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RCPCH Annual Conference 8–10 April 2014, Birmingham

‘Towards better outcomes for children’s health’

RCPCH International: Global Links programme page 7

Online registration closes 03 April but you can still register to attend on site at the ICC in Birmingham.

Council approves next steps in the development of Foundation of Child Health

Be part of the UK’s largest paediatric conference! Programme and further details at www.rcpch.

Free eLearning to support young healthy minds NOW LIVE

On 5 March, College Council agreed to support the development of a Foundation of Child Health within RCPCH. This decision represents a very important milestone in a journey of engagement, discussion, planning and development that began with my manifesto in 2011 and will continue through to a planned Extraordinary General Meeting in September 2014. At the heart of the proposal is the recognition that the best way to increase our influence is to work in equal partnership with other child health professionals round a shared table. Together, we can plan sustainable service models, develop policy and research, and advocate for the wider health needs of children. At the same time, we want to maintain control of

the core professional functions of the College that form the lion’s share of our work. The Foundation is a means of ‘walling off’ that part of the College which is already delivering work which is of direct benefit to children so that other child health professionals can join us, while at the same time ensuring that the College function is only open to paediatricians and is run by a paediatric Council. Our overarching Royal College status will be unchanged within the proposed model. I know many of you will want to know what this means for the College, and on pages 2-3 I lay out why we have embarked on this major change and what will happen now. DR HILARY CASS President


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News Annual Conference 2014 MindEd now live Council approves next steps in the development of Foundation of Child Health


From the President Positive changes to the way the NIHR Clinical Research Network supports children’s research


From the President

Your views Your website - your ideas NHS Change Day: Challenging the status quo Twitter-sphere Managing service change Retiring but not shy...


Training and support Tax relief for trainees Academic guide


Revalidation portfolio - are you using it?

A journey of a thousand miles begins with a single step


Laozi (c 604 - 531BC)

Global Child Health Consultancy

Foundation of Child Health

Global Links programme Investing in the four nations New ethics guidelines Disability Matters: eLearning to inform and inspire RCPCH courses and events 2014

10 Committee news Vice-President for Health Services Reflections on the Science and Research Vice-Presidency Training matters New Honorary Treasurer

Editors: Jo Ball Sarah Quinlan Brian Dow Email: 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


In 1948, Aneurin Bevan, quoted in The Lancet, said the following: ‘On 5 July we start together, the new National Health Service. It has not had an altogether trouble-free gestation. There have been understandable anxieties, inevitable in so great and novel an undertaking. Nor will there be overnight any miraculous removal of our more serious shortages of nurses and others and of modern replanned buildings and equipment. But the sooner we start, the sooner we can try to see these things and to secure the improvements we all want.’ It may seem arrogant to juxtapose Aneurin Bevan’s words about the birth of the NHS with a discussion about changes to our College. Yet children’s healthcare is a microcosm of the NHS, and one that is all too often ignored or sidelined, despite the fact that children represent 25% of the population and the seeds of our future. Bevan’s words are as true in relation to our proposals today, as they were in relation to the new NHS. Inviting other professionals to share in our work will generate some anxiety, and will not bring instant solutions, but the sooner we start, the sooner we can secure the improvements we all want. Every journey does indeed begin with a single step. A personal reflection on why we must take that step now My father was a rake and a rogue. Sent from Llanelli to London to study pharmacy - a subject in which he had no interest whatsoever - he took to student life like a duck to water, necessitating termly trips to

London by my grandmother to remove the accumulated baked bean tins and women lying around the flat. More by luck than judgement he secured the lease of a shop in the West End of London which purported to be a pharmacy on the door, but soon contained an extraordinary array of ‘job lots’ that would have made Del Boy look like a dealer in high-class goods. Silver plated teapots with the spouts missing, leaky cocktail shakers and cracked pseudo Capodimonte figurines all competed for space on the counter. The bizarre nature of the goods was only surpassed by the colourful mix of people who frequented the shop; the exiled minister of a despotic African state, Brian the tea boy who was wildly camp at a time when it was neither safe nor fashionable to be so, and a series of minor celebrities with various substance dependencies who were ‘resting’ between jobs. All would be invited to dinner and appear in various combinations at our table with no warning to my poor long-suffering mother, while my father would preside over the chaos telling interminable bad jokes. Since December, following an episode of severe sepsis, this once-ebullient man, now 88 and never having fully recovered from the death of my mother two years ago, has subsisted in a state between life and death. He has been through the best and worst of the NHS. The medical treatment was excellent, although with hindsight perhaps misguided, and he now lies mono-syllabic, needing 24/7 care, with no will to carry on. How could I fail to understand why so much of the NHS spend and Ministerial attention is on the elderly? How could any one of us who has watched a parent go down a similar path? There is a tsunami wave of care needs that cannot be denied or ignored. Taken in combination with the broader economic challenges, it would


