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Record attendance at RCPCH Conference 2012

A toolkit designed to help paediatricians make sense of the NHS Reforms: • A one stop shop for all College

information relating to the Health and Social Care Act 2012 • Latest news on secondary legislation and what it means in practice

Glasgow 2012

• A platform for Members to tell us about what is happening on the ground

Give us your views at: (See ‘From the President’ column, P3)

Paediatric Educators’ Programme

22-23 Nov 2012 12 CPD credits

For paediatricians interested in developing their skills and experience in medical education. • 2 core days of teaching at RCPCH, London • 2 regionally based Learning Group meetings (mid Jan & late Feb 2013) • A Learning Portfolio

More information and to register:

• Annual Conference held in Scotland for the first time • Highest number of delegates in five years • 96% of delegates “would recommend” the Annual Conference to a colleague

The RCPCH Annual Conference 2012 broke ground in two ways for the College. It was the first time the conference had been held either in a commercial venue or in Scotland. As with any break of tradition there was uncertainty in the lead up to the conference about the impact of the changes but, in the event, there was no need to worry. Not only were the number of delegates up at a five year high with over 1,200 from the UK and across the world but feedback from the programme and entertainment was exceptionally positive; even the sun seemed determined to enjoy itself. Continued on Page 8.


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News RCPCH Conference 2012 Cont. P8 Health Reforms - Your Say Paediatric Educatiors Programme

2 Registrar’s column 3 From the President 4 Research Science, research and the RCPCH

Registrar’s column Putting adolescent health centre stage

NIHR Medicines for Children Research Network (MCRN)

6 Health promotion focus What are we doing about childhood obesity?

7 Events BPSD to join Safeguarding Children training programme Forthcoming RCPCH events

8 RCPCH Conference 2012 9 Tony Jackson prize 10 Membership SSASG news Training matters Honorary Fellows and James Spence Medal

In 2007, The Lancet published its first adolescent health series, highlighting particular concerns related to sexual and reproductive health, mental health and substance misuse. Evidence reminds us that adolescents in the UK today are more exposed to harmful alcohol consumption, sexually transmitted diseases, challenges linked to social media and other risks than in the past. The Lancet’s second series on Adolescent Health, argues that ‘it is now time to put the young person, not the specific issue, centre stage.’ Adolescence is a critical phase in anyone’s life, where important choices impact life as an adolescent, as well as future life patterns. Being ill as an adolescent presents a number of additional challenges. The RCPCH is a strong advocate of improved health services for adolescents. We believe that their healthcare should be centre stage, their right to privacy and confidentiality is respected, they are treated with dignity and respect, and that their insights influence improved healthcare for adolescents.

Editors: Jo Ball Sarah Quinlan Brian Dow Email: Editorial services: Work Communications 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: Email: The College is a registered charity: no. 1057744 and registered in Scotland as SC038299


As a consultant in paediatric oncology, I am particularly impressed with the commitment from the Teenage Cancer Trust to improve clinical service provision and provide age-specific facilities across 22 new cancer units within the UK to ensure a service fit for purpose. We supported the launch of the Teenage Cancer Trust’s two new publications on 14 June: Blueprint of Care for Teenagers and Young Adults with Cancer; and Young Voices – a collection of messages from young people with cancer about the services they need and key advocacy messages, see: http://www. health-professionals/blueprint-of-care/. I am delighted that the RCPCH together with the Young People’s Health Special Interest Group (YPHSIG) has been instrumental in leading the way to improve adolescent health services. The RCPCH Youth Advisory Panel has also been involved in advising the

RCPCH in its policy development, engaging in the NHS reforms by actively advising the Future Forum briefings, the Children and Young Peoples Health Outcomes Forum and Strategy, and responding to the recent Department of Health consultation No decision about me without me. I was very happy to help chair a successful event at the RCPCH 2012 Annual Conference ‘Participation and Accountability – my right to be heard!’ Young people and paediatricians delivered practical, challenging and inspiring presentations. We launched a set of new information booklets for young people and paediatricians focussing on Having Your Say, Confidentiality and Consent along with a nationwide RCPCH e-consultation for young people by young people. In addition, we have set up a participation consultancy service due to the demand for our expertise in this area. You can find out more about all the RCPCH activities I have mentioned at: The changing landscape of the NHS presents an ever-challenging environment and places a duty of care upon us to advocate with and on behalf of our young patients and their families. It is crucial that the voices and insights of young people continue to influence our work to improve the standards and health services designed for them. Thank you to each of you for your continued support to date and I look forward to hearing more about how young people are continuing to influence the RCPCH to improve standards of healthcare for adolescents. PROFESSOR HAMISH WALLACE Registrar

Since the publication of this issue of ‘Notes’, Hamish Wallace has stepped down from the position of RCPCH Registrar. Recruitment for this College member post is now underway.


