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‘Our Children Deserve Better’
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Chief Medical Officer says ‘prevention pays’ England’s Chief Medical Officer, Dame Sally Davis, added weight to the call for improving child health in her annual report published in October. The report, ‘Our Children Deserve Better’ includes a range of recommendations designed to tackle issues such as rising childhood obesity, poor mental health services, lack of child health expertise amongst primary care providers and increasing rates of vitamin D deficiency. Many of the recommendations echo the RCPCH’s key policy and campaigning priorities – and indeed a number of RCPCH members have authored sections of the report, including Editorin-Chief of the report Dr Claire Lemer, Professor Mitch Blair, Dr Ronny Cheung, Dr Jason Strelitz and Professor Russell Viner. Among the 24 recommendations are: • All children with a long-term condition should have a named GP responsible for their ongoing care • National Institute for Health and Care Excellence should look at the costeffectiveness of extending vitamin supplement provision to all children under five
• Paediatrics and child health should be part of the core component of extended training for GPs • An annual audit of mental services for children and young people and expenditure in the area should be undertaken Responding to the report, RCPCH President Dr Hilary Cass said: ‘Investing in children is not only an investment in today’s young people; it’s a sound investment for the future. So in the run-up to the next election, as the political parties prepare their manifestos, the challenge is to ensure that child health is high on the agenda. We have a duty to this generation of children, to the next generation and to generations to come.’ The RCPCH is holding a policy breakfast in January (see page 4) to discuss the report and look at how the proposed actions can be best taken forward. MELISSA MILNER Head of Media and Public Affairs EMILY ARKELL Head of Health Policy
News Our Children Deserve Better Annual Conference 2014 RCPCH Revalidation Portfolio
2 From the President Best Beginnings: reducing inequalities in child health
4 Your views RCPCH policy breakfasts: key topics
From the President
RCPCH in the twittersphere Members website panel
5 Training and support Shape of training - the right people with the right skills in the right place Computer Based Testing (CBT)
6 Your RCPCH Workforce update New disability resource set to change hearts and minds
Healthy development eLearning
Health inequalities and the social determinants of health are not a footnote to the determinants of health. They are the main issue.
RCPCH Annual Conference 2014
Sir Michael Marmot
‘Calling the shots’ gets on target Membership subscription fees 2014
RCPCH events and courses 2014
9 Committee news Nutrition Committee Staff, Associate Specialist and Specialty Doctors (SAS) Committee Training Matters BPSU Committee RCPCH Annual General Meeting 2014 College member posts: new nominations process for 2014 Editors: Jo Ball Sarah Quinlan Brian Dow Email: firstname.lastname@example.org Supplier services: Work Communications www.workcomms.com Published by: The Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH. Tel: 020 7092 6000 Fax: 020 7092 6001 Website: www.rcpch.ac.uk Email: email@example.com The College is a registered charity: no. 1057744 and registered in Scotland as SC038299
Many years back, when I worked as a CMO in Islington, we had spectacularly poor vaccination uptake for two wildly different reasons. One child from trendy Canonbury would be brought in by her nanny, who would explain that her parents only wanted her to have ‘the homeopathic vaccination’. The next would be brought in by a streetwise parent from the local estate who would warn me that her baby wasn’t going to have ‘that needle that would give ‘im brain damage doctor’. The net result was identical; no vaccinations. My colleague, who had trained in India, was driven wild with frustration; back home, when they had run a vaccination programme, parents would walk two days from the surrounding villages, carrying their babies, in order to get them immunised. Indeed, when I went with her to India a few years later, she took me to the paediatric tetanus ward in the hospital where she had trained. At that time it had one ventilator which gave just one child a chance of life, whilst all the others died. It was against this background that I set off to one of my allocated nurseries to do an onsite vaccination blitz of those who had slipped through the net. The nursery boasted the highest concentration of disadvantaged children in the borough, and I held out little hope that more than one or two parents would turn up. On arriving at the nursery, I was astonished to find that I could hardly squeeze into the medical room through the crowd of mothers and children waiting patiently in a line that spilled out along the corridor and into the hall. After 45 minutes of relentlessly plunging needles
into screaming infants I ventured to comment to one of the mums ‘It’s a great turnout. I’m so pleased you’ve all come’. ‘Didn’t ‘ave any choice, did we?’ she muttered darkly. ‘Janet and Jenny said that if we didn’t show up, they’d sort us out’. The penny dropped. Janet and Jenny (names changed for my personal protection) were identical twins who had children at the nursery, and variously dominated, terrorized, and supported the other mums. In fact, if someone got pregnant they’d rush out and shoplift everything that might be needed for the baby. I found it hard to tell them apart, but rarely had to as it was unusual for both to be out of prison at the same time. Having put a lot of energy into sorting out a range of issues for their various children, they had both concluded that I was ‘alright’, and worthy of their special brand of support. I suppressed a passing twinge of anxiety about how the GMC might view this approach to ‘informed consent’ and pushed on with the next shot. That year my vaccination uptake in the most deprived nursery in Islington was 100%. Great expectations for our children Through the early months of my Presidency, I had frequent debates with our Media and Campaigns team about the correct balance of ‘sound bites’ that we should try to get into the press. My initial instinct was that members would want me to be getting media focus on the issues that were making their working lives stressful and miserable; staffing shortfalls, winter PICU pressures, and over-crowded A&E departments. Was it my role to be arguing the case for preventative policies such as plain paper cigarette packaging, stopping smoking in cars, and restricting junk food advertising before the 9pm watershed, I asked. Was that too political? As time
