endorsement. During the year the Department also led projects to develop the following guidelines: n UK Guideline on Screening and treatment of Retinopathy of Prematurity
(ROP). A collaboration between the RCPCH, Royal College of Opthalmologists, British Association of Perinatal Medicine, and the premature baby charity BLISS. Aimed at the neonatal and opthalmic teams involved in the care of the preterm infant, the guideline will be a resource for all healthcare professionals involved in the screening and treatment of ROP in the UK and will have a separate parent information leaflet. The guideline is available on the RCPCH website. n Evidence-based guideline on hypernatraemia. This guideline is based on a systematic review of the literature relating to hypernatremia and salt poisoning. It will provide evidence-based guidance on the differential diagnoses of hypernatremia in children, on which investigations should be undertaken and how to interpret the results. The publication is scheduled for release in 2008. The Quality of Practice Committee and Clinical Effectiveness team held a Clinical Guideline workshop at the RCPCH Spring Meeting in 2007. The workshop provided information on how to develop an evidence-based guideline to College standards and the process of College endorsement. The event also provided an opportunity to discuss issues surrounding guideline development using worked examples with experts in the field. This workshop is now a regular event. For more information: www.rcpch.ac.uk/Research/CE/Coursesand-Events/Guideline-Workshop Child Protection Research Research into Child protection is part of an ongoing College programme of support for doctors working in child protection (see also the Policy section on Page 13 in this report). The findings of a RCPCH qualitative study into complaints in child protection were published in January 2007 1. This report highlighted the difficulty some paediatricians face in communicating suspicions of child abuse to parents and led to a subsequent qualitative project with parents which was funded by the DCFS and DH and involved close collaboration with the EATON Foundation support group. The study aimed to understand parents’ experiences and communication needs when non-accidental injury is suspected.
It is hoped that the findings can be used to improve the dialogue between paediatricians and families in this situation and to inform child protection training. Ultimately, this should help to achieve a greater public understanding of the role of health professionals in child protection. The RCPCH in-depth review of the evidence-base for the physical signs of child sexual abuse continued apace through 2006-7. This review is scheduled to be published in April 2008 as an updated edition to the 1997 RCP publication ‘Physical Signs of Sexual Abuse in Children’. The new edition will focus on evidence for anogenital signs and sexually transmitted infections in relation to child sexual abuse. It will also include a section on “good practice”, based on consensus, which covers areas such as STI testing, examination technique, history and forensic sampling. Childhood Obesity Related Projects Research into childhood obesity continues to sit high on the RCPCH agenda and in parallel with the growing medical, social and governmental responses to this issue: n In the reporting year the Research Department brought together a group of researchers and specialists in childhood nutrition and obesity to identify research priorities. The first project developed by the group focussed on evaluating targeted support for parents weaning children at high risk of obesity and in 2006 this project was awarded funding under the Department of Health’s research programme relating to the children’s National Service Framework (NSF). n The Research Department’s project on non-type 1 diabetes in children, undertaken through the BPSU, was completed this year. The aim of the study was to establish the UK incidence of non-type 1 diabetes and in particular how many children developed obesity-related type 2 diabetes. The results of the study, published by Diabetes Care 2, showed that, although still rare (0.53/100,000 cases per year), the incidence of type 2 diabetes is rising with most of the cases occurring in obese teenagers.
British Paediatric Surveillance Unit (BPSU) The past 12 months to August 2007 has seen the commencement of five new BPSU studies into childhood conditions. These include vitamin k deficiency bleeding, fetomaternal alloimmune thrombocytopenia, genital herpes in children under 11 years and most recently, congenital adrenal hyperplasia. A study on intracranial idiopathic hypertension (IIH), funded by the Sir Peter Tizard bursary, commenced in July 2007. Studies on HIV/AIDS, congenital rubella, progressive intellectual and neurological deterioration, scleroderma, MRSA and MCADD continue. The orange card system for the surveillance of rare childhood disease continues to be viewed as a valuable epidemidological and educational resource. Paediatricians report anonymised cases each month on a distinctive orange card and details of the reporting clinician are passed on to the researcher so the cases can be followed up. Card returns rates have increased in the past year and currently stand at 94%, whilst questionnaire return rates are over 90%. For more information about the orange card system www.rcpch.ac.uk/Research/BPSU
The BPSU staff also continue to write and contribute to articles and reports of medical research interest. n Beyond Counting Numbers – Public Health Impact of Studies Conducted through National Paediatric Surveillance Units. Grenier D, Elliott EJ, Zurynski Y, Pereira R Rodrigues, Reece M, Lynn R, Kries R von. Arch Dis Child Jun 2007; 92: 527-533. The unit also demonstrated 20 years of achievement, as celebrated in the previous reporting year, with the following Archives of Disease in Childhood article in 2007. n British Paediatric Surveillance Unit – 20 years of surveillance. Lynn RM, Ross ER. Arch Dis Child – 2007- Sep 2007; 92: 744 – 745.