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Positive changes to the way the NIHR Clinical Research Network supports children’s research The National Institute for Health Research (NIHR) Clinical Research Network (CRN) is transitioning into a new structure from 1 April 2014, including the alignment of the Medicines for Children Research Network and Paediatric Specialty Group into the CRN Children’s Theme. This presents a fantastic opportunity to bring paediatric research together and to allow equity of access to support

take an uncharacteristically long-sighted government to invest not just in the acute care needs of children, but in the much broader determinants of their health and wellbeing, measures which will bear fruit in 10-20 years, when the next election is in 12 months. But that is the case we must make, and it will get tougher with every passing year. Furthermore, although we want to do the best for children, our endeavours are not only altruistic. For every one of us, working in fragmented, poorly-funded services with inadequate infrastructure, and nursing and secretarial shortfalls does not make for a fulfilling job or indeed a good work-life balance. A united voice of the children’s healthcare sector will not happen overnight, but it will grow incrementally, as has the best example of a similar endeavour - the Paediatric Society of New Zealand (PSNZ). The PSNZ was formed in 1946 and opened its doors to non-paediatricians around 2000. Since then, both its membership and its influence with government have grown. There were similar anxieties, as have been expressed by a minority of our members, about loss of control, but in reality, after 13 years, 66% of the membership is still paediatric, with the rest being a mix of other child health professionals. Closer to home the Children and Young People’s Health Outcomes Forum - a group of around 40 children’s healthcare professionals hand-picked by government has formed rapid consensus on the issues of most importance to children and has been highly influential within the English NHS. How did we go about this? The proposed model was developed iteratively over a two-year period through discussion with many different groups; generalists and specialists, consultants, SAS doctors and trainees, speciality

all children’s studies within the NIHR portfolio across England, something the paediatric community has been keen to achieve since the MCRN was established. Coinciding as it does with the recent publication of the Chief Medical Officer’s report on child health, and the subsequent NIHR funding call on longterm conditions in children and young people, this will build on the outstanding success of both the MCRN and Paediatric

groups, our Patient and Carer Group, our Youth Advisory Panel, children’s charities, other Colleges, nurses, allied health professionals, government officials and NHS leaders. People fed in through face-to-face meetings, conferences, webinars and Twitter, and ultimately the formal consultation and focus groups, which many of you contributed to, in Oct - Dec 2013. The consultation drew one of the largest responses we’ve ever had to such an exercise - comparable in turn-out to President elections and larger than the referendum on the Health and Social Care Bill. The consultation document was externally validated, and quantitative responses from forced choice questions were triangulated with open comments and transcripts of focus groups, with a high level of consistency obtained. Independent statistical analysis confirmed that respondents were fully representative of all College constituencies (by region, age, sex, grade etc), with confidence testing showing a 93-97% chance of obtaining the same result again. Although we included the option of a fully multi-professional College to ensure a complete range of options, the need to safeguard the core functions of our College and not just protect but enhance the support to paediatricians at all stages of their career through CPD, mentoring, and career guidance was compellingly argued. Of those who expressed a preference, 11% opted for no change, 61% for the two-armed model and 25% for a fully multi-professional College. Council took these preferences into account, as well as considering a detailed risk-benefit analysis, before recommending the further development of the preferred model.

Specialty Group to date. The new Children’s Theme will be launched at the RCPCH annual conference and further details of the changes to the network can be found online at the_network or by contacting Dr Vanessa Poustie: VANESSA POUSTIE NIHR CRN: Children’s Theme

Next steps and further member involvement Any changes are contingent on Council and EGM approval. That said, there is still further work to be done in firming up the proposals and, over the coming months, input from members will continue to be valued and important. We will be informing you about the further development of the proposals through webinars, roadshows, Twitter, bulletins and newsletters, and you can contribute by speaking to your Council Representatives, emailing us directly or attending one of the many events we are holding in the coming months. For details, visit our website: foundation-child-health Most importantly, we hope that as many people as possible will attend the EGM in September to approve the final proposals. This is an essential step before we can get Privy Council approval. We have taken legal advice on whether a postal vote or even telelinked voting is allowed, and unfortunately it is not, so in-person attendance remains the only legal option for changing our governing documents. I am justifiably proud of our membership. We chose to call ourselves the Royal College of Paediatrics and Child Health, not the Royal College of Paediatricians. Now, through the recent consultation, you have given Council a strong mandate to make that title a reality. Other Colleges are watching closely, and some are aspiring to follow our example. Many government and health service leaders are supporting our plans. We now have the chance to lead the way - not just in children’s healthcare, but in breaking down the professional silos that interfere with our ability to work together for the greater good of the children and families we serve. DR HILARY CASS President



Your views

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Your website - your ideas What is the College doing to improve your experience of the RCPCH website? We have been consulting with members in person, by phone and by an online questionnaire. We wanted to find out what content is important to you, and how you would you like to access this. You use the website to fulfil tasks – to find out about training, get a staff contact, look up a course or access meeting papers. You are particularly interested in content related to your career pathway, as well as up-to-date resources that support your work – including clinical guidelines

and standards, position statements and policy documents.

status of the website, latest members’ consultations and website accessibility.

Members gave many ideas on new, updated and more detailed content that they would value. Some noted the wide range of activity conducted by RCPCH wanting the website to reflect more of this and to encourage members to get involved. Many members want easier access to other paediatric resources, especially to support their day-to-day professional lives.

