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SUMMER 2011 NEWSLETTER

Notes RCPCH Courses across the globe RCPCH new start up for Gaza training College members with long memories will recall that the RCPCH Palestinian teaching course began in Gaza city, back in 1998 when David Baum was President. The Minister of Health for the Palestinian Authority was based there and we later gathered an enthusiastic set of teachers and organisers under the umbrella of the Ministry and Medical Aid to the Palestinians (MAP), then as now our firm allies in this mission. Sadly for the Gaza people, many disasters have afflicted them since then, and our failure to move forward – owing to the political difficulties and later embargo of Gaza by the West – was shared with many other outside organisations. Now, 13 years later, we are planning a limited start up for RCPCH support of healthcare education in Gaza. That we are able to do this is largely due to the enthusiasm and efficient organisation of the Gaza paediatricians and their supporting medical school, the Islamic University. With little outside help, they have established a Diploma course in child health and nutrition and have achieved accreditation with the Palestinian Medical Council and Higher Education Council (a feat we have yet to achieve in the West Bank) and are now able to charge fees to the doctors (no nurses as yet) who sign up for the course1. You might say, do they need outside help? Certainly, as at the present time they have a shattered health service following the three week war of January 2009, which devastated their population2, they have severe equipment shortages, and they have a strong sense of abandonment by the outside world. The paediatricians hold the RCPCH in high regard, and have requested assistance in relation to training of their teachers, development of modules in child protection and child mental health, and standard setting for their course.

RCPCH Trainee wins BMJ Award

Since travel to Gaza is difficult, we have held two successful video conferences with the local team and the President gave a well-received introduction by video to their paediatric meeting in October 2010. In March 2011, an educators course and a neonatal life support class were held in Gaza itself. This was facilitated by MAP and included UK paediatricians entering under MAP auspices and video input from others in the West Bank and UK. At the same time, we are working with Gaza paediatricians together with their West Bank counterparts on the development of new material for the course. In the future, we hope to run a child protection course and to assist further with educational support for their Diploma course. Meanwhile, the West Bank programme for the RCPCH Diploma in Palestinian Child Health continues to run successfully and the President will be coming to Ramallah for the next graduation in January 2012. We are proceeding with accreditation locally so that fees can be sought from the next group of candidates, an essential step towards sustainability for the course. The evaluation of the previous course may now be viewed on our special website www.palestine.rcpch.ac.uk TONY WATERSTON EZZEDIN GOUTA JEAN BOWYER

References: 1. http://blogs.bmj.com/bmj/2010/07/ 30/tony-waterston-going-againstthe-grain-in-gaza/ 2. Waterston, T. Eyewitness accounts from surgeons in Gaza. The Lancet, Volume 377, Issue 9759 http://www.thelancet.com/journals/ lancet/issue/vol377no9759/PIIS01406736(10)X6162-1 Page 19, 1 January 2011

The College sends its congratulations to Dr Dan Magnus of Bath, who won the BMJ’s “Junior Doctor of the Year” award. Dr Magnus, seen on the left in the photo receiving his award from one of the sponsors, was selected from more than 600 nominees. As well as working as a Paediatrician at the RUH in Bath, Dan is also a co-founder of the Kenyan Orphan Project, a UK charity supporting health, education and social welfare projects for orphans and vulnerable children in Kenya. Dan has also helped to develop global child health teaching for medical students at the University of Bristol and has lectured extensively at global health conferences around the UK to teach and inspire a new generation of doctors and professionals on the health and protection of children around the world.


Notes 1 RCPCH new start up for Gaza training RCPCH Trainee wins BMJ Award

2 Registrar’s Column

Registrar’s Column

3 A message from Professor Terence Stephenson

4 E-Learning Resources for the Healthy Child Programme “Knowledge is power”

5 Taking the College Forward Media update – summer 2011

6 A momentous event, unfolding knowledge, innovation and expertise

With some regret, I report that this is my last column as Registrar. I decided to demit office at the AGM after serving for three years to allow me to apply for the position of Honorary Treasurer as I was not comfortable with asking for re-election to one role and election to another at the same time. As a consequence, I am pleased to announce that I will be succeeded in this role by Dr Hamish Wallace, a Consultant Paediatric Oncologist in Edinburgh.

7 Annual Conference 2011, Warwick

8 David Baum International Foundation SSASG NEWS

9 Spence Medal Citations

10 Revalidation – gearing up to 2012 NHS-UK get free training in Safeguarding: Maintaining & Updating Competences (MaUC) e-learning programme

11 Training Matters RCPCH Events

Copy deadline for next issue: 7th August 2011 Managing editor: Graham Sleight Editor: Joanne Ball Email: newsletter@rcpch.ac.uk Editorial services: Work Communications www.workcomms.com Published by: The Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH. Tel: 020 7092 6000 Fax: 020 7092 6001 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.uk The College is a registered charity: no. 1057744 and registered in Scotland as SC038299

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I served for three years in this position, and have enjoyed the challenges it brings, and the opportunities it has given me for personal and professional development. However it is with some concern that I note that neither Hamish nor I had to contest an election. This is a symptom of the increasing pressure NHS employers place on Consultants in relation to College activity. RCPCH continues to argue the case that Medical Royal Colleges have a vital role to play in training, professional development, standard setting and service improvement. This is just as true for Senior Officers, as Councillors, as Committee members, as Tutors etc. If you are having difficulties with your employer about working with the College, you need to let us know, so we can try to support you. The College is a membership organisation, and as such needs the deep involvement of its members in all that it does. I have hugely enjoyed the work I have contributed to and the issues I have addressed within this role, and in some ways regret moving on. However, as noted above, we have had difficulties in recruiting new Officers. The Honorary Treasurer post attracted no applications on first call, and only me on second call. Following what I felt was a robust process I was appointed. My particular interest is in the governance of the College, so this new role is a natural continuation of this interest. One of the issues I will continue to try to address in the future is ensuring that the College operates in a way that maximises the use of staff time, and minimises the need for Officers to be involved in the day-to-day. As I look back, I feel a sense of achievement. RCPCH has moved on from a rather informal club to a proper business,