BEST BEGINNINGS: REDUCING INEQUALITIES IN CHILD HEALTH The charity Best Beginnings has just secured funding from the Department of Health to re-master their ‘From Bump to Breastfeeding’ DVD. The DVD is in Breastfeeding Care Pathway, is supported by RCPCH and many other organisations and has been given to almost two million families across the UK since its launch in 2008. The updated DVD will have new commentary and can be viewed in English, Bengali, Arabic, Polish, Urdu and BSL. A new ‘Breastfeeding Bundle’ document has just been created to explain how the ‘From Bump to Breastfeeding’ DVD can, once again, be made available to families across the UK for free. DH is also funding Best Beginnings’ Small Wonders project which is designed to compliment other initiatives and drive change in neonatal units across the UK towards more family-centred care. The funding will allow the production of 100,000 more Small Wonders DVDs for parents of premature and
has gone on, I have become increasingly passionate about our responsibilities to preventative healthcare and the role that RCPCH should be taking to ensure a better future for our children - both nationally and internationally. If we aspire to be Leading the Way in Children’s Health, as our strapline proudly proclaims, we cannot do this without ensuring that every paediatrician understands about health promotion, health inequalities, and the social determinants of health and illness. We don’t just owe this to our children, but to the adults they will become. For example, we have both the highest prevalence of asthma in Western Europe, and the highest mortality rate. So if we are going to do something about this we have to start from prevention and think about smoking policy and social protection, with all their political ramifications, as well as the downstream aspects that we are more comfortable with, such as asthma care pathways, the role of primary and secondary care services, and PICU provision. And as our Charter tells us, we have responsibilities for educating not just healthcare professionals, but also the public. If we didn’t know that before, it became abundantly clear with the MMR debacle, and the recent measles epidemic in Wales. Needless to say, I was therefore delighted that the Chief Medical Officer, Dame Sally Davis, chose children as the focus of her annual report (see page 1), with a very strong emphasis on the importance of preventative healthcare and reducing health inequalities. Please do download and read the report; many of the underlying messages are as relevant across the devolved nations as they are in England. Dame Sally has also been strongly championing the implementation of the recommendations of the Children’s and Young People’s Outcome Forum, so it is heartening that despite the understandable
sick babies and for healthcare professionals. Best Beginnings is now recruiting a new Small Wonders National Facilitator to support the 450+ Small Wonders Champions across the UK, a number of whom are paediatricians. In addition, the charity has just secured funding from the Galvani Foundation to create a series of free films to support Perinatal Maternal Mental Health. Some films will be for mothers and their families whilst others are being designed to support staff development and service improvement in this area. The College will continue to work closely with Best Beginnings to ensure their innovative projects have maximum reach and impact. For more information about these projects and how you can get involved go to: www.bestbeginnings.org.uk/rcpch
emphasis on the frail elderly, there is also government focus on children. Other important health promotion initiatives highlighted in this edition include the work by Best Beginnings on the Bump to Breastfeeding project, as well as the excellent Small Wonders DVD (see above), and our joint work with Public Health England to develop a free eLearning resource for those caring for young people who are engaged in substance misuse (page 7). You will also see that we have been active in raising the profile of global immunisation initiatives through our report Calling the Shots (page 6). Of the seven million children who die each year across the world, two million die from diseases that could be prevented by currently available vaccinations – and yet one in five children globally still do not receive basic immunisations against the main causes of child deaths. No wonder my colleague in Islington found our poor uptake so distressing! If you have heard me speak recently, you will probably have heard me recite the poem The Fence or the Ambulance by Joseph Malines. Brilliantly and wittily written in 1895, it demonstrates that in over a century we still have not learned the lesson that prevention is better than cure, so do Google it if you haven’t already seen it. You may also be interested to know that October saw the launch of the British Association for Child and Adolescent Public Health, an organisation worth joining if you want to learn more about these issues and get involved. And finally, last year’s RCPCH Christmas Lecture by Richard Wilkinson, author of The Spirit Level, is still available on our website, and is a useful source of CPD on the social and health outcomes of inequality.