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From the President Medical Royal Colleges - essential, desirable or irrelevant? “They have been threatened by successive governments......dismissed as dining clubs for the privileged, bastions of reactionism, anachronisms which are both archaic and obscure” The above quote, taken from a lecture by Professor Tim Connell of Gresham College, refers not to the Medical Royal Colleges, but to the City Livery Companies. In their hey-day, the livery companies were ranked according to power, with such intense jockeying for position between them that the term ‘at sixes and sevens’ refers to the annual switching of the Merchant Taylors and Skinners between 6th and 7th rank. Since then, the role of the Livery Companies has become so ill-defined that Professor Connell opens his lecture with the observation that if they did not already exist, then there is little chance that anyone would invent them today. Several years ago, shortly after taking up post as RCPCH Registrar, I thought I should find out about the role of other College Registrars. I duly left my small hot desk in a corner of our old premises at Hallam Street and went to visit the RCP Registrar in his very impressive office in St Andrew’s Place. After serving me tea from a silver teapot, he asked how long my post had been in existence at RCPCH. I told him nearly 10 years – as that was the age of our new College. He nodded sagely and explained that his post had been established in the mid 1500’s. It would have seemed rude to ask if he was the first incumbent. The RCP – originally our parent College – was founded in 1518, and much of its early activities focused on controlling medical licensing in London and punishing those involved in ‘malpraxia’. With the imminent arrival of revalidation, clinicians may perhaps fear that the Colleges will return to their roots and become party to similar activities today. Conversely, those who have been

extensively involved in the training of young doctors will see our primary role as the education of the next generation of paediatricians. Yet with the turbulence around the delivery and management of medical education even that seemingly core College activity could be deemed to be under threat. However, I do remain confident that our strong track record of leadership in this area will make us a very hard act to challenge. So are other aspects of our role sacrosanct and relevant today? I believe that regardless of any amount of organisational flux, our role in setting clinical standards and helping you deliver them will only increase in importance, and in this respect we have a strength and sense of purpose that outstrips that of many other Medical Royal Colleges. Because our focus is on Paediatrics and Child Health, not paediatricians, we have a mandate to speak out for our patients on a range of key issues from child protection and obesity to mental health and child mortality. Advocating for change – whether in the health policy setting or in terms of the structural changes to the NHS – is a key priority for me as President. Across all 4 nations we will be trying to make current health policy work for children to support service redesign, as well as to address our increasingly pressing workforce challenges.

2-way dialogue. That’s why (and as you will see on the front page of this issue of ‘Notes’)we’ve just launched a new part of the RCPCH website ‘Health Reforms: Your Say’ – which will provide a one-stop shop for information relating to the new NHS structures and implications for paediatricians. It will also allow Members to feed back on what works, what is going wrong, and how you have effected positive change in your area. This is part of a broader strategy that will see the College focus resources on improving our communications to make it easier for you to tell us the things that matter. By the time you read this column, those working in England will have received the recommendations of the Children and Young People’s Health Outcomes Strategy – a piece of work commissioned by Andrew Lansley and informed by a number of RCPCH Members. Measuring these outcomes is going to be a core part of College business and we will rely on Members to give us the ‘temperature check’ on the ground. At the same time, we will be supporting the development of quality improvement networks across the UK and delivering events to share innovation and ideas.

But standards and campaigns are not worth the paper they are written on unless there is the will and the power to make them a reality. Without the levers to effect change, you may feel that the College is howling into the wind. And what are those levers? They are the data and information that we can only get from you at the front line – and without which we do not have the ammunition and evidence to make our case.

We will not be able to secure safe paediatric services by salami slicing or tweaking around the edges; transformational change will be needed, and this will mean pulling together as a community of paediatricians, as well as working in strong coalitions with other children’s healthcare professionals. Our role at the College will be to make it easy for you to exchange information and expertise; yours will be to make use of those channels to work together for the benefit of children and young people.

The College can only help you to deliver changes if we have an effective




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Science, Research and the RCPCH Science and research activity at the College is staffed by an able and dedicated division, supported by Dr Jan Dudley and Dr Ian Maconochie. The division appraises and develops guidelines, as well as other tools and care pathways that have been adopted nationally and in a growing number of countries around the world. In addition to this ongoing work, the division is now leading several national programmes.