KIRSTEN OLSON Membership Website Coordinator

The College is considering the outcome on three recent reviews of the current

This year, amongst the pledges supported by the RCPCH was the ‘It’s about me’ campaign, which was started by Adam Bojelian – a 14-year-old boy with cerebral palsy. Many young people treated in the NHS feel they are not talked to directly by professionals with whom they come into contact everyday. Adam pledged to help ensure children with disabilities receive the best possible care, having experienced the best and worst of the NHS himself. Inspired by Adam’s story, the RCPCH, along with our Youth Advisory Panel, supported his campaign to ensure paediatricians to talk directly to the patient about their treatment, as well as their parent/carer, regardless of their age or disability. The effects of pledges have been felt at individual, organisational and national levels. At Birmingham Children’s Hospital, Ellie Milner was part of a great initiative leading to Feedback Wednesday, where different


If you would like to give your ideas and feedback about the website, join our new panel or complete our questionnaire at: or, contact Kirsten Olson directly Email: Tel: 020 7092 6041


Challenging the status quo NHS Change Day is a social movement to demonstrate how small changes can have a big impact. NHS staff pledged a change in their practice which would improve patient experience and/or clinical outcomes, by adopting best practice and championing innovation. In total, over 382,675 individual and organisational pledges were made.

Members website panel

departments receive feedback from patients. This Change Day initiative is changing practice and creating a culture that isn’t based on targets and haphazard feedback, but one that responds to patients’ needs.

It’s been a busy few months for the College on Twitter. Over 3,600 followers have been debating a range of topics including mental health, smoking bans, childhood obesity, QI, NHS Change Day and much more! Many of our members also tweet live from conferences and lectures, and use Twitter to share links to new research or articles. #savethestats

Last year, Change Day co-founder Dr Damian Roland (paediatric senior registrar) made a pledge to taste a variety of medications given to children, with the aim of understanding some of the challenges facing parents. He found on the day that a commonly prescribed medication was surprisingly distasteful. Damian, along with others, discussed how to improve its taste with their pharmacies. This is an example of a small but tangible behaviour change, which had an impact on young patients. Healthcare is an environment where ‘change’ can be an overused and moralesapping word. While there is much work to be done on demonstrating direct patient benefit, through the examples above NHS Change Day has shown that the passion for improvement is alive and that change is possible. SARAH NEVINS Media and Public Affairs Assistant


You’ll recall that the Office for National Statistics (ONS) recently proposed to stop collecting data on child mortality. Knowing how many children are dying is a basic tool to ensure that the number can be reduced, not least because the UK has the worst record on child mortality in Western Europe. Following the ONS announcement, the RCPCH convened a coalition of children’s charities including the NSPCC, NCB and the Lullaby Trust to ensure the stats were saved. The campaign was largely driven through social media using the hashtag #savethestats. #savethestats garnered huge support from our members, leading health journalists and a number of MPs and on 10 February the ONS announced that the stats would be saved. Trainees on Twitter The RCPCH has just launched a Twitter account specifically for trainees @rcpch_trainees. Follow us for all the latest information and updates specifically for trainee paediatricians. MEDIA AND PUBLIC AFFAIRS TEAM


Your views

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Managing service change Reconfiguring for improvement Despite the two-day tube strike in London, nearly 50 members and enthusiasts braved the capital’s travel chaos and attended a workshop held at the RCPCH in February to equip them with practical support and information to successfully input into the reconfiguration of services that may happen in their local area. As part of the ongoing work by the College to make the case for reconfiguration of services based on quality and safety, the event was hosted by the Paediatricians in Medical Management (PiMM) Committee and supported by the Invited Reviews and Health Policy teams. The workshop comprised discussions ranging from the national strategic picture for children’s health down to the detail of engaging colleagues through chalkboards and mugs of tea! Following introductory sessions on the complexities of the national picture for children and the difficulties in gaining traction in CCGs for focus on children’s issues, Chair of the Parent and Carers Group Zoe Picton-Howell, and Thines Ganeshamoorthy, member of the Youth

Advisory Panel, provoked fresh thinking around the practical value of involving young people and parents. A highlight of the day was a practical Above: Delegates preparing to pitch team exercise in quality improvement. The task required participants • ‘We need to work with dissenters to redesign an ailing service in six one at a time and convince them different ways through two-minute of the importance of prioritising ‘elevator pitches’. These included children’s health.’ radical suggestions such as immediate • ‘Need to encourage paediatricians suspension of overnight emergency to listen carefully to parents before services, closure of the inpatient ward, leaping in.’ urgent support for stressed out middle grades and shifting the daily child Feedback from the day was extremely protection clinics from community to the positive with delegates committing acute team. to make a change as a result of their The afternoon slots included three examples of service and team redesign in Manchester, London and Nottingham, plus an in-depth session on workforce planning, staffing strategies and alternate approaches to delivering care compliant with ‘Facing the Future’.

attendance and a call in the evaluation responses for another event. College staff will be working with the PiMM committee to host another event to continue this important area of work. You can view material from the workshop at:

Observations from delegates over the course of the workshop included:

Please contact if you would like to get involved with this work.

‘Continuing healthcare needs to wrap around children’s lives, not interrupt them.’