Best Beginnings is a charity working to reduce inequalities in child health in the UK. Founded in 2006 by Alison Baum, they produce innovative and engaging evidence-based resources for families and health professionals.
Great expectations for our trainees As well as encouraging you to think about the next generation of children, can I also point you to Dan Lumsden’s column (page 10) and persuade you to give some thought to the next generation of trainees. Like Dan, I have been incredibly impressed by the various paediatric societies in our medical schools around the country; they are vibrant and enthusiastic, and brimming with ideas and excitement. So as Dan says, if you have one on your doorstep, do take the time to meet with them and offer your support. They really do represent the future of our specialty, and we need to make sure they are completely sold on the diversity and rewards of a career in paediatrics. Finally, Simon Newell has highlighted the Shape of Training report as another ‘must read’. Whilst many of the recommendations are welcome and consistent with our existing direction of travel, there will be challenges. Assuming that the recommendations are accepted, the devil will be in the detail of implementation. The exit point of postgraduate training will be the Certificate of Specialist Training, four to six years after completing Foundation training. Thereafter, issues such as protecting funding and support for further subspecialist training, and indeed for post CST training of generalists, will need a great deal of discussion and creativity. If you have an active role in your School of Paediatrics or in any capacity in medical education, please make sure you are at the vanguard of any developments in your patch. With all best wishes for a very healthy and happy Xmas and New Year. DR HILARY CASS President
RCPCH policy breakfasts: key topics The RCPCH holds regular policy breakfasts to raise the profile of the College and engage with key stakeholders in the child health sector. The breakfasts provide an open forum for discussion of topical issues and help to steer and promote the College’s position. Themes have ranged from children’s public health (how can we give children and young people the best start in life?) to avoidable child mortality, healthcare for children in secure settings and child poverty. The breakfasts are early morning seminars with short presentations from three or four high-profile speakers followed by questions from across the floor. Conducted under Chatham House
rule they normally stimulate a lively debate! The last breakfast was held in October and considered urgent and emergency care: how can we improve outcomes for children and young people? The next breakfast in the new year will focus on the Chief Medical Officer’s annual report ‘Our Children Deserve Better: Prevention Pays’. We are seeking suggestions from RCPCH members of key topics they’d like to see covered at future policy breakfasts. Please send any suggestions to firstname.lastname@example.org ISOBEL HOWE Policy Lead
RCPCH in the Twittersphere The Chief Medical Officer’s report, child mortality statistics and the RCPCH’s Youth Advisory Panel were the subject of a large number of Tweets this quarter. The College’s Twitter following is continuing to grow, with 3,200 followers comprising RCPCH members, charities, MPs and journalists. In case any readers are wondering who Tweets on behalf of the College, there are now around 15 members of staff representing teams across the RCPCH who upload content on their areas of work. So whether it’s international, examinations, training courses, media, policy or research, there should be a range of content for followers. In addition to the official College account, you can receive updates from the RCPCH President, Dr Hilary Cass at @rcpch_President. Don’t forget the College’s other social media channels too – Facebook, Pinterest and LinkedIn. Our LinkedIn account includes the latest College vacancies and Pinterest includes photographs from various events and conferences. ‘Like’ the RCPCH Facebook page to see the latest College reports and to find out about opportunities to get involved in College activities.