Supporting Achievements in Research The RCPCH/Wellchild Research Award was created to recognise research achievements. WellChild is the UK charity dedicated to the needs of sick children and families. The RCPCH Vice President for Science and Research oversees the nominations and, in 2006, the first award was won by Dr Paul Gissen from Birmingham Children’s Hospital for his work on Arthrogryposis, Renal Dysfunction and Cholestasis (ARC) Syndrome. For more information visit the Research section of the RCPCH website at: www.rcpch.ac.uk/Research/Research-Activity.
Public Information The provision of information to the public is an important aspect of research activity. In January 2007, the Research Department, the Neonatal and Paediatric Pharmacists Group and WellChild started a joint project to produce drug information directed at the specific information needs of parents and children and the conditions/illnesses for which they are prescribed. The project aims to deliver this information in a variety of formats, initially as a leaflet.
Professor Terence Stephenson Vice President for Research
References: 1 RCPCH 2007An investigation into the nature and impact of complaints made against paediatricians involved in child protection procedures. 2 Haines L, Wan KC, Lynn R, Barrett TG, Shield JP. Rising incidence of type 2 diabetes in children in the UK. Diabetes Care 2007; 30 (5):1097-101.
1 Guideline Appraisal: Decreased Consciousness in Children. 2 Guideline Appraisal: Depression in Children. 3 Guideline Appraisal: Mouth Care for Children and Young People with Cancer.
4 RCPCH Publication: An Investigation into the Nature and Impact of Complaints made Against Paediatricians. 6
5 Well Child Researcher Award. 6 British Paediatric Surveillance Unit Report Card (‘orange card’).
International The College has a continuing commitment to improving child health throughout the world. The International Officer, Dr Steve Greene, and the Overseas Directors – Dr Steve Allen (Africa), Dr Ezzedin Gouta (Middle East), and Dr Mike Webb (India) – have led a number of new initiatives. Our limited resources mean that we have to focus our efforts – in terms of both geography and the type of projects we undertake. Geographically our focus is the Indian subcontinent, East Africa and the Middle East (but especially Iraq, Palestine and Jordan). The focus of most of our projects is medical education. During the past year, these have included:
India n Delivery of Evidence based Medicine Course, Chandigarh, March 2007. n Child Protection Course, Chennai, January 2007. Middle East n A second training course for Iraqi, Palestinian and Jordanian paediatricians in Amman, November 2006. n Funding and completion of pilot project in Palestine Certificate in Child Health: presentation ceremony October 2007. Africa n Delivery of evidence based medicine course in Dar es Salaam, October 2006.
In addition, a range of projects are ongoing and will continue the College’s work in this area. These include further delivery of Child Health training for Iraqi paediatricians, most likely in Jordan, and a continuation of the College’s long-standing commitment to training Palestinian paediatricians. A scoping visit has taken place to Malawi and Tanzania as a preliminary to a range of projects in both countries. Overall, the College’s international programme aims to make use of the unique resource of expertise represented by members and thereby to improve child health wherever this expertise can make a difference.
n Discussions with Paediatric Association of Tanzania on Memorandum of Understanding with RCPCH. n Discussions with West Africa Association of Paediatricians on Memorandum of Understanding with RCPCH. n Development of Programme with International Malnutrition task Force.