SUE EARDLEY Head of Invited Reviews

Retiring but not shy... ‘Retire from work, but not from life’ – M K Soni In the autumn 2013 issue of Focus, the President set out the College’s enthusiasm for involving retired members in its work. As she said then, there are two goals behind our current recruitment drive among retired members. Firstly, those senior members who have become involved with College work have found it stimulating and rewarding – as well as a way of keeping up to date with the paediatric world. Secondly, it helps the College manage some of the ever-increasing demands on it to provide views on current issues. The number of requests we receive to provide members for external groups, or to respond to government

consultations, has grown significantly just in the 18 months over which I have been in post. This is a measure of the authority the College has built over the 18 years since its foundation. However, if we are to maintain that authority, we have to continue providing the voice of experience and wisdom on paediatric issues.

already started to make a contribution include:

So I want to renew the President’s call for retired members to get in touch with the College if they feel they have skills to offer to our work. This is an especially topical call given the number of members who, for one reason or another, are retiring earlier than they might otherwise have done from paediatrics. We cannot afford to lose you from the field!

So if you are a retired member and are interested in helping with our work, please email

Areas in which retired members have

the College’s international work

mentoring members in current practice

undertaking work on the history of the College/BPA.

It would be helpful if you could specify any particular areas of interest you have (whether clinical or non-clinical) and any experience you have of College work. We look forward to hearing from you. DR IAN MACONOCHIE Registrar



Training and support

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Tax relief for trainees The College is advising trainees that they may be able to claim tax relief upon certain examination fees going back for up to four years. It had been understood that such expenses were not deductible against tax, but following a landmark decision in the case of Revenue and Customs Commissioners v Dr Piu Banerjee ([2010] EWCA Civ. 843) we have learnt that a former trainee at another of the Royal Colleges has successfully argued that these expenses are tax deductible by citing this case. The College has provided a template letter for trainees to use when seeking to claim back tax relief on exam fees, which can be found on the RCPCH website.

Trainees should note the following with regards to claiming tax relief on training fees including START:

Trainees should also note that only training fees paid on or after 10 May 2013 qualify for relief.

‘S343(1) ITEPA [Income Tax (Earnings & Pensions) Act 2003] allows for the subscription fee paid to RCPCH by trainees to be deductible for the purposes of Income Tax. HMRC previously took the view that while the part of the membership fee relating to “Subscription” was covered by this concession the part relating to the START Assessment was not. The regulations have now been amended [ITEP Order 2013] to allow that the whole fee, including the proportion relating to START assessment as an allowable deduction from tax.’

The College cannot advise individuals about their personal tax affairs, nor can we provide them with advice or assistance in making claims for tax relief on fees or subscriptions which they have paid, nor are we able to enter into any communication on an individual basis with them on this subject.

Academic guide

Neena Modi, former RCPCH VicePresident (Science and Research) says: ‘All paediatricians have a part to play in research to benefit infants, children and young people and their health services, and their training must reflect these needs. ‘The RCPCH Trainees’ Curriculum sets out the research competences required of all paediatricians. However, some doctors will aim to develop, or lead, research as consultant paediatricians or as appointees to academic positions. The RCPCH Academic Training Committee has, therefore, prepared this guide to assist trainees who wish to advance their involvement in research.’ Training in Research for the Benefit of Children provides helpful and practical guidance for trainees and supervisors. As well as giving answers to many frequently asked questions and advice from other paediatricians involved in research, the guide lays out the processes involved in securing research positions and the ins and outs of various research opportunities.


JOHN O’KEEFFE Education and Training Support Manager

Revalidation Portfolio - are you using it?

The RCPCH has published a guide to assist paediatric trainees in advancing their involvement in research. The Turning the Tide (www.rcpch. report highlighted recommendations in six key areas, including education, training and guidance. The production of this new academic guide will help the College to meet its aim of improving training in research skills for all paediatricians in our training programme.

For more information, please visit

As readers may be aware, the College offers a revalidation portfolio for consultants, SAS and Trust doctors practicing in the UK who don’t have access to an appraisal/revalidation system in their own organisation. Dr Kathleen Sim, Doctoral Research Fellow, comments on what she loves about being involved in research: ‘Being able to contribute towards the understanding of a disease using cutting-edge technology, and being involved in both the clinical and the laboratory side of the study, has been so exciting and fulfilling.’ Special thanks for the production of this guide must go to Dr Helen Budge, Reader in Neonatology and Co-Director of the Clinical Academic Training Programme at the School of Medicine, University of Nottingham, for her contribution to the content and for coordinating input from other members of the Academic Training Committee and academic colleagues across the devolved nations. You can view the guide online: We welcome your feedback: JOHN O’KEEFFE Education and Training Support Manager

The online portfolio is private, easy to access and free to use for RCPCH members. Aligned with GMC revalidation requirements, the portfolio assists with organisation and secure storage of your supporting information over the five-year cycle. Access can be given to appraisers and/or Responsible Officers (with user permission) and you can export information to other systems as needed. You can find out more, including access details at revalidationportfolio. Alternatively, if you are attending our Annual Conference in Birmingham on 8 April, why not come along to the auditorium space in the main exhibition hall during morning break (10.1010.40) to see the portfolio demonstrated in action? JULIE FROGGATT CPD and Revalidation Manager