changed for the better our staffing structure and skilled up our staff team. We have better supported training and education, developed some sentinel standards, improved our communication with our members and been better at a four nations improvement. We have also begun to develop a more comprehensive approach to involvement of children, young people, carers and parents etc. Most of this is not due to me, but I hope I have had some influence. Influence – an important word. Do you want to change the way Children’s Services are provided? Do you want to meet and potentially influence the Minister (in whichever country)? Are you frustrated that Paediatrics doesn’t get the hearing it deserves? Well. First of all engage locally within your Trust, with your Commissioner, but also think about working with the College. Increasingly we have the staff structure to support effective work with politicians, regulators and commissioners, but they need the clinical expertise you bring. I put myself forward for the position of Registrar three years ago because I wanted to make a difference. I hope I have. Yes it was a bit of a battle with my employer, and a huge learning curve. But the College supported me in doing this. We all make a difference for the children we work with, but if you want to try and make a wider difference, think about putting yourself forward for a College role. I did, and I have to confess that I felt intimidated by the “great and good” – but now realise they are no different from most us, other than that they have decided to volunteer. That is what “good” means. DR DAVID VICKERS Registrar


Notes As I go round the country I’m sometimes asked “what is the RCPCH doing for me?” Given the pride we have in our carefully chosen name, Royal College of Paediatrics and Child Health rather than Royal College of Paediatricians, perhaps the question should be “what is the RCPCH doing for children and young people?” At school, studying 19th century history, I was taught that Turkey was the ‘sick man of Europe’. The current European view is that the UK is the ‘sick child of Europe’. Many outcomes for children in the UK are worse than countries which spend a similar % of GDP on healthcare. This month we gave oral evidence to Baroness Finlay’s Commission examining the ‘general’ in General Practitioner. At present, less than 50% have had any formal training in child health, a lower percentage than in 1989. We have completely revised the DCH exam to be fit for purpose for GP’s, with input from GP’s to the syllabus, question setting and examining. But a minority of GP’s sit DCH. Should it be a mandatory requirement for a doctor practising in a field where 22% of the population are aged under 18 and account for a 1/4 of the workload? As we did two years ago, we will strongly support the RCGP in any bid to prolong GP training, ideally with mandatory training in child health. The Health & Social Care Bill for England is undergoing a ‘pause and listen’. I was asked to be a member of the Future Forum which is undertaking this exercise. I believe I am the only member of the forum who works exclusively with and for children. In three separate meetings in May with David Cameron, Nick Clegg and Andrew Lansley, I emphasised that a health service for hips, knees and cataracts, designed by old people for old people, is unlikely to serve children and young people well. The Kennedy Report emphasised the failings of the NHS in relation to young people under the previous government so things were not perfect and the status quo not tenable. Albert Einstein said “madness is doing the same thing over and over again and expecting a different result”. Furthermore, excluding emergency care obviously, I agree that carers and children should have choice, where possible. Non-NHS providers are not bad per se (think of the third sector’s contribution to palliative care) and competition is not bad per se (parents may choose one NHS unit over another on a mixture of clinical criteria, proximity, comfort etc). However, for children either with chronic, complex, disabling conditions (eg Cerebral Palsy, Down’s Syndrome) or who need safeguarding, collaboration to provide multidisciplinary, integrated care is preferable to competition and cherry picking. For children’s problems

A message from Terence Stephenson which are relatively rare for a GP (e.g. neurodisability, cancer, intensive care), but not so rare as to be covered by the Advisory Group on National Specialist Services, sensible geographical networks are preferable to localism and duplication by tiny consortia. To achieve quality, integrated services for children, GP’s will need input from paediatricians and I have been arguing for this. The Academy of Medical Royal Colleges is the body which brings together the views of all 21 colleges. The Academy believes that there are real benefits in medical care delivered by trained doctors but with the current financial climate, the debate about whether the NHS can or should afford this model of care is increasingly important. I am ViceChairman of the Academy and leading, on behalf of the Academy, a review of the evidence for benefits to patients of healthcare being delivered primarily by consultants. We plan to produce a report of our findings based on published literature across the world and evidence submitted from interested parties. Fourthly, on May 11th, Sir Nicholas Wall, President of the High Court’s Family Division, handed down in court a judgement granting a journalist permission to name a paediatrician who was an expert in care proceedings. The College gave evidence on a generic basis and our submission advocated for the best interests of children and young people. We highlighted the

concern that the removal of anonymity might prove to be a further disincentive for paediatricians undertaking child protection work. The judgement recognised the work that paediatricians do every day protecting children and young people. However, Sir Nicholas Wall stated that the RCPCH views must be subservient to the more powerful arguments under Article 10 of the European Convention on Human Rights which provides the right to freedom of expression. In the past months, the media has been awash with super-injunctions where Article 8, the right to privacy, takes precedence. If you want to read more, google “re x,y,z nicholas wall” or “re x mark potter” or read Her Majesty’s Court Service publication EX711 “Can the media attend my court case – a guide for family court users”. John F Kennedy said “while children are often the victims of fate, they should never be the victims of neglect”. Our ‘USP’ is training and assessing tomorrow’s paediatricians but all the College staff and officers strive to ensure that we do not neglect the topical children’s policy issues of the day. I hope the examples above, and the 22 inches of documents we have reviewed for Government alone in the last year, emphasise that we are truly a Royal College of Paediatrics and Child Health and not a Royal College of Paediatricians. PROFESSOR TERENCE STEPHENSON President, Royal College of Paediatrics and Child Health

RCPCH wins bid to host Europaediatrics Conference 2013 At the Europaediatrics meeting in Vienna in June 2011, the RCPCH bid to host the 2013 Europaediatrics meeting at the Scottish Exhibition and Conference Centre in Glasgow. The bid was led by the President, Terence Stephenson (pictured, along with Beverley Mclean from Glasgow City Marketing Bureau), and the competing cities were Berlin, Bucharest, Dublin, and Rome. The 2013 conference will be the first occasion when Europaediatrics has been held in the UK . More details will follow in future newsletters and on the College website.