Help us develop the RCPCH website so it meets your needs as a member. Feedback on proposed developments, tell us your requirements and test prototypes. Opportunities to participate include focus groups, phone interviews, surveys and user testing. For more information and to register your interest, go to www.rcpch.ac.uk/memberswebsite-panel
MELISSA MILNER Head of Media and Public Affairs
Members Website Panel
For questions, please contact email@example.com or 020 7092 6041. KIRSTEN OLSON Membership Website Coordinator
Training and support
Shape of Training – the right people with the right skills in the right place You may remember our College consultation on ‘Shape’ – it attracted massive involvement and thank you to all RCPCH members who responded. ‘Shape of Training: securing the future of excellent patient care‘ (Shape) is now published and the input from paediatrics and child health is evident. Chaired by Professor David Greenaway, Dean in Nottingham, it is a framework for future postgraduate medical training and is well worth a read – www.shapeoftraining.co.uk. The College welcomed the report and see areas where child health is ahead of the game and already Shape compliant. I see three key themes: Generalism Children and the older adult increasingly present needs that are complex and cross boundaries of specialist skills. In our view, children benefit when the General Specialist is at the centre of the multiprofessional team - a notion Shape supports clearly and loudly. Shape proposes that general specialist training will include experience in allied areas, under the theme of children’s health. All will be trained in generic skills of communication, leadership, quality improvement and safety. Flexibility around the needs of our patients Flexibility is important for the workforce and for the doctor. Our workforce and the
geographical distribution of training must be driven by the needs of UK children. Clear career guidance and expectations is called for amongst medical students and our trainees. Shape notes that training does not end with CCT. Consultants all know the steep learning curve in their first years and in a phased consultant career we are very unlikely to do the same job from CCT to retirement. The Certificate of Specialty Training (CST) will allow most new holders to work as general paediatricians. Some will move at this point, or later in their career, through subspecialty training or into an area of special interest. Accreditation of Transferrable Competences will prevent duplication of training in skills already acquired. Credentialing Credentialing aims for quality-controlled subspecialty training, from areas of special interest to training of the subspecialist. Some may undertake this after CST while others will do so later in their career. This is one of the points where Shape welcomes the SAS doctor into the training pathway. Importantly, training of our future academic leaders must be more flexible, built around the needs of the trainee and, for most, allowing certification in the same time as other trainees. An optional year for all may include clinical practice, education, management or research.
The timeline of training will change. Shape proposes registration at graduation, moving into GMC-approved training posts with good supervision. Foundation training will remain, blending with a period of broad based training across a theme (for example child health or, for other groups, general surgery, internal medicine, women’s health, etc). It is envisaged that general specialty training will take four to six years from Foundation. The specific duration of training for different specialties will have to be developed by the UK-wide Delivery Group. We must ensure that adequate time is provided for the training of the consultant General Paediatrician. Implementation is suggested over two to five years, with acceptance that the UK Delivery Group have much work to do on funding, equity, geography and finding solutions for disparate areas of patient care. If you have a chance, do read, reflect a little and lend us your thoughts by contacting Julia.O’Sullivan@rcpch.ac.uk. This publication lays down a challenge for the future but already you will see parallels with our high esteem for General Paediatrics, National Grid training and the SPIN modules. To be sure, training in paediatrics and child health is already in pretty good shape. SIMON NEWELL Vice President Training and Assessment
Computer Based Testing (CBT) What does this mean?
be the same duration.
This means that instead of sitting the MRCPCH and DCH written exams via paper and pencil in exam halls, trainees will sit exams at designated test centres in the UK and overseas.
How can trainees apply to sit exams via CBT?
When will this take effect?
How will CBT affect me?
The College plans to implement CBT in summer 2014, the exact date that the first CBT exam will take place will be confirmed in 2014.
For candidates in the UK it will mean that you will be able to sit the exams closer to home as the exam will be offered in more locations than it is currently.
Will the exams be different?
How can I get involved?
All the written exams (Theory and Science, Foundation of Practice and Applied Knowledge) will be in exactly the same format as they are currently and will
Before going live with CBT in summer 2014, the College is holding a pilot exam on 25 March 2014 to ensure the system works well and to gather feedback. For
Candidates will apply via the same online application system that is currently used during advertised application periods.