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Global Child Health Consultancy In an exciting development, the RCPCH is set to launch its Global Child Health Consultancy. This all new agency will work to meet the growing demand for authoritative volunteer and contract consultancy support in providing paediatric care and practice in global health settings. This will allow the College to harness the extensive experience of members, ranging from trainees who have participated in Global Links placements through to senior and retired fellows who have spent most of their professional life in a global health setting. The Consultancy will afford the College a ready and accessible workforce which is paid a commensurate fee for the expertise it offers. This will mean that the College can bid for further volunteer opportunities, as well as grantfunded and contracted work. With the RCPCH International Team

expanding its programmatic work, opportunities for volunteer and contract placements are beginning to emerge. From ETAT+ training in Myanmar and responding to the needs of disabled children in Palestine through to clinical audit training in Ghana – these opportunities are typical of the developing assignments which will be open to Global Health Consultants. Prospective partners with the Consultancy include the World Health Organisation, Save the Children and Hope & Homes for Children, and the College is making it clear that it has experience, skills and networks that can add value to their work and tangibly make a difference to the lives of children. Assembling the Consultancy’s architecture requires careful thought and so consultation is being undertaken both within the College and with external agencies such as the Register of

Engineers for Disaster Relief (REDR) and the Humanitarian and Conflict Response Institute at the University of Manchester. This is to ensure that the right processes for managing global health interests are in place. ‘We’re expecting to invite interested members to register with the Consultancy in the spring’ said Professor Steve Allen, RCPCH International Officer. ‘At the same time, we’ll be maintaining a watch for where we can best place College expertise in furthering our global child health agenda. It could be a volunteer placement with a community based NGO or a contract assignment with the likes of UNOPS. There are many opportunities; this is an initiative we are sure our members will want to support!’ STEVE CRUMP Head of International Operations

RCPCH International Global Links programme Sierra Leone’s national referral children’s hospital gets a boost The civil war in Sierra Leone, which ended in 2002 after 11 horrific years, damaged the country’s entire infrastructure, setting back its health systems so they became arguably the worst in the world. Since then, the country has been doing its best to rebuild. Sierra Leone is now politically stable and its health systems are very gradually improving, with the help of initiatives such as the RCPCH Global Links programme. An event which will significantly add to this progress is the recent accreditation of Ola During Children’s Hospital (ODCH) by the West African College of Physicians (WACP) as a national referral training hospital. The result is that for the first time since the war, Sierra Leonean paediatricians will not have to leave Sierra Leone to train. SHOs and registrars can now remain in their own country to do their training at ODCH. Some are even returning from overseas to complete their training, thereby significantly boosting the paediatric staffing and clinical capacity of the hospital, and the country as a whole. The RCPCH’s Global Links programme, in partnership with the Welbodi Trust, has been central to assisting with the accreditation process. The four Global Links volunteers who have been present at ODCH since July 2012 have helped local staff to develop clinical guidelines for the hospital, assist with child protection policies, chair and develop rotas for handover meetings, run disability clinics and develop the malnutrition ward, amongst many other improvements.

Providing these services helped to meet the WACP accredited hospital criteria. The profiles of the Global Links paediatricians are varied. ODCH has benefited from a UK retired consultant, a consultant taking a year’s sabbatical form his NHS practice, and two UK trainees, all spending between 6-12 months in Freetown working at the hospital. The Global Links programme has been able to provide a Above: Staff at ODCH consistent paediatric presence, replacing one doctor as another leaves to continue the capacity building work. One more trainee is due to go out to Sierra Leone in early March to take over from a returning London trainee slotting back into her UK rotation. As the Sierra Leonean paediatricians train, graduate and reach consultant status, they can then begin to add to, and eventually replace, the foreign doctors at the hospital to maintain Above: Dr Waldegrave conducting fluids training the accredited status. For now though we are still looking for UK paediatricians, especially consultants (or recently retired) who can keep the momentum going. If you are interested in joining the programme, which works in Sierra Leone and four other Sub-Saharan countries, please visit the RCPCH website ( or contact Peter Nash (0207 092 6016/ PETER NASH Global Links Manager

Above: Dr Gibson in ODCH emergency room Top and bottom photos © Timur Bekir/THET




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Investing in the four nations Over the last 25 years the UK has undergone a period of almost unprecedented political upheaval. From power-sharing in Northern Ireland to the creation of devolved assemblies and governments in Wales and Scotland respectively, the United Kingdom is unrecognisable from the way it looked in the early 1990s. These changes have also had a profound effect on the nation’s health and, indeed on the individual nations’ health systems. The fact that it is not now possible to smoke in enclosed public spaces throughout the UK has happened, arguably, only because the smaller nations of the UK took advantage of their less complex health systems and favourable public opinion to introduce pioneering legislation banning smoking in public places. The NHS in each country is also looking increasingly different from one another. There is of course an implication for the College in all this – we need to ensure we are fit to meet the challenges a more complex United Kingdom places on us. That is why over the last three months we have been reviewing the role of the national offices and at the beginning of the year appointed three External Affairs Managers to support the National Officers in carrying forward a planned and appropriately flexed programme of work for each country.