Programmes Across all of our many programmes, the engagement afforded by clinicians around the country has been superb, as has been the interest expressed in providing clinical guidance to the team at the RCPCH, or in joining one of the several working groups providing supporting expertise. National Neonatal Audit Programme Clinical lead: Dr Mike Watkinson The audit commenced in 2007 and is the only population-wide audit of its kind; our contract to continue to deliver this programme was renewed in 2009 and again in 2011. National Paediatric Diabetes Audit Clinical lead: Dr Justin Warner The audit was awarded contract in 2011. The RCPCH Information Services Team has provided invaluable help and support in developing an electronic web-platform and this audit will be the first project to use the platform, followed later this year by Child Health Reviews-UK.

Familial Dyslipidaemia register Clinical lead: Dr Uma Ramaswami We are collaborating in this Royal College of Physicians-led project to establish the register.

Guidance and tools Streamlining guidance for researchers In collaboration with the Royal College of Nursing we contributed to the development of a new qualitative route map, mirrored upon the well-known MRC research route maps []. This was launched this year and provides step-bystep guidance for researchers working with children. RCPCH guidelines for the ethical conduct of medical research involving children, 2000 I am currently leading a working party with representation from the Medicines for Children Research Network, Paediatric Non-Medicines Speciality Group, Medical Research Council, General Medical Council, National Research Ethics Service and Royal College of Nursing, to review and update this document. UK Growth Charts Led by: Professor Charlotte Wright New UK growth charts for 2-18 years launched in 2012.

Child Health Reviews-UK

Allergy care pathways

Clinical leads: Dr Peter Sidebotham and Professor Ruth Gilbert

Project board chair: Professor John Warner

This National Clinical Outcome Review Programme focuses on mortality and serious morbidity in children with epilepsy together with an epidemiological review of all-cause mortality. Formally launched on 8 May 2012, Child Health Reviews-UK is one of four elements of the National Clinical Outcome Review Programme, formerly known as the Confidential Enquiries Programme.

The work to develop six national care pathways began in June 2009 and in March 2010 the Department of Health provided additional funding to develop tools for use in the local implementation the pathways.

Epilepsy12 We run a National Epilepsy Audit and a number of regional audits.


They have been awarded after competitive tendering processes and have brought us approximately £1.2M per annum in new funding.

Child Health Safety Board In 2010 we were asked to host a new Child Health Safety Board. This is enabling us to conduct a national factfinding survey of paediatric parenteral nutrition in collaboration with the Royal Pharmaceutical Society, building on an earlier report, Improving practice and reducing risk in the provision of

parenteral nutrition for neonates and children, from the Chief Pharmacist’s Office.

Workforce Martin McColgan continues to lead our regular workforce census. To date, workforce information has been obtained from NHS Trusts but in 2011 we initiated a personal census directed at every UK paediatrician. This data will be invaluable in mapping the current workforce, forecasting requirements and planning training programmes.

Aims and objectives My aim is to enhance the extent to which our programmes benefit children by using integrated approaches and rigorous methodologies. Whether conducting a small single-centre audit, or a large multicentre clinical trial, valid conclusions demand sound methodological approaches that have their basis in science and research. I wish to see our College regarded as a ‘can-do’ organisation and a reliable source for objective UK data on paediatrics, paediatricians and child health. These data must be turned into information and evidence so that they can be used to effect change. We can make an immediate impact on children’s outcomes by ensuring that the ethos of paediatrics remains strongly supportive of science and research as much as expert clinical care. The RCPCH can lead in bringing a national focus to bear upon the need for high-quality research to generate evidence to benefit children and, ultimately, the health of the nation. The translation of evidence into national policies requires additional activity in advocacy and strong strategic partnerships with other children’s organisations, as well as young people and parents that we have yet to fully achieve. These issues have been the focus of ‘Turning the Tide’, a major RCPCH Commission initiative which I have been privileged to lead, to increase and strengthen child health research. ’Turning the Tide’ is due for publication in November 2012. PROFESSOR NEENA MODI, Vice President, Science & Research


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Strengthening the portfolio of paediatric studies being undertaken with support from the National Institute for Health Research (NIHR) The NIHR Medicines for Children Research Network (MCRN) is funded by the Department of Health to support the development and delivery of medicines for children studies across England. Growth of  the  MCRN   Por/olio  