1 Egyptian Members Association and RCPCH Examinations.
2 Jordan - Amman Course Teaching Facility.
3 Jordanian students receiving their certificates.
4 Palestinian Course organisers.
Dr Stephen Greene International Officer/ David Baum Fellow
Devolved nations Wales The Wales Office was particularly busy during 2007. The Office is further developing a two-way consultative relationship with the Welsh Assembly Government. The Officer for Wales regularly meets with the Health Minister and Minister for Children to keep children’s issues in Wales high on the political agenda in Wales and keep politicians well informed of child healthcare needs. The Office has contributed to consultation documents and reviews of service developments including Children and Young People’s Specialist Services Project (CYPSSP). These standards are being discussed at length and it is hoped the launch will take place in the near future. There are further reviews into CAMHS in Wales and the Office is working in close liaison with all involved to try and improve the present service, which is very variable in the different parts of Wales. The NSF is currently being implemented in Wales, it is felt that this will help to deal with problems in children’s service areas once fully rolled out. The Wales Office contributed to the consultation of Modelling the Future. With the planned reconfiguration of secondary care services in areas of Wales, this document will be helpful to paediatricians. The College in Wales held its St David’s Day Lecture in Swansea in 2007, and we enjoyed an interesting main lecture given by Dr Jean Matthes, a neonatologist from Swansea. We have also held our two joint conferences with the Welsh Paediatric Society, the first hosted by paediatricians in Conwy & Denbighshire; the second by paediatricians in Carmarthenshire. Both of these were a huge success. There have been a few changes within Committee during 2007. Professor Sailesh Kotecha took over from Professor John Gregory as Academic Representative and we all thank John for his hard work. Dr Donna Khalil finished her role as Trainee Representative and has been replaced by two part-time people, Dr’s Ajay Reddy-Hande and Shahera Rahman. Elen Evans, the Administrative Assistant at the Office left in November 2007 and we are seeking to replace her in early 2008.
There are to be some changes to Committee in 2008. Dr Gwyneth Owen’s role as Officer for Wales comes to an end in May 2008, at which point Dr Iolo Doull will take over for the next 3 years. We all thank Gwyneth for her hard work and wish her well in the future.
Scotland Scottish Committee The new streamlined Scottish Committee meets twice a year in the Board Room in our offices in Queen Street and once a year in Glasgow. Our 3 Regional Committee are up and running, each meeting 3 times per year and reporting back to the Scottish Committee. RCPCH Scotland Policy Conference Our Policy Conference held on 3rd May 2007 in Stirling concentrated on College Education from a Scottish Perspective with Dr Chris Verity VP for Education as a main speaker. St Andrew’s Day Symposium This was held on 24 November 2006 in RCPSG. Training Courses A court skills training course for 12 Paediatricians which was held in the court setting took place on 17/18th November 2006. An ALSG Safeguarding Children Trainers Masterclass for 24 Trainers took place in RCPCH Scotland in May 2007
Ireland The meetings of the Ireland Committee have been especially important this year given the number and speed of changes within paediatrics and child health in the Province and the Republic, especially in training and education. The committee has been seeking ways to develop and build on cross border initiatives and how best to move forward in identifying priorities for children and child health services. The Ireland Committee has produced information for the College website, covering the areas within its remit, namely – examinations, training and research. It is hoped this will be of benefit to trainees and career grade staff who are contemplating applying for posts both north and south of the border. With regard to training, two subspecialty training posts in gastroenterology and neurology have now been approved for training by RCPCH. This information will be disseminated to trainees in Northern Ireland who may wish to apply for these posts as part of subspecialty training. It is also planned to set up joint training days for SpRs in The Republic of Ireland and Northern Ireland in an attempt to develop joint training programmes.
Video Conferencing Facility Our new video conferencing equipment has allowed members of the Scottish Committee and the Child Protection Committee to attend meetings without any travel expenditure. The office staff are also able to participate in meetings which take place in the London Office. Staff Changes Daniel Crane the Examinations Co-ordinator in Scotland returned to the London Office in October 2006 where he continues with his Scotland role. Deanne Tomasino the Office Manager for the previous four and a half years left in August 2007.
Structure Senior management team Chief Executive Officer Len Tyler Director of Internal Services Mike Poole Director of Operations Jacqueline Fitzgerald Director of Policy and Standards David Ennis Head of Human Resources Michelle Macadam
2006/2007 College Boards and Committees The governing body of the College is its Council, which consists of the Trustees of the College. Trustees are elected by members and fellows of the College and comprise honorary officers, representatives from each of the College regions in the UK and the Republic of Ireland, paediatricians in the training grades, associate specialists, honorary and senior fellows and specialty paediatrics. The Collegeâ€™s primary functions are co-ordinated by a number of boards and committees, which are in turn supported by sub-committees and working parties, which report their activities to Council. The officers of the College meet formally and informally with representatives from other Royal Colleges, and with government and external organisations allied to child health. The College also participates fully in consultation exercises and wider discussions on paediatric health care issues at national level. Regional representatives, regional advisers, paediatric tutors and specialty advisers work on behalf of the membership across the UK and Republic of Ireland. Regional committees have been established to improve communication at all levels. The Collegeâ€™s national network is managed through its Scottish, Welsh and Irish committees. These provide a powerful voice for fellows and members, and also ensure effective communication with the four UK Departments of Health. The College is in regular touch with its members through the monthly publication of its scientific, peer-reviewed journal, Archives of Disease in Childhood, and quarterly newsletter which contains general news and information.