Northern Ireland The creation of a new office in Belfast means that for the first time in the College’s history it now has a staff presence in Northern Ireland. As the External Affairs Manager there, John McBride will be responsible for not only ensuring the work of the Ireland Committee under its Chair, Dr Emma Curtis, is carried forward but that we engage on the key health policy issues that impact on children. This will undoubtedly mean lobbying Ministers and other influential figures but also that we can deliver localised training and events for our members in both Northern Ireland and the Republic of Ireland. Scotland As the Scotland Office manager, Claire Burnett has been working closely with the Scotland Officer, Dr Peter Fowlie, who represents the College on the Scottish Government’s Children and Young People’s Health Support group. On issues such as obesity, child death review process and workforce challenges as well as the concerns around the 9:1 contract there is an enormous body of work for the team in Scotland to undertake. Of course that means close collaboration with the Scottish Government – well illustrated by the fact that it has announced the development of ‘A Care Pathway for Foetal Alcohol Syndrome’ following two awareness day

sessions that were run from the College office in Edinburgh. However, in her new role Claire will also be involved in further public campaigning – trying to persuade various agencies to go further and faster on health inequalities. Wales Though it is comparatively small, there are significant geographical, political and cultural issues in Wales which means that reconfiguring services so that they are safe, sustainable and in keeping with the needs and desires of the Welsh people represents a major under-taking. The Officer for Wales, Dr Mair Parry and the wider team, including the External Affairs Manager for Wales, Nick Morris, will ensure the College is at the heart of this debate – lobbying the Health Minister, Assembly Ministers as well as local health boards to ensure any decision about the shape of services is clinically led. Equally, as the recent outbreak of measles in South Wales demonstrates, there remains a vital role for the College in the wider public health and prevention arena. So this is an incredibly exciting time for the College as it faces a constantly evolving health landscape in Northern Ireland, Scotland, Wales and England but we are now better placed than ever before to become the leading voice on child health in all parts of the UK. BRIAN DOW Director of Communications

New End of Life ethics guidelines Since the RCPCH Ethics and the Law Advisory Committee (ELAC) first produced Withholding or Withdrawing Life Sustaining Treatment in Children: A Framework for Practice many aspects of paediatric and child health practice have changed significantly. Increasing use of aggressive and once novel interventions alone necessitates an update and colleagues in general paediatrics and community child health have seen the complexity of the case-mix increase beyond recognition.


between children, their families and child health professionals - shared decisionmaking with families and children - that the refashioning of the document is based. Making Decisions to Limit Treatment in Life-limiting and Life-threatening Conditions in Children: A Framework for Practice (DtLT) is a document rooted in this shared approach. It seeks to put the child and family at the centre of decision making at what is an extremely challenging time.

Palliation of chronic organ failure using at home parenteral nutrition, dialysis, and ventilation is now commonplace and as a result, children with complex life-limiting conditions are now sustained for many years.

Qualitative research has increasingly allowed the voices of children in these situations to be heard more clearly and this document seeks to normalise this while recognising most, although certainly not all, children will be a part of some sort of family group.

However, it is on the changing relationship

Greater coverage of the issue of organ

donation reflects a recognition that this too is a decision for children and families that, where possible, ought to be offered at the end of a child’s life and which can lead to the ‘gift of life’ for others as well as better outcomes for bereaved surviving families. Into this complex terrain now comes the new DtLT document - its aim, to provide a shared language for professionals to use with children, families and each other. The ELAC hopes this document will prove helpful for those faced with guiding children and families through this most difficult area. View the guidance online at www.rcpch. or contact ELAC Administrator John Pettitt for more information: JOE BRIERLEY Chair, ELAC



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Disability Matters: eLearning to inform and inspire To address inequalities and improve the lives of thousands of the UK’s disabled children and young people, the Department of Health in England (DH) has awarded the RCPCH, on behalf of a consortium of experts, nearly half a million pounds to produce a website that provides high-quality, bite-size, eLearning materials.

What Disability Matters means for paediatricians

Disability Matters will be a suite of free online educational resources to help a large number of organisations, including healthcare professionals, travel and leisure, care workers and teachers, equip their workforce to meet the physical, emotional and mental health needs of disabled children and young people aged between 0 – 25 years old. In addition to this, the resource, which launches in autumn 2014, will enable all workers and volunteers to reflect on their own attitudes and beliefs around disability.

Give direct insight into the experience of disabled children, young people and their families, including the challenges they face.

Enhance professional development and learning.

Act as a central hub where professionals can learn from best practice.

Improve confidence, communication and inclusion for disabled children and young people.

Improve the overall quality of service that disabled children and young people receive in the healthcare setting.

Promote equal access to the best health and wellbeing outcomes for all children and young people.