The network has recently reached a key milestone, having adopted its 300th study. The network supports both publicly-funded and non-commercial studies and its portfolio is composed of 52% of studies sponsored by the pharmaceutical industry and 48% sponsored by NHS/academic institutions. The EU Paediatric Regulation has resulted in a large increase in the numbers of industry studies supported by the Network, with MCRN supporting the largest proportion of industry studies of all NIHR Clinical Research Networks. The MCRN was created in 2005 to improve the coordination, speed and quality of randomised controlled trials and other well-designed studies of medicines for children and adolescents, including those for prevention, diagnosis

and treatment. The Network has extensive knowledge and experience of paediatric research, and supports noncommercial, pharmaceutical/biotechsponsored and investigator-led partnership studies in NHS sites across England. The MCRN supports studies through its infrastructure of six Local Research Networks and three MCRN Areas, supported in partnership with the Comprehensive Clinical Research Network, and has 100% coverage of England. Approximately 30,000 children have been recruited to MCRN portfolio studies since its inception. Dr William van’t Hoff is the Co-Director of MCRN, and is Chair of the MCRN Study Assessment Committee (SAC) which assesses issues pertaining to study feasibility/delivery. Dr van’t Hoff says:

‘We are delighted by the strong growth in the number of studies in the MCRN study portfolio, especially in the rapid increase in industry studies. We have restructured our team and processes to meet this demand and to further improve our research delivery. We now want to support more paediatricians and centres to enable larger numbers of children to have access to these studies.’ The MCRN also supports the activities of the NIHR Paediatrics (Non-Medicines) Specialty Group, which is chaired by Professor Anne Greenough. The Paediatric Specialty Group was established in 2009 and began with a portfolio of 34 studies. This has now grown to 218 studies, 89% of which are open and currently recruiting participants. A total of 30,597 participants were recruited to Paediatric Specialty Group portfolio studies during the last year, an increase of around 20% on the previous year. Professor Greenough says ’I am delighted by the year-on-year growth in the number of studies on the portfolio and very grateful to the Specialty Group members and the support of MCRN’. Within the MCRN, a series of Clinical Studies Groups covering all paediatric specialties are available to support the development of both medicines for children and Paediatric Specialty Group studies, and paediatricians with ideas and proposals for future studies are encouraged to contact the network to access support for developing their proposals further. For more information about the MCRN and Paediatric Specialty Group portfolios, please go to: http:// Further information on both networks can be found here: or by contacting



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Focus on health promotion: ‘What are WE doing about childhood obesity?’ The answer is that your College is doing a lot, and you can too. It is helpful to consider this question in the context of primary and secondary prevention. By the first I mean preventing obesity from occurring in the first place and in the second, early detection and management both at population and clinical levels. A survey of around 10% of RCPCH members in 2010 clearly placed obesity as one of your top clinical priorities. The scale of the problem is well known to you: 30% of 2-15 year olds are obese, over £4 billion is spent in the NHS on obesity-related illness, and there are huge social disparities in prevalence. Recently, there is some evidence from the National Obesity Observatory in England that the rate of the ‘epidemic’ is slowing, which is good news. Secondary early prevention Most readers will be familiar with the clinical situation of a GP referral of an obese child for further investigation and management. In 2007, we developed a pathway across primary and secondary care based on NICE guidance which we hoped would limit referrals to those likely to need further work. Criteria for referral are shown below: 1. BMI > 99.6th centile 2. History of Hypoglycaemia and/or Hypotonia in newborn period 3. Preschool onset of obesity 4. Short stature/slow rate 5. Rapid onset/progression of obesity 6. Absence of family history of obesity 7. Learning difficulties 8. Co-morbidities, eg high blood pressure, abnormal Ix (glucose, insulin, lipids, LFTs and TFTs) 9. Menstrual irregularities 10.Other associated abnormalities, eg Dysmorphism, hypotonia, hypogonadism, eye abnormalities, deafness, skeletal abnormalities At the same time, we aimed to strengthen community-based services, such as dietetic and lifestyle support, to tackle the large numbers of children without clear medical causes. However, the recent NHS cost savings have reduced access to many of these services with resulting increases in referrals to


‘By 2015, 60% of members responding to a poll should believe

HCP_10_06 Obesity Prevention in Children Candida Hunt and Mary Rudolf

the campaign has been effective and

Policy and advocacy recommendations

be aware of and have access to the

• Explore and cost the extension of free school meals so that it is universal, while academies and free schools should be mandated to follow nutritional standards.

training materials available.’ (RCPCH College Plan 2012-15) secondary care as parents and GPs look for answers. Sadly, there are very few medical treatments suitable for obesity and bariatric surgery, which is limited to the morbidly obese, only gives a 30% reduction in BMI two years post-op, at best. So what of primary prevention? Clearly, pathways of causation of obesity in childhood are complex and involve system changes at multiple levels. The RCPCH position statement on obesity recommends action in a number of areas, with the intention of achieving a cultural shift to reduce the numbers of our children and young people that are obese or overweight: Training • All health professionals should be trained in weight management issues, following NICE and SIGN25 guidance, alongside emphasising the importance of parenting style and parents’ lifestyles where their children’s weight is considered. HINT Have a look at the following relevant sessions in the Healthy Child Programme e learning ( html) written by experts in the field:

• Local authorities need to implement strategies to encourage active travel and play, by making the built environment more accessible for young pedestrians and cyclists. These plans can be implemented through joint partnership with Health and Wellbeing Boards. • Food manufacturers’ influence on younger children should be curtailed by implementing a ban on junk food advertising before the 9pm watershed. • Increases in taxation on foods high in salt, sugar and fat in other countries should be independently evaluated, scoped and costed with a view to implementation across the UK. At the time of writing, The Academy of Royal Colleges (representing 44 Colleges and Faculties) is leading a UK-wide campaign to look at what is working across the world and make recommendations to government. What are YOU doing about childhood obesity? Visit to find out more about the College’s obesity strategy and the ways in which you can get involved.

HCP_08_13 Obese Toddlers and Infants Nichola Aspinall

Acknowledgement I would like to particularly thank Dr Penny Gibson who has worked for nearly a decade for our College in highlighting obesity as an area for paediatricians to be actively involved in.

HCP_10_05 Health Promotion in Pregnancy: Obesity Eugene Oteng-Ntim and Nina Khazaezadeh

PROF MITCH BLAIR Officer for Health Promotion

HCP_08_07 Weighing and Measuring Infants and Children Gary Butler


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British Society of Paediatric Dentistry (BSPD) to join the Safeguarding Children training programme

Forthcoming RCPCH events

We reported in a recent newsletter that the CPRR: Recognition and Response in Child Protection educational programme for doctors in training (a collaboration between the RCPCH, NSPCC and ALSG) has trained 2,532 people in 38 centres since 2006. The course has been well received by the target candidate groups: ‘This was an excellent course and by far the best child protection teaching I have ever had. The content was great and was very well structured – I liked the variety of different ways of teaching and in particular the discussion sessions and the role-play of scenarios. It was extremely useful and relevant and I would recommend it to every paediatric trainee.’ We are pleased to report that the course has attracted the interest of other specialty groups, including the BSPD. A project is now underway to adapt the course for paediatric dentists and run a ‘dental stream’ alongside existing courses. This will make use of the existing course materials, but with selected sections adapted for dentistry, such as specially developed dental scenarios. This new venture has provided a great opportunity for dentists and paediatricians to work together on common issues and to explore new solutions. Eight experienced paediatric dentists, nominated by their specialist society, will facilitate the training on the pilot courses. The first pilot course was in Manchester in April 2012 and the initial responses have been very positive from candidates and trainers alike. Further pilot courses will run at other venues during 2012, after which the project will be fully evaluated. Neela Shabde, the Programme Director for the CPRR course commented: ‘I am delighted that the BSPD has played a key role in driving safeguarding training for dentists in conjunction with RCPCH, ALSG, and NSPCC. I believe this course will strengthen the skills and knowledge of the dental trainees in understanding the challenges and barriers, identifying child abuse and preventing children from suffering further abuse. Most importantly, dentists treating children will be able to come forward as advocates in protecting children from abuse and work jointly with other agencies to safeguard children.’ Evender Harran, representing the NSPCC added: ‘This initiative acknowledges the complimentary specialist knowledge and important contribution that paediatric dentistry and junior doctors play in the early identification of vulnerable children. Paediatric dentists and junior doctors provide universal non-stigmatising service to all children and families, and are therefore strategically well placed to identify parents/carers who may also be in need of support services.’ Further information: •

how to



One-day training events for trainees, consultants, SSASGs and health professionals

Bacterial Meningitis: early signs and symptoms 24 September 2012

Child Mental Health in General Paediatrics 8 October 2012

End of Life Care 6 November 2012

• CPRR • CPIP NEELA SHABDE – Programme Director SUE WIETESKA – Project Manager and CEO of ALSG



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Record attendance at RCPCH Conference 2012 Continued from page 1 Although the venue has changed, the shape of the three-day meeting was familiar to delegates who have attended in previous years. Each day started with a choice of personal practice sessions (exploring a specific topic in paediatrics), followed by morning plenary sessions, which opened and closed with stimulating keynote lectures from engaging and thoughtprovoking speakers. On the first afternoon the Scottish Paediatric Society, celebrating its 90th anniversary, and with whom the RCPCH held the meeting jointly, ran a successful session for trainees, offering prizes for best presentations. Other

afternoon sessions were run by paediatric special interest groups, offering a mixture of lecture updates, interactive sessions, workshops and abstract presentations of the latest research in general and subspecialist areas of paediatrics. There was, of course, a strong Scottish flavour to the proceedings, with a plenary lecture by Sir Harry Burns (Chief Medical Officer for Scotland), a reception by the Deputy Mayor of Glasgow in the Science Centre, piping in of the haggis at dinner and a wonderful exhibition of Highland dancing followed by well-instructed guest participation at a high tempo ceilidh. All in all what better trailer could there