the pilot to run successfully, we’re looking for trainees to volunteer to sit the exam. Who can take part in the pilot? Anyone can take part in the pilot exam but the College is keen to have volunteers who have taken an exam with the College previously so that we can gather feedback on taking a CBT exam in comparison to taking a paper and pencil exam. How can I apply to take part in the pilot? For more information and to apply for the pilot exam please see: www.rcpch.ac.uk/CBTPilotExam ROMANA MOSS Exams CBT Project Manager
Workforce update Key to the realisation of the College’s policy priority ‘a better NHS for children and young people’ is a comprehensive and cohesive UK-wide workforce strategy. Building on the Child Health in the UK conference in 2013, a working group of officers and staff have developed a workforce strategy which has been approved by RCPCH Executive Committee and can be viewed at: www.rcpch.ac.uk/workforce. It sets out a vision under the four main priority principles – the right system, the right approach, the right people and the right innovation - and identifies current work contributing to these aims, how we intend to achieve the vision and an action plan of immediate, short, medium and long term pieces of work. Key themes underpinning all four priorities are the meaningful participation of children,
New disability resource set to change hearts and minds A new website is being developed to address the needs of the UK’s disability workforce in a bid to share best practice and improve the lives of disabled children. The RCPCH is heading a Consortium of experts to produce a ‘Disability e-Portal’, which offers free eLearning to address the training needs of all professionals working with disabled children and young people up to 25 years old. The online tool, will acknowledge a spectrum of conditions ranging from learning difficulties, autism, physical impairments and cerebral palsy through to complex disabilities that arise in childhood and that continue to require support and management into adulthood. The portal will be written in plain English and will encourage organisations and individuals to link up and share best practice, which in turn, will help disabled children and young people get the most out of life. For more information, please visit the RCPCH website or email your enquiries to firstname.lastname@example.org LAUREN SNAITH Media and Campaigns Officer
young people and their parents and carers, and the consideration of the child at every stage of development, particularly focussing on transition to adult services. Although the College can only directly change what paediatricians do, it is essential that we reach beyond this group at a time when sustainability and safety concerns for the service are paramount and the workforce planning landscape provides the opportunity for the College to influence and set the agenda by strengthening and developing partnerships. The strategy requires strong commitment and leadership across the College and will increase engagement with members to ensure it adapts to changing needs. Part of the strategy is to monitor the career progression of recent CCT holders and the report of the 2011 and 2012 cohort has been
published recently (www.rcpch.ac.uk/cctsurvey). The findings emphasise the need for action on several strands of the strategy. Although almost 87.3% of new CCT holders obtain consultant posts and around 1 in 10 are moving abroad, the growth of non-substantive posts and concerns over a possible future surplus drive the need for a policy position on future training numbers and demand for trained paediatricians, which the College will release in early 2014. The squeeze on supporting programmed activities included in new consultant contracts highlighted by the survey, especially in Scotland, puts professional and service developments at risk and the College has committed to pushing workforce planning bodies to reverse this trend. MARTIN MCCOLGAN Workforce Information Officer
‘Calling the Shots’ gets on target The Strangers Dining Room in the House of Commons was packed on 16 October 2013 with more than 60 global health practitioners and parliamentarians to hear DFID Minister, Lynn Featherstone MP, former Nigerian Minister of Health, Professor Nike Grange and RCPCH International Board Chair, Professor Steve Allen, call for continued and sustained work on immunisation. Gathered for the launch of the RCPCH’s newly published report ‘Calling the Shots’, current global immunisation initiatives were reviewed and future priorities assessed. Steve Allen commented: ‘There’s no doubt that immunisation works. We’ve seen a marked fall in deaths from vaccinepreventable diseases amongst underfives, but there is more to be done. Regions such as West Africa still need our attention and there can be no room for complacency.’ Delivered in partnership with the American Academy of Pediatrics, ‘Calling the Shots’ notes that polio remains endemic in three countries - Afghanistan, Nigeria and Pakistan - and that whilst ‘investment in immunisation programmes has included building the capacity of health and immunisation systems in more than 50 countries - progress has slowed in all areas of global vaccination due to a shortfall in
committed funding’. From a College perspective, all of this is interesting as we look to see what role paediatricians play in shaping the post-2015 agenda and, in particular, the newly-emergent strategic development goals. Suffice to say, the need for continued advocacy for immunisation is right up there and we’re already moving forward on this. Reflecting on the recent measles outbreak in Swansea, Steve Allen iterated to the audience the need for partnership and trust between child health and public health professionals both in the UK and overseas. ‘We have a lot to learn from each other’ said Steve; ‘we’re moving into a new era of global health and one where we at the RCPCH will continue to promote the sharing of innovation and learning’. STEVE CRUMP Head of International Operations
Membership subscription fees 2014 The College aims to keep subscription increases in line with, or below, RPI inflation. Despite a difficult financial climate and reductions in funding this aim has been met for all recent years. The College, like most organisations and individuals, is affected by inflation and therefore will need to increase subscriptions to help cover extra costs related to inflation. Council have agreed a 1% subscription rise. At the time of
writing this is significantly less than RPI inflation which is 3.2%.