To ensure Disability Matters is of the highest quality and relevance, it is being developed by a Consortium of experts. It is anticipated that Disability Matters will become the ‘go-to’ for disability eLearning and will inform and inspire those who work with disabled children and young people to aspire to the best possible participation, quality of life, health and wellbeing outcomes for them. Find out more about Disability Matters: LAUREN SNAITH Media and Campaigns Officer

RCPCH courses and events 2014 EVENTS TEAM


A fair deal for all children: How do we tackle child health inequality? 28 April 2014 RCPCH, London How to Manage: Paediatric allergy 12 May 2014 RCPCH, London Progressing Paediatrics: Assessing and treating motor dysfunction in children with neurodisability - a practical approach 13 May 2014 York How to Manage: Paediatric sickle cell disease 20 May 2014 RCPCH, London

tel: 0207 092 6000

Evening of Evidence: More than obesity - steps towards physical health in adolescent years 20 May 2014 RCPCH, London Introduction to quality improvement 20 May 2014 Portsmouth How to Manage: End of life care and bereavement 3 June 2014 RCPCH, London Royal Society of Medicine/ RCPCH meeting: Acute paediatric care 17 June 2014 RSM, London


Evening of Evidence: Safeguarding - health service response to violence in adolescencegang related, sexual exploitation 24 June 2014 RCPCH, London Progressing Paediatrics: Challenges for the consultant paediatrician secrets of success in neonates 25 June 2014 RCPCH, London Evening of Evidence: iTeen - the paediatrician’s guide to common presentations during adolescence 8 July 2014 RCPCH, London

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You might have noticed that we recently redesigned our Courses & Events section on the RCPCH website – Users can now more easily find courses and events relevant to their sub-specialties, interests and regions, and control how much information they see on the page. Do let us know what you think: 9


Committee news

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Health Services Vice-President Outgoing message from Dr David Shortland Coming into the role of Vice-President for Health Services five years ago, I felt that there were three key challenges facing paediatric services. These were configuration of services, workforce pressures and the need for clear service standards. The UK was seeing a significant expansion in the paediatric consultant workforce. However, there was not a clear view on standards for service provision, configuration of paediatric services or a model for how many consultant paediatricians were needed. ‘Facing the Future’ was a bold blueprint that brought these three strands together: we introduced 10 standards that should be met by acute services and models for the number of paediatricians that would be needed to implement these standards. We believed that the trainee/consultant ratio was unsustainable in paediatrics and, with an assumption of the likely future consultant workforce, were able to predict the number of in-patient paediatric

services that we could sustain into the future.

Wallace and provides an excellent conduit for the College to assess the current state of paediatric services.

Two years after these standards were agreed by the College, we launched ‘Back to Facing the Future’, a national audit to assess compliance with these standards. The audit benchmarked individual units against these standards and it was successful in raising the profile of paediatric standards and demonstrating the College’s commitment to ensuring these are met. Building on the progress of this work, I am now leading a project to develop standards for urgent care services for children: ‘Facing the Future Together for Child Health’.

Alongside this work, I have contributed to a range of resources designed to support paediatricians and service providers. As well as developing a toolkit for assessing the safety of acute services, Dr Veline L’Esperance and I recently produced a handbook which provides advice and guidance for paediatricians at all stages of their career.

In order to make individual services aware of our standards and to support healthcare organisations and clinical teams to resolve concerns or benchmark their paediatric service provision, the RCPCH’s Invited Reviews Programme was established in 2012. I was very pleased to take over the lead role for this programme, which was so effectively developed by professor Hamish

All of these initiatives have been professionally supported by the committed RCPCH staff. It is amazing how quickly five years passes and I am looking forward to continuing to support this work in the coming years in the projects I am involved with. DAVID SHORTLAND Vice-President for Health Services, 2009-2014

Reflections on the Science and Research Vice-Presidency Neena Modi is Professor of Neonatal Medicine at Imperial College London, President of the Neonatal Society, the UK’s longest standing paediatric research society, and outgoing Science and Research Vice-President. The Science and Research VicePresidency has been rewarding and challenging, the latter in part because of uncertainty within the RCPCH around the role’s remit, exemplified by the sudden metamorphosis of the Division during my tenure, from ‘Science and Research’ into ‘Research and Policy’. Here, I offer a few reflections, in the hope that they will help achieve clarity of vision. Children require treatments and services shown to be effective through research. They are harmed by a poor evidence-base, and health services not tailored to their needs. The contribution that doctors and the RCPCH can make to generating evidence, and assessing patient care and outcomes is important. These obligations provide focus for the


Science and Research Vice-Presidency: to steer RCPCH evaluation of health services, advocate for research that benefits children and advances the science of paediatrics, and ensure that paediatricians are well trained for their involvement in these activities. In the last years we have expanded our portfolio of national audits (Neonatal, Diabetes, and Epilepsy), completed a major Clinical Outcome Review Programme, Child Health Reviews UK, and published Turning the Tide: harnessing the power of child health research. It is heartening that so many of this report’s recommendations for strengthening children’s research have been realised; we have developed a guide to Training in Research for the Benefit of Children (page 6) and a set of generic research competences to be attained by all paediatric trainees, a move that has been adopted by other Royal Colleges. Trainees are establishing their own networks for research experience. The NIHR Medicines for Children’s Research