Executive Committee Reviewing College activities, offering strategic direction to College activities and advice to Council Chair: President, Dr Patricia Hamilton Finance Committee Responsible for ensuring the proper management of the finances of the College Chair: Honorary Treasurer, Dr Sue Hobbins Specialty Forum Coordinating the work of College specialties Chair: Vice President, Dr Simon Lenton Training Board Setting, delivery and maintaining the standards of paediatric training and examinations throughout the UK and Republic of Ireland Chair: Vice President, Dr Mary McGraw Research Division Executive Committee Reviewing research activity and offering strategic direction in the areas of research, surveillance and data collection Chair: Vice President, Professor Terence Stephenson Health Services Committee Provision of child health services and service configuration Chair: Vice President, Dr Simon Lenton International Board Coordinating the international activities of the College Chair: David Baum Fellow, Dr Steve Greene Academic Board Managing conferences, scientific meetings and CPD Chair: Vice President, Dr Chris Verity Secretary: Dr Alistair Thomson Examinations Committee Setting and conducting the MRCPCH and DCH examinations Chair: Officer for Examinations, Dr Tom Lissauer Publications & Communications Committee Strategic management of College publications Chair: Registrar, Dr Hilary Cass
Patron: Her Royal Highness The Princess Royal Trustees 2006-2007: The Officers of the College and members of Council are as follows: Officers of the College
Dr Ramesh Mehta
President Dr Patricia Hamilton
Dr Nisar Mir
Dr Geoffrey Lawson
Vice Presidents Dr Simon Lenton (Health Services) Dr Mary McGraw (Training & Assessment) Professor Terence Stephenson (Science & Research) Dr Chris Verity (Education)
Dr Russell Viner
North East Thames
Dr Ruby Schwartz
North West Thames
Honorary Treasurer Dr Sue Hobbins Registrar Dr Hilary Cass Scotland Dr Adrian Margerison
Dr Nicholas Mann
Dr John Trounce
South East Thames
Dr Ruth Charlton
South West Thames
Dr Michael Webb
Dr Peter Macfarlane
Dr Robert Scott-Jupp
Dr Steve Bennett Britton
Wales Dr Gwyneth Owen
Dr Adrian Minford
Dr Iolo Doull
Ireland Dr Moira Stewart
Dr Donald Macgregor
N, NE, E Scotland
Dr Sepideh Taheri
South Eastern Scotland
Examinations Dr Tom Lissauer
Dr Katherine Mckay
Dr Barbara Bell
David Baum Fellow (International Affairs) Dr Steve Greene
Republic of Ireland
Dr Paul Dimitri and Dr Mo Gnanalingham
Professor Richard Olver
Association of Clinical
Assessment Dr Colin Campbell Child Protection Dr Rosalyn Proops Policy Dr Geoff Lawson Training Dr Ian Doughty
Professors of Paediatrics Dr Keith Dodd
Dr Jeremy Kirk and Dr David Vickers
Details correct as of 31 August 2007.
Continuing Professional Development Dr Alistair Thomson Workforce Planning Dr David Shortland
Treasurer’s report As Honorary Treasurer it is my duty to monitor the College finances very closely on behalf of members and Fellows, especially so this year with the decision to purchase and move to 5 Theobalds Road. It has been a challenge (and at times extremely stressful!) working to support and enable the decision to move premises. The many positive changes and benefits that will follow will be for the future good of the College. Finance led the discussions in committees early in 2007 about affordability and that resulted in 5 Theobalds Road appearing on the College’s property search “radar”. As reported last year, it is important for you to understand and be aware of how your fees are allocated and utilised. This report aims to explain and put into context the figures for the College’s financial year to 31 August 2007, which are summarised on pages 24 to 26. It includes an update on the current financial health of the College. The College by virtue of its constitution undertakes a wide variety of activities, which are described within the other reports in this document and explains why income and expenditure vary from year-to-year. Reporting year 2006-2007 The overall “bottom line” is a large net increase in funds of over £5.75million. This is made up of a “one-off” £5.15million gain on revaluation of 50 Hallam Street (the difference between its original cost of £2.15million and eventual net sale price of £7.3million in January 2008) and a £610,000 surplus from normal activities.