All requests are treated confidentially and considered on a case-by-case basis.
The College appreciates that some members may have difficulty in paying their subscription due to financial hardship and encourages those members affected in this respect to apply for a non-standard concession by contacting the Member Services Team on 0207 092 6060 or via email@example.com.
The main subscription rates for 2014 are outlined below. As membership subscriptions are fully tax deductible UK tax payers can claim up to 40% back from the Inland Revenue.mnes in SASKIA OTTIGNON Membership Supervisor
2014 annual subscription
Rate shown - includes Archives?
Fellow UK* and Republic of Ireland
Fellow rest of EU and North America
Ordinary UK* and Republic of Ireland
Ordinary rest of EU and North America
Associate UK*, EU and North America
Junior (UK only)
Medical Student Affiliates
*as in previous years, UK residents pay additional levies and payment surcharges may apply for some payment methods.
Healthy development eLearning The RCPCH and Public Health England have developed a free eLearning course to support those working with substance use in children and young people. The aim is to improve young peoples’ health and wellbeing outcomes, by helping to develop practice which is appropriate to their developmental stage. These materials will benefit professionals screening for substance use in wider children’s services such as psychiatrists, social workers, nurses and youth workers. They are also relevant to clinicians, as indeed paediatricians may come across these cases during the care of young people misusing substances. This short online course comprises 2.5 hours of content, split between seven interactive sessions with videos, case studies and self-assessments. It is hoped that both individuals and teams complete the course, for inspiring discussion and sharing best practice. RCPCH CPD approval has been applied for 2.5 points. After
completing all seven sessions users will be able to: •
Describe healthy adolescent development
Understand the range of factors that impact on healthy adolescent development
Recognise common sleep problems, sexual health problems and mental health problems in young people
Make their practice and service young people friendly.
To find out more please visit: http://rcpch.learningpool.com or contact us on: firstname.lastname@example.org . LUIS ABRAAO Education Provision Administrator
Towards Better Outcomes in Children’s Health This is the must-attend conference for people working within child health. The 2014 conference will attract 1,500 attendees from the UK and overseas to discuss and debate key clinical issues, latest paediatric science and share innovation and best practice. Be part of the UK’s largest paediatric conference and take advantage of the early bird booking (deadline: 14 February 2014). • • • • •
Prestigious keynote speakers Peer-reviewed abstracts Trainees session Over 30 specialty group sessions Quality improvement symposium
• • • •
Clinical guideline sessions Child protection symposium Personal practice sessions Best practice updates
To view the programme and to register visit: www.rcpch.ac.uk/conference2014
RCPCH events and courses 2014 EVENTS TEAM:
tel: 0207 092 6000
Introduction to Quality
Child Health in Low-
21 Jan 2014
10 – 12 February 2014
1 April 2014
Holiday Inn Eastleigh
How to Manage:
Managing Service Change -
27 March 2014
12 May 2014
6 February 2014
Child Protection: from examination to court 17-18 March 2014 RCPCH, London
Further details and to register visit: www.rcpch.ac.uk/events
Nutrition Committee Vouchers for breastfeeding - the right way to go? The benefits of breastfeeding to mother, child, family funds and the NHS budget are well documented. But it’s fair to say that in the UK we’re failing dismally at maintaining breastfeeding up to six months of age. Latest statistics show that although 81% of babies are breastfed at birth, at three months just 17% are being breastfed exclusively, with the figure dropping to 12% by four months. At six months, the rate is around 1%.
Sheffield approach offers a similar strategy to help improve the health of a mother and the next generation too.
Evidence suggests that breastfeeding is most common among mothers who are over 30, are from minority ethnic groups, who are in managerial and professional occupations and who live in the least deprived areas. In other words, the more educated, older and well off you are, the more likely you are to breastfeed.
Responses to the vouchers approach have been mixed and vociferous. Some in favour claim the scheme will help tackle some of the stigma around breastfeeding, particularly amongst younger women who may regard it as embarrassing or even immoral. Another argument given by the lead clinician Dr Clare Relton, is that the strategy should help redress the social imbalance of breastfeeding rates. She stated that ‘not breastfeeding is a cause of inequality’. This particular issue cannot be ducked given that these same health inequalities drive considerable volumes of activity in many parts of paediatric healthcare.