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Notes

E-Learning Resources for the Healthy Child Programme

“Knowledge is power”

Introduction A new e-learning resource to support healthcare professionals in delivering the Healthy Child Programme1 (pregnancy and the first five years of life) has been launched by Anne Milton MP. The RCPCH has worked alongside partners over the last two years to develop this comprehensive e-learning resource. The resource will be available free of charge to all healthcare professionals working in the NHS. What is contained in the e-learning? The e-learning resource will take you from pregnancy to five years in 76 individual e-learning sessions, spread across 12 discrete but complimentary modules: The module titles are: • Healthy Child Programme Basics • Communication, Record Keeping and Inter-professional Working • Family Health • Safeguarding • Positive Parenting and Parenting Issues • Development and Behaviour • Speech, Language and Communication Needs • Growth and Nutrition • Immunisation • Health Promotion • Screening • Health Visiting Model of Practice How long does each session take? Each session will take 20-30 minutes to complete and will contain case studies, self assessment questions and links to further information. There will be approximately 25 hours of ‘learning time’ across the full curriculum. The sessions are designed for selfdirected learning from any computer with internet access.

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How do I access the materials? The resource is accessible via the e-Learning for Healthcare (e-LfH) Learning Management System (e-LfH LMS)2. The website address is: www.e-lfh.org.uk/healthychild The RCPCH has already created accounts for all members who are working for the NHS. If you need to be reminded of your username and password, contact the e-LfH support team: support@e-lfh.org.uk Who are the sessions designed for? The sessions are designed for ALL health professionals involved with pregnancy and children up to five years of age. The learning levels vary between sessions and are designed to challenge you as well as educate you about the latest evidence base. Contact: Daniel.Riddell@rcpch.ac.uk References: 1. Healthy Child Programme: pregnancy and the first five years of life: www.dh.gov.uk/prod_consum_dh/grou ps/dh_digitalassets/@dh/@en/@ps/d ocuments/digitalasset/dh_118525.pdf 2. e-LfH webpage: www.e-lfh.org.uk/healthychild DANIEL RIDDELL Project Manager

This pithy observation, attributed to Sir Francis Bacon some 400 years ago, could be translated in the language of today into “Information effects change”. Why is this relevant to the RCPCH? Well, in addition to numerous other activities, the Science & Research (now Policy & Research) Division has been busy placing the RCPCH centre-stage as a source of high quality child health information. We lead audits in Epilepsy (Clinical Lead: Dr Colin Dunkley) and Decreased Consciousness (Clinical Lead: Dr Stephanie Smith) and in the last year have been awarded prestigious grants in open competition to continue the National Neonatal Audit Programme (Chair: Dr Mike Watkinson), for a National Paediatric Diabetes Audit (Clinical Lead: Dr Justin Warner), and a new programme, Child Health Reviews-UK that involves the systematic capture of national information on death and serious childhood morbidities. We will use a case-control methodology to review the quality of healthcare and health services against pre-defined standards for specified clinical conditions. Expressions of interest to provide clinical leadership were invited earlier this year and we will shortly be advertising for this and other appointments to the programme. We will also be inviting recommendations for topics for the reviews. I am well aware of the difficulties many of you have faced in persuading your Trusts to release you for College activities but paediatricians have always given generously of their time and expertise, and I am confident the College can count on your support. These programmes offer unique opportunity for us to influence child healthcare in the UK. I intend that the information and objective data we acquire will not only lead to recommendations about clinical care, service delivery and commissioning, but will be embedded into education and training, clinical and service standards, and used to inform and guide national policy. NEENA MODI Professor of Neonatal Medicine, Imperial College London RCPCH Vice President, Science & Research June 2011

Deaths The College notes with sadness the deaths of the following members: Name Professor Angel Ballabriga Dr Michael C Joseph Professor Niilo Hallman Dr Stefan Herber Professor Henry Basil Marsden Dr James Partridge Dr Margaret Taylor

Membership Type Honorary Fellow Honorary Fellow Honorary Fellow Fellow Senior Fellow Honorary Fellow Senior Fellow