Network will be replaced by a unified Children’s Theme (page 3), and a research call on children’s long-term conditions has been launched. I am particularly pleased to have helped establish the UK Child Health Research Collaboration, a forum involving the Medical Research Council, Wellcome Trust, NIHR, medical charities, and other organisations including the RCPCH, to increase children’s research through alliances for capacity building, grant funding, and training. Going forward the RCPCH must grow in ability to conduct and utilise rigorous health services evaluations, involve children and their families, and strengthen an ethos among paediatricians of pride in children’s research. I have been privileged to have worked with inspiring colleagues and to have been a small part of this endeavour. NEENA MODI Science and Research Vice-President, 2009-2014


Committee news

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Training matters It’s probably no surprise that Workplace Based Assessments (WBAs) is one of the topics I get the most emails from other trainees about. WBAs take up a lot of time and effort for trainees and trainers alike, but when done well are invaluable to our development as clinicians. The College is now several months into its pilot of a new assessment strategy, which we’re all taking part in. I’ve written before about the reasons for the changes that have been made, and the move towards a more formative assessment experience. Early signs are that the new WBAs are getting off to a good start, with good uptake from trainees at all grades. It already looks like people are spreading assessments out throughout the ARCP year, rather then leaving them to the last couple of weeks before the deadline to complete. A number of new tools are under assessment, and it’s important that we get your feedback on whether they’re working or not.

Handover Assessment Tool (HAT) The HAT is a Structured Learning Event (SLE) focusing on this very important part of daily practice. Acute Assessment Tool (ACAT) The ACAT SLE focuses on aspects of working in the acute medical care setting. The assessment form provides suggestions for several different elements of work within this setting that could be the focus of discussion. LEADER The LEADER SLE is a case based discussion concentrating on clinical leadership. Discussion of Correspondence (DOC) The final new assessment, DOC, replaces the old paper-based SAIL. Starting from Level 2 of training, trainees are now expected to complete five letters or pieces of written correspondence in each level of training. For the three pilot SLEs we hope

trainees will complete one HAT and one LEADER at Level 1, and one of all three assessments at both Level 2 and Level 3. I hope you see these as a minimum though, as the more of these assessments that get done, the better feedback we can get as to whether they’re doing what they should be. There’s lots of ways you can feedback to us your experience of the new tools. A link to a short survey will be coming out soon to all trainees and trainers. We’ll also be looking for trainees to contribute to some focus groups on the new tools a little later in the year. If you’re interested in contributing to those groups, or if you have anything you’d like to feedback about the new assessments now, then please email me at DAN LUMSDEN Chair, Trainees’ Committee

New Honorary Treasurer Introducing Lisa Kauffmann I am excited to be taking up the post of Honorary Treasurer, although somewhat anxious about meeting the very high standard that has been set for me by my predecessor. David Vickers, with the Senior Management Team, steered the College through some difficult times to a stable financial position. I am a community paediatrician with a special interest in palliative care working in the North West, so this role also comes with the anticipation of many happy hours on Virgin trains! This is a time of great challenge and great opportunity for the College. As paediatricians we are facing up to the unacceptable reality that the health of our children is poorer than that in other comparable countries. Alongside its essential core functions in training and education, and assessment and exams, the College is developing major projects around reducing mortality, increasing quality improvement skills of members, developing standards for urgent outof-hospital care, and supporting service redesign.

In order to fund these and other initiatives, we need to increase our income. Subscriptions for our members have been kept below inflation for three years, and we feel provide good value for money. We cannot ask our members to fund all the work the College wishes to do, so we need to look to other sources; increasing our research bids, developing our publications and working collaboratively with other organisations. We also need to address the challenging area of sponsorship and working with industry. This is an area that has always been difficult, particularly in relation to companies producing baby milk, but it has the potential to provide the College with the funds it needs to realise its ambitions in terms of improving outcomes for children and families. We must therefore sensitively explore opportunities available that are acceptable to members. Following consultation with members, the Executive Committee has developed a policy around potential sponsorship to ensure that any partnership the College

considers is transparent, ethically sound, and acceptable to members. As a member of the Executive Committee and the President’s Advisory Group, I am looking forward to helping develop and deliver the College’s strategic vision. Alongside the College’s aspirations we must recognise the daily challenges facing our members and their teams with increasing demand and diminishing resources, and ensure the College remains relevant and responsive to their needs. My opportunity to contribute to this important and exciting work would be impossible without the support of David Howley, Director of Corporate Services, and his finance team, whose hard work ensures the College’s books are secure and well managed. Finally I would like to thank David Vickers for the fantastic contribution he made as Honorary Treasurer, and previously in his role as Registrar; he will be sorely missed. LISA KAUFFMANN Honorary Treasurer


BNF for Children 2013-2014 New Edition Guiding health professionals on all aspects of paediatric drug therapy. Significant content updates for latest edition  Changes to the criteria that define paracetamol overdose  NICE guidance on the use of omalizumab for severe persistent allergic asthma  Advice on prescribing adrenaline autoinjectors for anaphylaxis by brand name only  Important advice on the prescribing of caffeine; doses now expressed in terms of caffeine citrate only  Revised drug treatment of septicaemia in neonates  Updated doses of rifampicin and ethambutol in the standard regimen for the treatment of tuberculosis

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