be for the Europaediatrics Conference in Glasgow next year? Planning for the joint RCPCH Europaediatrics 2013 meeting is well advanced in design and innovations and the conference content over five days promises an even better meeting than the RCPCH Annual Conference 2012. No doubt the SEC, Conference Centre in Glasgow, local hotel accommodation, and the wider city will prove as warm and professional hosts as they did this year. We look forward to welcoming paediatric and allied healthcare colleagues from across Europe and the world to this exciting joint meeting. The only thing we can’t guarantee is a repeat of the sunshine! ALISTAIR THOMSON, Vice President, Education

ns Together

6 Europaediatrics th


The RCPCH Annual Conference 5-8 JUNE, 2013 GLASGOW, UK


Bringing European Paediatricians Together


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Tony Jackson prize - winning entry Every year, at the College’s Annual Conference, the Tony Jackson Memorial Prize is awarded for an essay by an undergraduate medical student about any aspect of their work in paediatrics. This year’s winner is Anna M. Rose (MBPhD student, UCL Medical School). An excerpt from her essay is reproduced below:

I usually take great pleasure in putting pen to (metaphorical) paper, but I write this piece with a heavy heart. Each and every one of us studying or practising medicine will, at some point, face situations that challenge us – whether this is academically, physically or emotionally. I wish to relate to you a story that fits into the latter category: a story of one child and many, a story of death, and perhaps most of all, a story of life. I have been lucky enough to be working with a small charity based in Livingstone, Zambia since 2004. The charity runs a school for children aged 3-15 years and a medical facility in the centre of town, as well as running mobile medical outreach clinics, amongst other projects. Each trip has provided me with the opportunity to develop my interest in paediatrics and child health and I would encourage all undergraduate medical students to undertake some voluntary medical work in a developing country. It truly is an eyeopening experience that can be formative in your future medical career. Most recently, in the summer of 2009 I spent two months in Livingstone, specifically to carry out research into child mortality in the area.

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It is well known that the global epidemic of HIV and AIDS is most problematic in sub-Saharan Africa. In 2008, WHO reported that more than two million children worldwide were infected with the HIV-1 virus, with almost 300,000 deaths occurring due to this disease in sub-Saharan Africa. Zambia is one of the worst affected countries, with an adult HIV prevalence of up to 30%, although this may be higher in urban areas. This situation places a massive strain on the country’s already over-burdened healthcare system. It was estimated that 95,000 children were living with HIV infection in Zambia, although no formal figures exist for the child population. In 2007, UNICEF reported that the death rate of children under five in Zambia was 170 deaths per 1,000 live births, the thirteenth highest child mortality rate

in the world [1]. The same survey also reported that 15% of under-fives are underweight and malnourished, these being a significant contributing factor to child mortality. It is not surprising, therefore, that in the numerous paediatric facilities I have visited in Zambia, there has been one recurring theme – I have seen children dying from protein energy malnutrition (PEM), respiratory tract infection and gastroenteritis. In my research work, these three conditions were shown to be the cause of death in the vast majority of cases. In addition, all of these conditions are more frequent and more complicated to treat in HIV positive children. The condition I would like to focus on in this piece is PEM in HIV, a problem that I have seen so often, each time being struck by the unnecessary nature of it. I will start by telling you about Matthews, a five-year-old child I met on a mobile clinic in Malime, a remote village in Southern Province, where most villagers are farmers living a hand-to-mouth existence. When I met Matthews, the consultation was for a common and easily treatable condition – scabies. We were able to provide the appropriate treatment for this problem, but there was a lot more to this child’s story. On examination, Matthews appeared emaciated and generally unwell; his legs were so weak that he had trouble standing up and he was extremely small for his age. During our consultation, Matthews’ mother told us that the boy had never had an HIV test, but she and her husband were both HIV positive and she feared that Matthews had contracted the virus as well. The family had three other children, but the parents’ illness had made it difficult to produce enough food to feed them—let alone sell in town – so the whole family was malnourished. My heart ached as the mother, Chipo, described how she wanted to be able to send Matthews into town to start treatment, but they simply could not afford it – if they spent their money on Matthews, their other children would starve. This child would be dead within the next year, and the family, the doctor and I were powerless to stop it. The feeling of helplessness was overwhelming – I knew that in the UK the treatment would be relatively straightforward and Matthews would have an excellent chance of recovery. I also knew that the treatment was easily affordable to me – purchasable with the money in my pocket. These thoughts were heartbreaking, but worst