Admission Date 1989 1962 1972 1985 1973 1972 1967

Town BARCELONA, Spain RICHMOND HELSINKI, Finland GRIMSBY MANCHESTER LEAMINGTON SPA SOUTH SHIELDS


Notes

Taking the College Forward John Harvey Jones asserted that the greatest help in setting a strategy is a hefty slice of cynicism and the openness of mind to re-examine cherished beliefs. I’m not sure about the cynicism and would prefer ‘questioning’, but strongly support the emphasis on being open minded to the ‘way we do things around here’. The last year has seen a major re-organisation in the way College staff are managed and it rightly begs the questions as to why it was necessary and how things will be better. My initial observations on the College were threefold. The College is fortunate in having some bright, committed and talented staff who deserve to be nurtured. Secondly, that the successful, ‘organic’ growth of the College had led to a structure which (by universal consent) no longer made sense. Thirdly, there was no culture of performance management. I know that, from my own career, the comments which have always hit hardest have been the personal challenges to do things better and differently. Now the College has been restructured and there is a huge onus on me and the new senior management team to demonstrate that we will not only be better at what we do, but that the College will reach out more effectively to its membership. The structure is driven by three basic principles: 1. Every day, RCPCH members work to improve the health of children and young people throughout the world. It is children whom the College serves and the task of staff to support paediatricians in the invaluable work they do. Just as the toilet cleaner at Cape Kennedy said he was helping to get a man on the moon, so each of the staff are helping to improve the health of children, through the members we serve. 2. In order to do this, we need to work even more effectively and raise additional income to further the College’s work. This is particularly important as some income sources are diminishing. 3. To be effective we also need to punch above our weight in influencing child health policies across the four nations. In order to achieve these principles the College has been reorganised into four divisions, which broadly replicate what other Colleges do. So, Education and Training are linked together under Julia O’Sullivan, Research and Policy under Jacqueline Fitzgerald, Communications under Brian Dow and Corporate Services under David Howley. This is the new senior management team. There is also a strengthening of the international work and, through the recruitment of a new Head of HR, the chance to develop and grow existing staff. At the same time that I launched plans to restructure the College, I also issued a People Strategy called “From Good to Great”, which aimed at ‘growing’ the staff. The College is fortunate in having bright staff who are capable of achieving more. The People Strategy proposes a number of new initiatives, in addition to the run of training courses you would expect a College to organise. These will include secondments, to and from the College, an internship scheme, shadowing, mentoring and job swaps.

Media Update – Summer 2011 Whilst the newspapers have been dominated by the proposed health reforms, the College has also seen a rise in media coverage over the past few months, entering into many of the debates and creating our own as well. An exclusive was successfully secured in April in The Guardian to launch our new policy document ‘Facing the future’. In the interview, Terence Stephenson drew attention to the pressure that children's hospital services are under in the UK. Flagging up the shortage of consultants and the need to merge smaller children's units around the country in order to provide safe care, he stressed: “We're not telling government or individual hospitals what to do. We're trying to flag up that there is a big problem.” He also said that “it would be reasonable to speculate that if services are not being adequately staffed, that it is not a safe and sustainable service." The story was also covered in other national and local newspapers as well as the BMJ, Lancet and Nursing Standard. Earlier in the year, in mid-February, the College was mentioned on BBC Radio 5 Live and Heart radio as supporting the plan for children's heart surgery to stop in some hospitals. The Colleges’ policy conference in Cardiff in March featured in the Western Mail. It reported on the rising levels of child obesity, quoting Jerry Wales, senior lecturer in paediatric endocrinology at the University of Sheffield – who spoke at the conference. Into April and the Annual Meeting was mentioned in an article in The Independent and Nursery World magazine. They reported on research into the health of children born to older mothers, presented at the conference by Dr Alastair Sutcliffe, UCL Institute of Child Health. The Coventry Telegraph, Coventry Observer, Warwick Courier and Nuneaton Telegraph all reported on HRH Princess Anne’s visit to the conference as well. The Sunday Times published a letter from the College supporting banning smoking in cars with children travelling in them, which was in response to an article reporting on Scottish Labour’s plan to fine drivers. Children and Young People Now magazine reported on the Coalition one year on at the start of May and CEO, Chris Hanvey contributed. He wrote: “The coalition’s first year has been one of well-meaning strategies, offset by a lack of focus and detail and, furthermore, major budget cuts.” Professor Eileen Munro submitted her final recommendations for the future of child protection in May. The College responded, stating that the review “had answered perfectly well the brief it was set and is a good vision for how child protection might work in the future. What it has failed to do is acknowledge the huge turbulence within the NHS and the impact this will clearly have for the protection of children.”

Last year we were inevitably focussed on the internal workings of the College. This year – with the new brand and website in place, plans to launch a fundraising campaign and a strengthened public affairs and policy department – we can lift our eyes up to the hills. The proof of all of this will be, hopefully, in members’ observations on improved services.

To keep up-to-date with news articles that mention or quote the RCPCH, or to stay informed about what is going on within paediatrics and child health, visit the website for a regular summary of articles – www.rcpch.ac.uk/news

DR CHRIS HANVEY Chief Executive

CLAIRE BRUNERT Head of Media Affairs

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Notes

A momentous event, unfolding knowledge, innovation and expertise Hosted by the RCPCH at the National Museum of Wales, Cardiff Friday 4 March 2011 ‘My Right to the Highest Standard of Health’ provided us with a unique opportunity to advocate with and on behalf of children and young people. This event provided a much needed platform for children and young people, health professionals, child rights advocates and politicians to stand together and move a step closer to upholding and protecting the rights of the child. The RCPCH was delighted to host this innovative event in Wales and thanks all our presenters ‘for their enthusiasm, passion and commitment to children and young people.’ Dr Iolo Doull, Officer for Wales, RCPCH. The Welsh Assembly Deputy Minister for Social Services, Gwenda Thomas A.M. opened this inspiring and challenging flagship conference, and gave a keynote address. The conference culminated in a Question and Answer forum chaired by Helen Mary Jones A.M., Chair of the Children & Young People's Committee in the National Assembly. “Speakers highlighted many of the issues pertinent to children’s health today ranging from policy and strategic contributions from politicians and advisers, highlighting current evidence and thinking on Obesity and CAMHS services, to the powerful and often harrowing stories told by young people who had fled to the UK seeking refuge from countries where turmoil and violence have been the norms. It was also the first time that all four of the UK Children’s Commissioners had joined forces to publicly speak at the same conference. It has set an important precedent for similar meetings in the future and has demonstrated how the College can play a key role in facilitating dialogue between the various organisations who have the interests of children and young people as their