A new and relatively small feasibility study, launched by Sheffield University, will target 130 mothers in Yorkshire and Derbyshire in communities where breastfeeding rates are low. Women will be offered £200 in shopping vouchers if they breastfeed until six months – with payments staggered at two days, ten days, six weeks, three months and six months. Pragmatically vouchers have a long history of being employed to motivate or persuade individuals to seek better health. As with ‘Healthy Start’, the
Arguments against financial incentives cite principally those women who cannot breastfeed. Either because of medical complications or because they are not given the right advice and support, such mothers may perceive that they are being penalised by the scheme. Arguments of equity merit formal research – just how significant are they? Less well founded is the claim is that breastfeeding should be a positive choice rather than one motivated by financial gain. However, currencies
of lactation and finance are already closely linked, as paediatricians purchasing donor milk from banks or counselling a surrogate nurse will have discovered. Wherever you position yourself, the fact remains that ongoing attempts to promote breastfeeding – particularly when it comes to maintaining this – have been only modestly effective. Despite very robust and well evidenced work by UNICEF with ‘Baby Friendly’ initiatives, we have some way to go in order to improve this metric of paediatric public health. This failure merits continued innovation. The results of this pilot will be relevant to all paediatricians and those interested in public health. Healthcare professionals at all stages of training must not shirk their responsibility to advocate to parents the benefits of breastfeeding. Mothers who wish to breastfeed must be actively supported to do so during the pregnancy and following the birth. Education and support – as well as tackling stigma – surely lie at the heart of persuading families that breast really is best. DR COLIN MICHIE Chair, Nutrition Committee
Staff, Associate Specialist and Specialty Doctors (SAS) Committee ‘In it to win it’ My name is Malla Radhakrishna Haranadha Varaha Narasimhamurty (aka Murty) and I am the new Chair of the SAS Committee and SAS Representative on Council. My career in paediatrics began in India in 1972. Since my arrival in the UK 36 years ago I have been working for the same employer at the Royal Cornwall Hospital in Truro and currently hold the position of Associate Specialist in Community Child Health. I therefore fully understand the plight of SAS doctors in this current climate, which persuaded me to volunteer my services to the College. It’s needless to say that I was very excited when my nomination to represent SAS doctors was accepted. My predecessor, Dr Jane Wilkinson, worked very hard to raise the profile of SAS doctors and I will be working closely with the College to do my very best to continue this process. GMC revalidation is up and running and the College’s revalidation team can offer support and advice to SAS doctors. Some other developments include a revised
strategy for workplace based assessments (supervised learning events (SLEs)), the forthcoming Paediatrician’s Handbook, simulation and Technology Enhanced Learning (TEL), special interest (SPIN) modules, new eLearning resources and the Paediatric Carers of Children Feedback (PaedCCF) tool. See www.rcpch.ac.uk for more information about these initiatives. A survey of SAS doctors in 2012 revealed that more than half of SAS doctors working in paediatrics and child health are not members of the College (see www.rcpch. ac.uk/sas). Member benefits are enormous, including free access to the CPD diary and revalidation portfolio and a number of eLearning resources. For a fee, access to other support tools is available, including ASSET and ePortfolio, which can support CESR applications for those SAS doctors seeking entry to the Specialist Register. This could not be a better time to become an associate member, and if you have colleagues who are not yet members of the College, please do encourage them to
think about joining for the opportunities to further their career prospects, to access learning resources, for guidance on CESR and to improve their Personal Development Plans which underpin CPD and the GMC’s revalidation process. You have got to be ‘In It to Win It’; the famous catchphrase. Prospective and existing members can find out more by visiting www.rcpch.ac.uk/member-services There are still some SAS representative vacancies across the regions so why not consider joining our enthusiastic team to get SAS doctors’ voices heard? You can visit www.rcpch.ac.uk/nominations for further information. I hope to see you all at our next Annual Conference in Birmingham, in April 2014. If you would like to contact me directly, please email: malla.narasimhamurty@rcht. cornwall.nhs.uk DR MALLA R.H.V. NARASIMHAMURTY Chair, SAS Committee
Training matters The future is bright On 28 September I had the pleasure of helping to host a meeting of undergraduate medical student societies at the RCPCH building in London. The day was largely masterminded by Claire Matthews, a Foundation doctor, who pulled in representatives from medical schools across the UK. I was humbled to see just how much these student societies had achieved, from Teddy Bear Hospitals and Career Days to revision lectures and some truly fantastic student play schemes on the ward. It was a real privilege to spend the day with dynamic individuals who had already shown such a commitment to improving the child health experience of children and young people. It was quite clear that the diverse efforts of these societies were making a difference, sometimes on a national scale. It’s important to remember that despite what we’re sometimes told, we trainees aren’t the ‘future’ of paediatrics. We’re