Today’s children, tomorrow’s graves: an unscientific and very personal perspective on child mortality in Zambia

of all, this was not the first time I had heard this story, and it was not the last. Matthews is not one child, he is the many thousands of children facing the daily struggle of extreme poverty, malnutrition and HIV. I am acutely aware that a conclusion must make an impact, enforce a message, change the reader. I also want to convey the emotion that is in this message, without crossing into the dangerous territory of mawkish sentimentality. It is too late for Matthews. In the hospital death records, I saw the words I had been waiting for: Matthews Banda, age 5 7/12. PEM. HIV positive. Matthews’ final admission lasted three days before he died. I do not know that that boy is the same child as I saw in Malime – both Matthews and Banda are extremely common names – but, metaphorically, he is. I cried the same as if he was. It is too late for Matthews, but he is not one child. He is one of the many thousands of children who could be helped with simple preventions and simple treatments. As medics, we can change things: inch-by-inch; painfully, creepingly, frustratingly slowly. The implementation of preventative strategies and education programmes is crucial to this – both the prevention of vertical transmission of HIV and decreased incidence of PEM through education into nutritional requirements for children. We also need the continued improvement in availability and effectiveness of affordable home and community based therapies for PEM. It is especially important that research continues into the pathogenesis of PEM on a background of HIV infection. This will allow the establishment of more effective care pathways for this complex medical condition. You might call me a hopeless optimist, but I firmly believe that it is possible for us to implement year-on-year improvements in the survival of malnourished HIV positive children. It is a daunting task, but with the co-operation of the medical profession, governments and local and international charitable organizations, we will see a change. Only then will we stop today’s children becoming tomorrow’s graves. References 1) UNICEF country information, survey 2007.



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SSASG NEWS SSASG update meeting at the RCPCH Annual Conference, Glasgow, May 2012 Dr Hilary Cass, President of the RCPCH, spoke at the meeting and gave the clear message that SSASG paediatricians are a key part of the paediatric workforce, both now and in the future. She outlined the challenges facing us all as paediatricians, including the need to continue to drive up standards of care for children’s health and to look at new ways of integrating services, particularly at the primary/ secondary care interface. Workforce pressures will continue to steer career change, with portfolio careers potentially becoming more varied. Dr Cass’s address was followed by a presentation by Dr Carol Roberts, Deputy Chair of the RCPCH SSASG Committee, on results from the recent SSASG survey, which our committee recently commissioned. These results can be seen in Carol’s slides, which are available at: ssasg. The results show that SSASG careers and aspirations are changing. RCPCH is committed to addressing the educational needs of SSSAG paediatricians and to working towards more career choice and flexibility within the grades.

SSASG survey – summary of results Demographics • SSASG paediatricians make up almost 30% of the career grade workforce • 65% are women • Most are over 46 years of age Key findings • 88% of respondents work independently • Approximately 25% have Designated Lead roles or management roles, such as Medical Director, Associate Dean, Clinical Lead and College Tutor • 50% undertake teaching


• 76% are satisfied or very satisfied with their SSASG post • 75% said their decision to become a SSASG had been a positive choice • 56% plan to stay in this grade for whole career • Average duration of time in current post 12.5 years (stable workforce) Career progression • 90% feel there are or may be barriers to entering or re-entering higher specialty training • 90% are or may be interested in accessing the RCPCH e-portfolio CESR • 7% are on the specialist register • 43% are currently planning or may plan to apply • 71% would or may apply for nonCCT (sub-specialty) CESR if current legislation was changed to allow this for UK graduates Benefits of RCPCH membership for SSASGs Dr Jenni Dixon gave a presentation on College membership benefits for SSASG paediatricians. Jenni’s slides are also available at ssasg. Jenni pointed out that the current RCPCH SSASG membership demographic shows that most members are Associate Specialists who may be within 15-20 years of retirement. There is an urgent need to make College membership attractive and relevant to specialty doctor paediatricians as well. To this end, Jenni is working with the Membership Team at the College to look at membership incentives for SSASG paediatricians. Other SSASG committee activity We have been involved in submitting formal responses to recent GMC consultations which have major significance for SSASG paediatricians.