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central remit.” Dr Huw Jenkins, Member RCPCH & Chair, Expert Advisory Group, Welsh Assembly Government. “…children and young people are the key stakeholders in these services. They are the ones for whom the provisions are designed and commissioned for – naturally the service delivery will have the child’s interests at its centre. Thus, it is vital that those that will use the service play a constructive role in developing it…” Ravi Mistry, Youth Advisory Panel Member, RCPCH. “My Right to the Highest Standard of Health provided a unique opportunity to explore the issues of common concern whilst highlighting the variations across the four nations.” Keith Towler, Children’s Commissioner for Wales. “Children and young people have a right to have their opinions taken into account in all decisions affecting them – it is one of the principal articles in the United Nations Convention on the Rights of the Child. I am encouraged by politicians and health professionals’ increasing willingness to listen to children and young people. However, we have a long way to go before we can be satisfied that children's views are being given due weight, particularly in relation to the issues facing the most vulnerable.” Tam Baillie, Scotland’s Commissioner for Children and Young People. “I welcomed the opportunity to discuss these issues at the RCPCH conference so that we can all consider the importance of our role in making children's rights a reality.” Maggie Atkinson, Children's Commissioner for England. “Children and young people are often among the most vulnerable groups in our society. Too often their basic human rights, as outlined in the United Nations Convention on the Rights of the Child

BHARTI MEPANI Children and Young People’s Participation & Advocacy Manager

(UNCRC), are not safeguarded and protected. As adults and society in general we need to be doing more to ensure these rights are a reality.” Patricia Lewsley, Northern Ireland Commissioner for Children & Young People. Congratulations on the excellent organisation of such an interesting and passionate conference: it was a real privilege for the Baobab Centre to be involved. Tonny, Maylar, Serge, Moussa and Isaac gained so much from being able to tell some of their stories to a hall full of people that they could trust. “My Right to the Highest Standard of Health’ is more than a title, a statement or an article found in the United Nations Convention on the Rights of the Child (UNCRC). ‘My Right to the Highest Standard of Health’ is a nationwide outcry advocating for transformation that is urgently needed to ensure the best health outcomes for every child and young person. Transformation that will uphold the child’s right to be visible, to be heard, to be safe, to thrive, to belong and to be happy; A nationwide outcry because the status quo is not good enough, we cannot afford to continue as we are, the health of our children is at stake and we need to address real issues, with real change that brings about real positive impact on the health outcomes for children and young people.” Professor Terence Stephenson, President, RCPCH. Contact details: Rebecca.Robson@rcpch.ac.uk Bharti.Mepani@rcpch.ac.uk


Notes

Annual Conference 2011, Warwick

Make sure you are part of next year’s conference when we will be in Glasgow on 22-25 May 2012. www.rcpch.ac.uk/conference2012 7


Notes

David Baum International Foundation On the evening of 30th June 2011, the David Baum International Foundation (DBIF) will be reinvigorating its fundraising work by hosting an event at the College to celebrate some of the projects it has funded. In addition to the launch of the new DBIF website and an exhibition of photographs from Tanzania by Angela Baum, the DBIF committee will be awarding the inaugural David Baum Prize to an outstanding young paediatrician based in a low-income country. The first recipient of this annual prize is Dr Bill Kigathi (pictured). He is a senior resident in the Department of Paediatrics at the University of Nairobi, Kenya and has been instrumental in the scale up of ETAT+ training in Kenya. ETAT (Emergency Triage Assessment and Treatment) is a course originally designed by the WHO that with the help of DBIF funds has been extended in scope (hence ETAT+) and disseminated widely throughout Kenya. 1 It is taught to a range of health care workers and at various different levels of hospitals from the national referral hospitals to district hospitals in all provinces in Kenya. 2 More recently in 2010, the course has also been conducted in two other East African Countries, Rwanda and Uganda, with good reception for its evidence based approach and relevance to their health care settings. The 5-day course is also offered at the University of Nairobi as an entry level course to all enrolled Paediatric Resident Trainees on a yearly basis. In addition to this 5-day course, a 3-day abbreviated course is offered to undergraduate medical students as part of their paediatric rotation at the University of Nairobi and to medical students at the University Teaching Hospital of Kigali in Rwanda (CHUK). Key to the success of this work has been its sustainability which has been achieved in part by the identification and training of the best course candidates in recurrent Generic Instructor Courses. In these courses, exceptional ETAT+ participants have been trained as ETAT+ Trainers with a specific focus in conducting sessions using adult learning techniques. Support to help maintain the quality of training and provide a sustained administrative base has in particular been provided by DBIF funds. Dr Kigathi has been instrumental in much of this activity, having acted as course director within the university. Professor Fred Were, Chair of the Kenya Paediatric Association, described him as a “young leader with tremendous potential [who] richly deserves the presentation”. Commenting on being awarded the David Baum Prize, Dr Kigathi said, “I am deeply awed and grateful for having been considered and selected to be the recipient of the Prize. I look forward to our meeting and the opportunity to shed more light on the current efforts being made to improve child health in Kenya.” 1

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Mike English, Annah Wamae, Rachel Nyamai, et al. Implementing locally appropriate guidelines and training to improve care of serious illness in Kenyan Hospitals: a story of scaling-up (and down and left and right). Arch Dis Child (2011). doi:10.1136/adc.2010.189126 Published January 10, 2011. ETAT+ Course – Where we have been. http://www.idoc-africa.org; (Accessed 26 April 2011.)