the ‘now’ of paediatrics, delivering a large proportion of the care children and young people receive every day (particularly out of hours!). If we want to safeguard the future of child health, we need to look to the next generation of paediatricians, students already at medical school, and young people still making decisions about what to study at university. What can we do to make sure we are attracting the brightest and the best into child health? Competition ratios for applications to paediatric training are holding steady at a respectable average of two applicants for every post – but there are many other specialties which remain more popular. Medical students have only limited exposure to paediatrics during their undergraduate courses, and it’s essential that we make the most of this and offer them the most positive experience possible. Taking the time to teach the students about some of the cases on the ward round can make
all the difference, as can encouraging them to present the cases they’ve seen. The best advert for our specialty is happy trainees, providing good role models as professionals fulfilled by their work. It’s important to be realistic with this though, and anyone considering applying for paediatrics needs to have an understanding of the types of hours most paediatricians work, and the reality of consultant delivered care. Across the UK there are careers days you can help out at, run by the BMJ, by the College or by the individual medical schools. If you’re involved in a research project or in a quality improvement programme why not contact your local undergraduate paediatric society and offer to give a lecture about it? Think of it as an investment for your own future – making sure you get the kind of trainees you want to have when you’re a consultant yourself. DANIEL E LUMSDEN Chair, Trainees’ Committee
New Chair for British Paediatric Surveillance Unit (BPSU) Scientific Committee The BPSU has the pleasure of announcing that Richard Reading has re-joined the BPSU as Chair. He has taken up the position from the outgoing Chair Alan Emond. Richard is a consultant community paediatrician at Norfolk and Norwich hospital and has vast experience of working in the field of disease epidemiology; he was a BPSU committee member for seven years to 2012. Richard is versed in the BPSU ways of working, having undertaken several BPSU-facilitated studies. He was coinvestigator on the conversion disorder
study and lead investigator in two studies, one on genital herpes and the other researching sexually transmitted infections in children under thirteen years of age presenting to secondary care. Richard has also sat on the Child and Adolescent Psychiatry Surveillance System Scientific Committee as a paediatric representative. Richard states: ‘BPSU has successfully come through several turbulent years under skilled hands. I am immensely grateful to Alan Emond, the outgoing Chair, for steering
New Chair Richard Reading
the BPSU and leaving it in such a strong position. I hope to build on Alan’s work and continue the implementation of newer methods of working, including the use of electronic systems, and expansion of public involvement in BPSU working. What must not change is the integrity of robust surveillance methods. This is what underlies the high esteem the BPSU is held in across the world, and I hope to maintain and strengthen this reputation.’ RICHARD LYNN BPSU Scientific Coordinator
RCPCH Annual General Meeting 2014 The College’s Annual General Meeting (AGM) for 2014 will be held as part of its Annual Conference in Birmingham this April.
Such motions should be submitted to the Registrar, Dr Ian Maconochie, c/o the College. The deadline for receipt of motions is 30 January 2014.
In accordance with Bye Law 6 viii e), the AGM will consider motions ‘submitted in writing to the College not less than 10 weeks before the date of the meeting, accompanied by the signatures of 15 persons being Ordinary Members or Fellows.’
The agenda for the AGM will be made available to members via the website, and publicised via the RCPCH eBulletin, nearer the time. GRAHAM SLEIGHT Head of Governance and Contracts
Birmingham ICC: 09 April 2014
College member posts: new nominations process for 2014 The College’s new process for nominations is now in place. Vacancies will now be advertised on a monthly basis via RCPCH emails to members and on the College’s website. Job descriptions will be posted online, and will specify the time commitment and skills required. The nomination form is also online, and can be found, along with the job descriptions, at: www.rcpch.ac.uk/nominations
Supporting the work of the College by taking on a role of this kind can be extremely rewarding, as well as a positive developmental experience enabling the member to build skills and contacts at a national level. Members who contribute to the work of the College in this way can add a new dimension to the ways in which they support child health. For enquiries please contact: email@example.com
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