The surplus from normal activities results in: n £71,000 increase in restricted funds (funds received and used for a specific purpose) n £282,000 decrease in designated funds (unrestricted funds earmarked for particular activities) n £821,000 increase in general funds (available for general purposes) The increase in general funds is important and timely given the purchase of premises and potential effects of current uncertainties and the demands on the College. Other headlines include: n Total incoming resources of £8.7m, an increase of 4.9% n Total resources expended of £8.3m, an increase of 9.0% n Membership subscription income of just under £2.5m, an increase of 6.0%, reflecting the real growth in membership by 5.1% from 8,946 to 9,404 members n Membership subscription rates increased by 2% on 1 January 2007 for those resident in UK, Ireland the rest of the European Union and North America. For members in resource-poor countries, no increase was levied meaning that for over 1,100 members their 2007 membership subscription remained at 2005 levels. n For the first year since the College’s formation, examinations income (of just over £2.5million) has not increased but has reduced slightly (by £41,049 or 1.6%). This is due to a reduction in candidate numbers, which is understood to be a result of the end of permit-free training. The College is monitoring this effect and is conscious of the increasing costs of developing and running the examination. n Gains on investments of £180,604, which is a return of 9.0% (2006 £399,943; 12.1%) n Successful publication in July 2007 of the third edition of the British National Formulary for Children (BNF-C) resulted in net Publications income of £213,470 (2006 - £548,896 for the first two editions) n Publications income in addition includes £471,188 (2006 - £333,358) because of the surplus due to the College from the joint venture to publish Archives of Disease in Childhood (ADC)
n Successfully attracting increased grant funding totalling £969,366 (2006 - £520,477) n Unexpectedly low attendance at the 2007 Spring Meeting resulted in £54,301 lower net income than 2006. The increase in total expenditure reflects a significant expansion across all of the College’s work, particularly in Education, Research and Other Professional Activities (principally creation of a Health Services Department). There has been increased expenditure to support activities to develop the examination and improve its quality and robustness. Meeting the requirements set by PMETB for training, assessment and examinations have had an impact on costs and will continue to do so for the foreseeable future. The College has continued to use the Everley Jones fund towards Education, Training and Research initiatives, which have been unable to attract external funding. The balance on the Everley Jones fund at 31 August 2007 is £558,962 of which almost £120,000 has been committed to underwrite such activities. The increase in expenditure has been kept to a minimum by continuing to carefully monitor and control costs. There is an annual “Budget Scrutiny Day” where Finance Committee members and senior management thoroughly review with budget holders their draft budgets. Current Year 2007-2008 Cost control and income generation is especially important now that the College has purchased its new premises. To fund the purchase the College has completed the disposal of all its unitised investments and has taken out a mortgage of £4million. The loss of investment income and the cost of the mortgage interest together outweigh the saving made in not paying rent. This overall increase in net cost is considered worthwhile because of the expected continual increases in rents, the first of which would have affected the College as early as February 2010. Additionally the new premises will allow the College some scope for expansion as well as enabling more efficient working and better use of resources.
Nevertheless, this particular financial squeeze has come when the College’s finances for the first time have reached a financial equilibrium where income and expenditure are finely balanced. The current financial year to 31 August 2008 will record a significant deficit because of the one-off costs attributed to the move to new premises. Prior to deciding to move premises, the College had already accepted a lower than usual budget increase in the General Fund of £200,000 compared with the normal target increase of £250,000. The main reason is the loss (to PMETB) of Department of Health grant income for Training and Assessment work at a time when this work is growing and demanding more resources. Council felt it is currently unfair to expect trainees to bear these financial burdens. Fortunately vigorous lobbying of PMETB and the Department of Health has resulted in some of the grant income being restored, but only for the current year. The financial effects of factors such as PMETB, examination and membership numbers and recertification will be kept under close review and opportunities for income generation are actively being explored. Achieving sustainability for a number of current education initiatives is important. Electronic publishing remains a potential threat to the ADC and BNF-C income streams but this effect may be mitigated as both ventures are actively engaging in electronic initiatives themselves. The recent expenditure on IT to enhance communication and productivity in general and the website in particular are already yielding noticeable benefits and money for “Phase 2a” of website development is in the current financial year’s budget.
The General Fund allows the College to respond appropriately to most eventualities. As at 31 August 2007 it stood at over £8.1million but it has subsequently been used to fund the property purchase. In the meantime, should it be necessary to safeguard the College in the longer-term, the value of 5 Theobalds Road means it should be possible to borrow further. The task of rebuilding the general fund begins again in earnest and, in addition to focussing on operating costs and new income generation, a proactive approach to fund-raising is being developed.
Independent Auditors’ statement to the Trustees of the Royal College of Paediatrics and Child Health We have examined the summarised financial statements of the Royal College of Paediatrics and Child Health.
Transparency in general and particularly with finances is essential and encouraged by the College. If you have any queries about the finances of the College, please do not hesitate to contact me (email@example.com) or Mike Poole (firstname.lastname@example.org), Director of Internal Services at the College.
Our responsibility is to report to you our opinion on the consistency of the summarised financial statements and Trustees’ Annual Report.