SSASG NEWS RCPCH SSASG Information Day. This popular meeting has run annually for many years. It has proved a successful forum for discussion of matters important to SSASG Paediatricians. It is encouraging to see how many more National and Regional SSASG Educational Meetings there now are and how well these are attended. The Joint Royal Colleges SAS Group now runs a two yearly Educational Conference. The next will take place on Friday 27th January 2012 at the Royal College of Physicians, London. The RCPCH SSASG Committee has opted to alternate our own SSASG Information Day with the JRC Conference and will be held at the end of 2012. We will continue to meet during the RCPCH Annual Conference in May 2012. RCPCH Annual Conference: Dr Carol Roberts Dr Carol Roberts, Deputy Chair of the SSASG Committee, chaired this year’s SSASG Update Meeting at Warwick. Below is Carol’s summary of the meeting: This year the SSASG Update Session welcomed Heather Currie who spoke on her experience of ‘Making the job work as a SSASG Leader’. Heather is an Associate Specialist in Obs and Gynae working in Dumfries, where she recently took on the role of Clinical Lead. It was refreshing to hear her talk unapologetically about her positive choice to remain a SSASG. To paraphrase, she encouraged us to enjoy the benefits, to specialise and not to view our roles as ‘second best’. There were also brief updates of relevance to SSASGs on Workforce Planning, ‘Facing the Future: Standards for Paediatric Services’ and Revalidation. We were delighted that three senior members of the college were able to join us and contribute to the discussion. Thanks to those of you who came along – please do let us know if you have ideas for future sessions. BMA SSASG Update: Dr Nicola Balch We often receive queries regarding SSASG Contracts and supervision etc. Dr Nicola Balch, BMA Rep. RCPCH SSASG Committee, helps to provide answers to these and other

BMA related topics. Nicola has written an update for SSASG News on current SSASG issues: New Contract Implementation continues to be variable across the UK. In Scotland and Wales it is almost complete; in England there are some areas where assimilation has been delayed and in Northern Ireland the process has been slow to start. Similarly, Regrading to Associate Specialist in some areas has been a protracted process and is not yet complete. Training and Development Funding Northern Irish and Scottish doctors are not yet able to access the same funding as their counterparts in England and Wales, but SAS National committees are working hard to overcome any obstacles in achieving parity. Heath and Social Care Bill A Special Representative Meeting (SRM) was held on 15th March 2011 where concerns were vigorously debated by all crafts including SAS doctors. Revalidation The General Medical Council has just released its latest guidance on preparing for revalidation and it is clear that Appraisal is likely to be the basis of the process. The BMA is aware that not all SAS doctors are currently having annual appraisal and this is an issue which must be addressed. The BMA website www.bma.org.uk has full information for members on: • New SAS Contract FAQs • Certificate of Eligibility for Specialist Registration (CESR) Guidance • Updated SASC Appraisal Guidance (Dec 2010) • Guidance for Work On Call (Feb 2011) • Development Funding FAQs (Feb 2011) DR JANE WILKINSON Chair RCPCH SSASG Committee


Notes

Citation for the James Spence Medal The College’s highest honour, the James Spence Medal, was presented to two paediatricians at this year’s Warwick meeting. Below are edited versions of the citations for the presentation. Professor Anthony Costello Anthony Costello is a world-renowned clinician and researcher whose career has been devoted to improving the survival of newborn infants in the world’s poorest communities.

Professor Costello began his career in clinical paediatrics, becoming FRCP in 1994 and FRCPCH in 1997. After a posting as Medical Officer in a remote hill area of Nepal in the mid-1980s, he joined the Department of Medical Microbiology at University College and Middlesex Hospitals to conduct research on tuberculosis. He moved to the Centre for International Child Health at the UCL Institute of Child Health as Senior Lecturer in 1990, where he was promoted to Reader in 1995 and Professor in 2001.

Almost everything about the trial was new: conducting a cluster trial in poor communities in a mountainous area; creating a surveillance system for vital events among women and children whose contact with health services was minimal; and implementing a programme of participatory research which drew on the interests and strengths of poor people in setting their own priorities and developing their own strategies for improvement. The findings were published in The Lancet in 2004, and showed that community women’s groups had led to a 30% reduction in neonatal mortality.

Professor Costello ran a series of studies in Kathmandu, in a collaboration with Professor Dharma Manandhar. This led to the foundation of Mother and Infant Research Activities (MIRA) which continues to the present. The early studies looked at the realities of neonatal care and outcomes in challenging circumstances, describing hypoglycaemia and hypothermia in infants born at Kathmandu’s public maternity hospital. This was followed by studies on the incidence and outcomes of neonatal encephalopathy in constrained settings which remain seminal in the literature.

Professor Costello’s two exceptional abilities are his capacity for bringing diverse disciplines together and to put together partnerships. The MIRA Makwanpur trial led to others in Bangladesh, India and Malawi. Each involved a different group of people, local activists and clinicians with an interest in improving child survival. The Perinatal Care Project was implemented across three huge districts in Bangladesh and included work on neonatal resuscitation with traditional birth attendants. The Ikjut project, worked with the tribal poorest in Jharkhand and Orissa States in India and achieved a 45% reduction in neonatal mortality. Both of these trials were recently published in The Lancet . The Maimwana project extends the community group approach to rural Malawi, and also involved lay breastfeeding counsellors in an effort to reduce mother-to-child transmission of HIV. The SNEHA community mobilisation project, led by Dr Armida Fernandez and Dr Wasundhara Joshi, extends the remit to urban slum communities in Mumbai. These diverse programmes cover a total population of about two million and have reached out to tens of thousands of young mothers in poor communities.

In 1998, enthused by the success of work with women’s groups in rural Bolivia, Professor Costello conceived and won funding for an ambitious cluster randomised controlled trial of community action to improve newborn survival in Nepal. Over the next few years, this initiative became the well known MIRA Makwanpur trial.

Two decades ago, Anthony Costello committed to an issue that underlay almost half of all global child mortality, and it is a testament to his creativity, charisma and tenacity that many developing country governments have now implemented strategies to improve the health of newborn infants.