The GMC consultation on ‘Routes to the GP and Specialist Register’ proposes significant changes to the CESR application process. Whereas the focus of the current model is on the accumulation of documentary evidence, the focus of the new model would be on doctors demonstrating their specialist knowledge and skill. This would primarily be through workplace evaluations of their performance in practice. We have made response to these proposals as part of a RCPCH response, which includes a strong recommendation for educational support for SSASGs who aim to make application for CESR under the proposed new model. We have also called for the GMC to address the anomaly posed by current legislation, which bars wholly UK-trained SSASG paediatricians from applying for a CESR in a non-CCT specialty while allowing those with overseas training/ qualifications to do so. I have, on behalf of the Academy of Medical Royal Colleges SAS Committee, compiled and submitted a response to this consultation. The GMC consultation ‘Recognition and Approval of Trainers’ outlines the GMC plans for recognition and approval of trainers, such as educational and clinical supervisors. We have contributed to this consultation in stating the RCPCH view that SSASG paediatricians should continue to be eligible to become educational or clinical supervisors if approved as such. The Spring edition of Notes The College would like to apologise for an error that appeared in the last issue of Notes. The ‘Going for Gold’ conference was described as being ‘excellently hosted this year by RCPCH’, it was in fact hosted by RCP. Dr JANE D WILKINSON Chair, RCPCH SSASG Committee


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Training matters What do you want to be when you grow up?

With the introduction of run through training, we ask foundation doctors to make the decision to become paediatricians when most of them are in their mid-twenties. After that, it might be eight years or even longer before their next interview, trying to persuade a baffling array of people in suits that they should be given a consultant job. It’s very easy to end up concentrating most of your energy into passing membership exams when you’re a Level 1 Trainee. When you start Level 2 training you suddenly have

to cope with the responsibilities of being a middle grade, which can seem overwhelming at first. You just about find your feet when, before you know it, you’re in Level 3 training, and have to make the decision to go for a Grid post, specialize in community child health or develop an interest within general paediatrics. All along the way it’s other people, people you may never physically meet, who ultimately decide what jobs you get and where you end up working. Trying to chart a course for yourself can feel like trying to go against the flow. Keeping your CV up to date? How many of us actually do that? Training doesn’t just happen to you; it’s an active process that you need to be driving. The end result of training shouldn’t be to have accumulated a list of competencies like Boy Scout or Girl Guide badges, but rather to prepare you for the kind of consultant job that you want to have. That means that for your training to be effective you have to have some idea of what kind of consultant job you want to work in when you get your CCT. It’s never too early to start thinking about that. Let people know what interests you and

you’ll be amazed what opportunities open up. If you don’t get the training posts you want it may not mean you have to give up on your career goal, but it does mean you have to be more creative and identify opportunities. If life gives you lemons you don’t need to make lemonade. A Level 1 training rotation heavy in neonatal training doesn’t mean you have to become a neonatologist (not that there’s anything wrong with either lemonade or neonatology!). If you want to spend some time out-ofprogramme, then plan ahead. The more warning you give your deanery; the more likely it is that they’ll be able to accommodate you. The more thought it looks like you’ve put into it, the more likely it is that your application will be taken seriously. Training’s a journey; make sure it takes you where you want to go. As always, please contact your local representative or trainees.committee@ for advice or to make comments and suggestions regarding training and education. DR DANIEL E LUMSDEN Chair, Trainees’ Committee

Honorary Fellowship and James Spence Medal 2012 call for nominations Honorary Fellowship is bestowed by the College to individuals who have demonstrated, through research or clinical commitment, major contributions to paediatrics during their career. The James Spence Medal is awarded for outstanding contributions to the advancement or clarification of paediatric knowledge and is the highest honour the College can bestow. The College is once again inviting nominations to be considered for these distinguished awards.

Nominees will be in the following categories:

Nominees for Honorary Fellowship should satisfy one of the following criteria:

• Paediatrics International

• demonstrates sustained achievements in paediatrics throughout their career beyond those which are normally expected. For example, developing services and/or fundraising at a local level or contributing to the work of the College

• Non-Scientists to include Pioneers form the Voluntary Sector, Sociologists, Philosophers, Politicians – UK and International.

• extremely high scientific calibre and has contributed to the advancement of the science or practice of paediatrics in a sustained and substantial way

• Paediatrics UK

• Non-Paediatrics Scientists UK and International

Nominees for the James Spence Medal should satisfy the following criteria: • Persons working in the United Kingdom or in any country of the British Commonwealth within the fields of clinical or social paediatrics, clinical science, epidemiology or family practice are usually

considered for the award, but neither those working in other countries nor in the other scientific disciplines are necessarily excluded. Process The award shall be made on the recommendation of the Council of the Royal College of Paediatrics and Child Health after it has been advised by the Executive Committee. The nomination form is online, and can be found at: The deadline for receipt of nomination forms is Sunday 2 September 2012. JOSEPH CALLANAN Project Co-ordinator and Committee Administrator


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RCPCH newsletter Summer 2012  

Newsletter for the Royal College of Paediatrics and Child Health

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