Dr Sue Hobbins Honorary Treasurer
Respective responsibilities of trustees and auditors The trustees are responsible for preparing the summarised financial statements in accordance with the recommendations of the charities’ Statement of Recommended Practice.
We also read the other information contained in the Annual Report and consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with the summarised financial statements. Basis of opinion We conducted our work in accordance with Bulletin 1999/6 “The auditors’ statement on the summary financial statements” issued by the Auditing Practices Board for use in the United Kingdom. Opinion In our opinion the summarised financial statements are consistent with the full financial statements and the Trustees Annual Report of Royal College of Paediatrics and Child Health for the year ended 31st August 2007. Kingston Smith LLP Chartered Accountants and Registered Auditors 27 February 2008
Accounts Summarised Financial Statements for the Year Ended 31 August 2007
Consolidated Statement of Financial Activities for the Year Ended 31 August 2007 Unrestricted Funds £
Restricted Funds £
Endowment Funds £
2007 Total £
2006 Total £
INCOMING RESOURCES Incoming Resources from Generated Funds Voluntary income Activities for generating funds Investment income Incoming Resources from Charitable Activities Examinations Spring Meeting Education Training Research Members’ subscriptions Publications Other income
5,133 160,760 514,025
164,320 160,760 537,544
277,338 165,347 417,469
2,486,720 343,077 97,593 32,339 200,115 2,539,890 891,541 316,633
282,641 179,716 459,977 -
2,486,720 343,077 380,234 212,055 660,092 2,539,890 891,541 316,633
2,527,769 433,416 139,039 296,408 442,422 2,396,048 896,401 291,873
Total Incoming Resources (see note 3)
RESOURCES EXPENDED Costs of Generating Funds Costs of generating voluntary income 34,791 Fundraising Trading: Costs of goods sold & other costs 44,738 Charitable Activities Examinations 1,980,282 451,783 Spring Meeting Education 509,167 537,762 Training 806,877 Research Other professional activities & standards 2,741,507 Governance Costs 44,419
342,057 345,416 281,389 143,678 -
1,980,282 451,783 851,224 883,178 1,088,266 2,885,185 44,419
1,923,486 487,821 643,050 874,837 1,020,676 2,514,401 45,196
Total Resources Expended (see note 1)
NET INCOMING/(OUTGOING) RESOURCES BEFORE INTEREST IN ASSOCIATE AND TRANSFERS Interest in result of Associated Undertaking Transfer between funds
702,663 98,049 -
NET INCOMING RESOURCES BEFORE OTHER RECOGNISED GAINS AND LOSSES Gains on revaluation of fixed assets Gains and losses on investment assets
357,606 5,144,106 180,604
429,000 5,144,106 180,604
800,712 10,140 399,943
NET MOVEMENT IN FUNDS Fund balances brought forward
TOTAL FUNDS CARRIED FORWARD
There were no recognised gains and losses for the year other than those included in the Statement of Financial Activities.
Consolidated Balance Sheet as at 31 August 2007
Fixed Assets Tangible Assets
Group 2007 ÂŁ
Group 2006 ÂŁ
Current Assets Stock of Publications and Merchandise Debtors Investments Cash at bank and in hand
79 1,131,464 7,996,097 493,736
1,209 1,278,106 5,289,272
Creditors: Amounts Falling Due Within One Year
Net Current Assets
8,657,912 4 8,161,368
3,796,227 4 7,340,737
Represented by: Unrestricted Funds: Designated Funds Charitable Trading Subsidiary Fund General Funds Total Unrestricted Funds Restricted Funds Permanent Endowments Total Funds of the College (see note 2)
Notes Notes to the Summarised Financial Statements for the Year Ended 31 August 2007 1. TOTAL RESOURCES EXPENDED
Costs of generating voluntary income Fundraising trading: cost of goods sold & other costs Examinations Spring Meeting Education Training Research Other professional activities and standards Governance costs Total Resources Expended
Staff Costs £
Other Direct Costs £
Other Allocated Costs £
2007 Total £
2006 Total £
Other allocated costs in 2006-2007 can be further analysed by activity as follows: Premises & Facilities £
Human Resources £
Information Technology £
Total Other Allocated Costs £
Costs of generating voluntary income Fundraising trading: cost of goods sold & other costs Examinations Spring Meeting
Research Other professional activities and standards Governance costs Total Allocated costs
Costs of generating voluntary income are those incurred in seeking voluntary contributions and do not include the costs of disseminating information in support of the charitable activities. Governance costs include the costs associated with the meetings of the Council, Executive Committee and Finance Committee and those incurred in connection with the statutory external audit. All allocated costs have been allocated on the basis of the headcount except £32,352 of the Information Technology cost which has been directly attributed.