Professor Andrew Wilkinson Andrew Wilkinson is Professor of Paediatrics at the University of Oxford and Director of Neonatal Medicine at the John Radcliffe Hospital. He is a leading international authority on neonatal medicine. After spending five years training in adult medicine, Professor Wilkinson took up a post in paediatric neurology and infectious diseases at Great Ormond Street Hospital in 1973. Thereafter, apart from a two-year Fellowship at the Cardiovascular Research Institute at the University of California in San Francisco, his career has centred on Oxford where he has held posts as Nuffield Medical Research Fellow, Clinical Lecturer in Paediatrics, Consultant Paediatrician, and Clinical Reader in Paediatrics, before becoming Professor of Paediatrics in 1997. He was elected a Fellow of All Souls College, Oxford in 1992, where his interests are registered as ‘clinical neurodevelopmental research, particularly in newborn babies’. He is also Knight, First Class of the Order of the White Rose of Finland for contributions to student teaching in that country. Under his direction, work in the Neonatal Unit, at the John Radcliffe Hospital in Oxford has shown the importance of prospective surveillance of perinatal infections and described the management of potential viral and bacterial epidemics and the use and misuse of antibiotics which laid foundations for modern therapeutic regimens. Notable scientific contributions were one of the first randomised controlled trials of artificial ventilation and of surfactant therapy in the UK, thus laying the foundation for many subsequent neonatal clinical trials.

Throughout Professor Wilkinson’s career in teaching and training, including the supervision of DPhil students and clinical trainees, he has disseminated clarity and expertise in research and clinical practice to many who have gone on to senior posts throughout the UK. Many of his research fellows now lead in centres across the globe. As well as over 150 peer reviewed publications and numerous chapters in leading obstetric and paediatric texts, Professor Wilkinson has chaired and authored 18 national working party reports leading to advancement in, for example, resuscitation, safe practical procedures and assessment of brain death in the newborn. He was co-author of the 1992 UK Guideline for the screening and treatment of Retinopathy of Prematurity. He then chaired, for the RCPCH, the joint BAPM/RCOphth revision in 2008 which has been published after international peer review. In addition to his own research, Professor Wilkinson has chaired the Steering and Data and Safety monitoring committees for a number of Multicentre RCTs and international advisory boards. From 2000 to 2003 he was chairman of the National Advisory Board of the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI, now CEMACH). He was independent external chair of the Welsh Assembly Government’s Children and Young Peoples Specialist Services ‘All Wales Standards for Neonatal Services’, launched by Minister of Health, Edwina Hart in December 2008, which has led to the reorganisation of neonatal services in Wales. As President of the British Association of Perinatal Medicine, 1999-2002, he was responsible for the publication of the ‘Standards for Hospitals Providing Neonatal Intensive and High Dependency Care’, on which the 2003 Department of Health review of Neonatal Care in England and 2010 Toolkit were based. In short, Professor Wilkinson has devoted his career to successfully raising the standards for the care of newborns internationally.

9


Notes

Alistair Thomson, Sarah Fellows

Following confirmation from the GMC and the Departments of Health in the UK, revalidation is set to commence at the end of 2012. The following article provides an update on key activities.

The RCPCH is reviewing is own revalidation guidance and standards in light of the GMC changes and a simplified version of the current guidance will be ready for July 2011, pending Council approval.

GMC launch revised ‘framework for appraisal and revalidation’ and ‘supporting information’ guidance

The College’s revalidation team continues to advise all paediatricians to maintain a portfolio of supporting information as listed above, to undertake annual appraisals with personal development planning and ensure job plans and job descriptions for their whole practice are up-to-date.

Following a consultation exercise last year and a significant period of discussion and stakeholder engagement, the GMC has revised and published its framework for appraisal and revalidation and accompanying supporting information guidance. The framework is still based on the principles set out in Good Medical Practice (GMP) but has been broadened to ensure it encompasses non-clinical as well as clinical practice. All doctors should consider how they meet core GMP attributes but doctors will not be expected to mechanistically map supporting information to the GMP attributes. There are six types of supporting information that all doctors (irrespective of role type) should provide and reflect on at their appraisal at least once in each five year cycle: 1. 2. 3. 4. 5.

Continuing professional development Quality improvement activity e.g. audit Significant events (if occurred) Feedback from colleagues Feedback from patients (where applicable to practice) 6. Review of any complaints and compliments Full framework and supporting information guidance are available at http://www.gmc-uk.org/doctors/ revalidation/revalidation_plans_and_ proposals.asp

NHS-UK get free training in Safeguarding: Maintaining & Updating Competences (MaUC) e-learning programme Are You Competent in Safeguarding Children? Child protection is an issue that none of us can avoid, whether we are a jobbing, front-line trainee, a general paediatrician dealing with whatever comes through the door, or a specialist with a narrow group of clients within a particular area of expertise. Given that as many as 1 in 10 children may suffer emotional abuse or neglect each year, with at least similar numbers experiencing physical or sexual abuse1, it is inevitable that some of our patients will be suffering, or at risk of suffering, significant harm. Recognising those children who are at risk and responding appropriately could make a crucial difference to the well-being and outcomes for an individual child. The aim of the RCPCH is that “children in the UK will be looked after by paediatricians who are the best trained and best supported in the world”. This applies equally to safeguarding

10

Revalidation – gearing up to 2012

GMC review of Continuing Professional Development (CPD) CPD is part of the requirements of revalidation but is also a separate component of the GMC standard setting processes. To ensure its CPD requirements and role are in keeping with changes in education and training and revalidation expectations, the GMC is undertaking a review of its own role in the CPD of doctors, while also considering its interaction with other professional bodies’ roles. The review includes a consultation exercise with individual doctors via a web survey, and review by a working group of key stakeholders including the Academy of Medical Royal Colleges. The College has responded to the web survey via its Officer for CPD and has links to the working group via the Academy of Medical Royal Colleges Directors of CPD sub group. Further information on the CPD review can be found at http://www.gmc-uk.org/ education/continuing_professional_ development/review.asp

children. As part of its overall strategy for supporting safeguarding, the College has developed an e-learning training programme for use by consultants and other career grade paediatricians. This training programme equates to Level 3 competences as described in the Intercollegiate document2. The aim of the Maintaining and Updating Competences (MaUC) online training programme is to enable paediatricians in the UK to develop and maintain up-to-date knowledge and skills in order to contribute safely and effectively to interagency working to safeguard, and promote the welfare of children and young people. It follows on from the Level 1 and 2 training programmes already developed by the College in association with e-Learning for Healthcare and the Advanced Life Support Group. The programme consists of seven on-line learning modules, each of which is designed to be done in your own time and takes about 20-30 minutes to complete (see list). The starting point is an introductory module which allows you to carry out a self-assessment exercise and develop your own learning plan. The subsequent optional modules are based on case studies geared towards the kinds of situations which general and specialist paediatricians might face.