2. FUNDS Unrestricted Funds The General Funds of £8,161,368 (2006 - £7,340,737) represent the “free” funds of the College which are not designated for particular purposes or restricted in any way; they are essentially the College’s reserves. Such funds need to be held as reserves to permit a responsible reaction to uncertainties. During the year the College reviewed the level of reserves it requires and set the requirement at one year’s expenditure, which is currently in excess of in excess of £7million. In addition, the purchase of 5 Theobalds Road has established that a further £10million is required to enable the College to acquire the type of premises it considers appropriate for the long-term. The required target total annual increase in reserves of £250,000 remains unaltered. In response to changes in Training, for the year to 31 August 2008 the College has accepted a budgeted increase of £200,000. Designated funds comprise unrestricted funds that have been set aside by the trustees for particular purposes. They include the Fixed Assets Fund £7,373,189 (2006 - £2,235,268) and the balance of the Everley Jones Bequest £558,962 (2006 - £870,204).
Restricted Funds Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised by the College for particular purposes and comprise funds for the WellChild Fellowships, David Baum International Foundation, Education, Training, Research and Awards & Prizes. Permanent Endowments Permanent Endowments are monies which have been given to the College in trust with the restriction that they are held as capital with the income generated from them to be used for specific awards.
3. INCOME FROM COMMERCIAL COMPANIES A list of commercial companies who pay for a presence at the Spring Meeting and similar events organised by the College is available on request from the Director of Internal Services at the College. Any commercial companies who have made significant financial contributions to the College in the calendar year 2007 are included in the Fund-raising report within this Annual Report.
Fund-raising The College has done well in attracting external funding for its work for the financial year ended 31 August 2007. Most of it is shown in the restricted funds column of incoming resources in the statement of financial activities. In 2006-7 it totalled £1,105,040 compared to £674,481 the previous year. Research, Education and Training Departments have contributed to 80% of this income in both years. The Healthcare Commission has given £180,000 to help develop and deliver obesity workshops for professionals working with parents to ensure their babies and preschool children are healthy and to help prevent or reverse obesity. A multidisciplinary group of experts is closely involved in the design and piloting of these practical intense training workshops. This type of funding cannot be considered as “statutory” or in any way guaranteed, and without attracting such funds the College would be significantly smaller and less effective. Certain areas which the College wishes to progress, such as aspects of child protection work and international education initiatives are particularly difficult to link with any external funding.
Hence there is a continued need to generate additional income in order to fulfil the College’s vision and ambitions. David Baum International Foundation Active fund-raising by the Foundation has continued. On 23rd June 07 Harold and Glenda Baum organised ‘An evening of Gershwin’, a concert and supper soiree with Catherine Galloway (Soprano), Roger Prout & Neil Crossland (Piano), where a total £6,875 was raised. There was the Palace to Palace sponsored walk from Windsor to Hampton Court at the end of June 2007, which raised £14,888. The walkers were greeted by HRH The Princess Royal, the College’s Patron, and then set off along the Thames Path for the first of two days’ walking. Another notable event was the barn opera event organised by friends of the Baum family Mr & Mrs Charles Crowther. This took place in Fingest, Oxfordshire on both the 1st & 9th September 2007, with a performance of Puccini's much loved opera ‘Tosca’. Their efforts resulted in a donation of £10,000 in December 2007. This represents a generous addition to a healthy Foundation, which is now funding a growing number of educational projects
Details of total “Other voluntary income” are as follows: Legacy income Levies collected from UK-resident members for visiting fellowships and College work overseas Donations from members to Foundation Appeal Other donations (see note below)
David Baum International Foundation
British Council support for course in Jordan
Grant from Department of Health to establish Adolescent Health Special Interest Group Total
in developing countries in Africa and Asia as well as in Gaza and the West bank. The New Building – 5 Theobalds Road The College has bought a new building and will be relocated from the 25th March 2008. By that time more than £19million will have been invested in the purchase, fit out and move. Until now the College has consciously adopted a low-key approach to fund-raising. The purchase of new premises has been a trigger to review this approach with the intention of starting a major fund-raising process by the time of the move. This initiative will aim to maximise the benefits of 5 Theobalds Road and strengthen the College’s finances following the purchase. Professional fundraising advice will be commissioned to establish an effective strategy and methodology for the process. Further progress will be regularly reported in the College Newsletter. Legacy fund raising In comparison with the more established charitable organisations, the College is receiving very little in the way of legacies from its members and others. Other Medical Royal Colleges have well established mechanisms encouraging their members
Note: “Other donations” in 2005-6 includes the anonymous donation of £150,000 used to create the Paul Polani fund, which aims to bring about improvements to the lives and health of children with neurodisabilities.
to include them as beneficiaries in their wills. This is an area of fund-raising that the College would wish to develop and gain the benefit from.
Major donations, grants, gifts and other funding
A gift in your Will The College is a charity and a gift in a Will can help reduce the inheritance tax burden. Such gifts are often referred to as “legacies” or “bequests”. There is a standard codicil form (an appendix to a Will) that can be sent to Members and Fellows for their professional adviser to consider. The College can assist Members and Fellows who have not written a Will and need a professional adviser.
We would especially like to thank the following who have helped to further the College’s vision towards better child health by supporting our activities in 2007 through major donations, grants, gifts and gifts in kind (including consultancy services and advice):
Other ways of making donation include: n regular donations by direct debit n single donations by cheque or credit card n gifts of shares n gifts of dividend income n support by payroll giving through the workplace n taking part in an event such as sponsored walk or even a marathon!
Department of Health
Alternatively please contact Pardeep Bhakar at the College. Email: email@example.com Telephone: 020 7092 6016. Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH
Dr Ben Ko Assistant to the Honorary Treasurer
Mr Harold Baum Mr & Mrs Charles Crowther Mr & Mrs Foster-Brown The Galley Family Charitable Trust
The British Council Department for Education & Skills
Healthcare Commission Health Protection Agency International Atomic Energy Authority (a specialised agency of the United Nations) Institute of Child Health International Union of Nutritional Sciences Karim Said Foundation
Further information Please visit the website www.rcpch.ac.uk and select the Fundraising section from the link headed ‘About the College’ for ways in which you can contribute.
Specifically as support for the David Baum International Foundation:
Royal College of Obstetricians and Gynaecologists The National Patient Safety Agency United Nations International Children's Emergency Fund (UNICEF)
Mr Anthony Goschalk Mr Dermot Wallace Yvette & Hermione Jacobson Charitable Trust
Bequests Bequests to the Royal College of Paediatrics and Child Health The health and well being of children has always been the concern of paediatricians. The enormous advances made by the medical profession have cut a swathe through previously fatal diseases, and better nutrition and living conditions have produced a healthier child population. However, other dangers, social and medical, continue to threaten, and in today’s market-oriented climate, money is always needed to enable us to fight for children’s welfare, to fund research and to provide better education for paediatricians in whose hands lies the health of the nation’s children.
A bequest to the RCPCH in your Will would help the College to continue its important work. Overleaf you will find a printed form which, duly signed and witnessed, would become a codicil to your exiting Will. It can be simply filled in, detached and sent to your solicitor. If you intend to do this, will you please note the following points: 1. Please read the document to ensure that it accords with your wishes. Any alterations must be made before you sign. 2. Then date the document where indicated. 3. Then in the presence of two witnesses sign your name at the end of the document where indicated. 4. The witnesses must sign their names and write their addresses where indicated. The witnesses are needed in England, Wales and Northern Ireland; one witness in Scotland.
5. You and the witnesses must all be present together when you sign, and the witnesses must see you sign. 6. No person taking benefit under the document or the husband or wife of any such person should be a witness, otherwise such person will not be able to take any benefit under the document. 7. All alterations should be initialled by you and the witnesses in the margin opposite the alteration. 8. On no account should anything be pinned, stapled, paper-clipped or fastened in any way whatsoever to the document. Members wishing to contribute in this way are asked to contact the fund-raising section of the College (e-mail firstname.lastname@example.org), especially if they wish any bequest to be used for a specific purpose.
...money is always needed to enable us to fight for children’s welfare. 29
Form of Codicil Please complete this form, detach and send to your solicitor. I (name in block capitals) of
Declare this to be a Codicil which I make this
To my Will which bears the date
(1) I bequeath to the ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH (‘The College’) or to any successor body carrying out the same or similar charitable work the sum of
amount in words
free of all taxes whether payable in the United Kingdom or in countries overseas for the general purposes of the College and I declare that the receipt of the – Honorary Treasurer for the time being of the College shall be sufficient discharge for the same. (2) In all other respects I confirm my said Will. In witness thereof I have here unto set my hand the day and year first above written. Signed by the said Testor/rix (Signature) as a Codicil to his/her last Will in our joint presence and by us in his/hers.
Witness (name in block capitals)
Witness (name in block capitals)
The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in Scotland (SC038299).
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5-11 Theobalds Road, London WC1X 8SH Tel: 020 7092 6000 Fax: 020 7092 6001 e-mail: email@example.com
www.rcpch.ac.uk The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in Scotland (SC038299).
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Royal College of Paediatrics and Child Health