England Revalidation Support Team (RST) pathfinder pilots closed March 2011 The first year of piloting of revalidation standards and processes came to an end on 31 March 2011 with over 3,000 doctors in over 57 separate sites having had a strengthened medical appraisal during the pilot. Interim findings from pilots are available but the full findings will be published in summer 2011. Dr Alistair Thomson (assisted by Dr Minoo Irani and Sarah Fellows) has sat has an observer on the South Central pilot. Feedback has been given to the Academy of Medical Royal Colleges on a number of topics, but particularly emphasising the major problems with the appraisal software. The overall findings of these pilots will feed into a second year of pilots. This second year will deliver pilots in two core projects: • The Medical Appraisal Framework (MAF), which supersedes the Strengthened Medical Appraisal and links closely to the GMC framework for appraisal and revalidation; and • Organisational Readiness (OR), which will prepare healthcare systems and designated bodies for their role in delivering revalidation The RST is currently recruiting to this further pilot round from the NHS and the independent healthcare sector. For further information on these pilots go to http://www.revalidationsupport.co.uk Queries from paediatricians about revalidation can be addressed to Dr Alistair Thomson (clinical lead for revalidation) or Sarah Fellows (staff lead for revalidation) at revalidation@rcpch.ac.uk

Case study Sessions: 1. Introduction: Keeping up-to-date with safeguarding 2. A new born baby with antenatal risk factors 3. A toddler with unexplained injuries 4. A disabled child with issues around neglect 5. A family with unexplained symptoms that may be fabricated or induced 6. An adolescent presenting with intoxication 7. A sudden unexpected death in infancy This programme is just one tool in a much wider array of local and national learning. The programme is freely available to consultants and career grade paediatricians in the UK. You can access the training through our partner e-LfH website: www.e-lfh.org.uk/projects/safeguarding Refs: 1. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet. 2009 Jan 3;373(9657):68-81. 2. RCPCH. Intercollegiate Safeguarding Children and Young People: roles and competences for healthcare staff. London: RCPCH; 2010.

JO LAWTON Education Projects Leader


Notes

Training Matters The onset of summer gives everyone a chance to (slightly) relax after the winter pressures but with rotas still short, admissions generally still rising and economic uncertainty beginning to bite, it might only be a brief respite. Education and training must still occur however and a number of issues were discussed at the Warwick meeting. SPIN (Special Interest Modules) These have previously been known as Special Study Modules and have had a name change to prevent confusion as to their purpose and role in training. It was increasingly recognised that many general paediatricians have special interests ranging from cardiology to dermatology. There previously has been no formal accreditation of these “special” skills. Special Interest Modules enable a curriculum for participants to follow to gain them, although there will be no formal testing. Participants can be Level 3 trainees or consultants, however, training is to occur locally which means trainees would not be allowed to move deanery to undertake them (unlike GRID training). This does mean not all modules will be available in all locations and the Trainees Committee will be working with the Training Committee to ensure equality of access can be maintained where possible. SPINs are being piloted at present (such as High Dependency Care and Endocrinology) but more modules will be present as time progresses.

STARCP A number of names have been floating around (previously ST7A) for the assessment of readiness to become a consultant which will take place during Level 3 training. Having staged two successful pilots (and validating the process for trainees and examiners) STARCP will commence in 2012. The timeline for those affected has previously been defined as is available on the college website. It will NOT be required of current ST7 trainees. The Trainees Committee have been heavily involved in the pricing structure which we feel must not dis-enfranchise those who live furthest away from the sole initial training centre in Croydon. There will be more information available on these developments in the summer. Other Issues The Trainees Committee have been active in raising concerns regarding equity of access to Out of Programme experience and guidelines regarding Maternity Leave. I hope by the time of print statements regarding these issues will be available on the Trainees Committee pages of the website.

A Trainees Committee guide to professional behaviour in the workplace will also be available. This piece of work has been produced in response to concerns about bullying (and how it is defined). We hope that it will provide a useful resource for all trainees regardless of year of training. You may have also noticed the website has received a new look. Please get in contact if you have any comments regarding its usability or function. I hope you have taken the time to read the trainees guide to the “Facing the Future” document and look forward to receiving comments (and concerns!). For any training queries you may have please email trainees.committee@rcpch.ac.uk Your regional representative may be found at www.deaneries.rcpch.ac.uk and will be able to assist with local issues. DR. DAMIEN ROLAND Chair of the RCPCH Trainees’ Committee

RCPCH Events Child Protection: from examination to court (previously known as Court Skills Course) This popular and successful course is developed and delivered by medical and legal experts who are trained and experienced in this complex and emotive area. Fee: £300 (RCPCH members) and £375 (non-RCPCH members) 24th October 2011 - 25th October 2011 Contact events@rcpch.ac.uk for more information

Paediatric Educators’ Programme The aim of the Paediatric Educators’ Programme (PEP) is to equip Paediatricians with the knowledge and skills required to deliver high quality training and education to health care professionals in Paediatrics and Child Health.

Annual Conference Make sure you're a part of the 2012 conference when we will be in Glasgow next year with an exciting new conference programme. 22nd May 2012 - 24th May 2012 Contact events@rcpch.ac.uk for more information

Fee: £450 3rd November 2011 - 4th November 2011 Contact events@rcpch.ac.uk for more information

11


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RCPCH Newsletter Summer 2011