NotesSPRING2011NEWSLETTER

The Safeguarding Children and YoungPeople e-learning project developedby the College in collaboration withe-Learning for Healthcare (e-LfH) wasselected as a finalist in three categoriesat the e-government awards held onJanuary 26th 2011.

Finalist under categories for ‘Learning& Skills’, ‘Sustainable, ‘green IT’ or‘carbon-efficient services’’ and‘Leadership & Professionalism’, theproject narrowly missed out on thenight, whilst another e-LfH project,Sexual and Reproductive Health (e-SRH) collected the award for the‘Learning & Skills’ category.

The event marked the seventh annualceremony of the e-Government NationalAwards. Covering national, localgovernment, NHS and the third sector,the Awards recognise initiatives that

enable UK businesses and citizens tointeract more effectively with the publicsector institutions that serve them.

This project was supported by theDepartment of Health (DH),Department of Children, Schools andFamilies (DCSF), the National LearningManagement System (NLMS) and anumber of leading organisations in thearea of Safeguarding.

The Clinical Lead for this work wasAndrea Goddard, consultantpaediatrician at Imperial College.

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Neonatal Life support Course in Gaza, Feb 2010 showing UK paediatricians, localinstructors, and participants from nurses and doctors

‘Safeguarding Children and YoungPeople’ e-learning project shortlistedat e-government awards event

RCPCHInternational:Clinical PracticeGuidelines inKenya

RCPCH Courses across the globe

Steve Allen and Tony Akobengrepresented RCPCH International onthis 5 day scoping visit to Nairobiin November.

The 2008-9 Kenya Demographicand Health Survey estimated under 5mortality to be 74/1000 live births – a farcry from the Millennium DevelopmentGoal 4 target of 32/1000 by 2015. TheDavid Baum International Foundationalready supports Emergency Triage andTraining + (ETAT+) training in Kenya asone of its flagship programmes. Thisnew initiative aims to build capacityin developing, implementing andevaluating paediatric Clinical PracticeGuidelines (CPGs) in Kenya. Researchhas identified that preventablechildhood deaths result from differencesin care across the country. This maybe addressed by implementation ofstandardised, locally-adapted CPGs.

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11RCPCH International: ClinicalPractice Guidelines in Kenya

‘Safeguarding Children and YoungPeople’ e-learning projectshortlisted at e-governmentawards event

22 Registrar’s Column

33College Update

44International Q&A

55Organisation Update

Media Update – Spring 2011

66Coming of Age: Training inAdolescent Health in the UK

88Get ready for the CPD Annual Audit

Children’s Food Campaign

2011 Annual Conference Chorusand Orchestra

99Clinical Champions to raiseawareness of brain tumoursymptoms in children

The Tony Jackson Prize essay

1100SSASG NEWS

RCPCH to run the NationalPaediatric Diabetes Audit

1111Training Matters

RCPCH Courses

CCooppyy ddeeaaddlliinnee ffoorr nneexxtt iissssuuee::1st May 2011

MMaannaaggiinngg eeddiittoorr:: Graham Sleight

EEddiittoorr:: Joanne Ball

EEmmaaiill:: newsletter@rcpch.ac.uk

EEddiittoorriiaall sseerrvviicceess:: Work Communicationswww.workcomms.com

PPuubblliisshheedd bbyy:: The Royal College of Paediatricsand Child Health, 5-11 TheobaldsRoad, London WC1X 8SH.Tel: 020 7092 6000 Fax: 020 7092 6001

WWeebbssiittee:: www.rcpch.ac.uk

EEmmaaiill:: enquiries@rcpch.ac.uk

The College is a registeredcharity: no. 1057744 andregistered in Scotland asSC038299

Networks, both clinical and strategic, arean important tool in the development ofhigh-quality services. By strategic networks,I mean something that addresses theplanning and development of services,usually across a large geographical area,and a number of providers. There are wellestablished examples, such as in neonatalcare, oncology etc, which are resourced,have strong clinical involvement andleadership and coordinate the delivery ofspecialist services.

As a College we are supportive of thisapproach, as it leads to more sensibleand effective use of resources, and drivesup standards. The approach is howeversomething that can support smaller andless technology dependent services, suchas children’s palliative care and as we have recently supported with the EnglishDepartment of Health, safeguarding. Over the next year, as we transition from the current arrangements, to the new landscape of GP Consortia ledcommissioning, we will be pressing forthis type of network (or sub nationalcommissioning) to be retained and used to support the new consortia as they grapple with the challenge ofcommissioning low volume and high costservices. Clinical networks can be part ofthese, but may also exist in other forms.Last year the Royal College of Surgeons,with our support and involvement,published suggestions for thedevelopment of clinical networks ingeneral paediatric surgery. Other clinicalnetworks already exist, both formal andmore informal. Many rely on a significantdegree of goodwill from those involved.They help to overcome some of thebarriers created by an increasinglycompetitive NHS system. With the adventof the concept of “Any Willing Provider”,in my view it is increasingly important towork in this way. As the clinical leaders ofservices for children, we should ensurethat we work across organisationalboundaries, to provide a coherent servicefor children and families, which makessense, and is not driven solely bycompetition. And in fact, it is often the

case, that this approach also makes sensefrom a business perspective. Trusts arecharged with delivering high quality andefficient services, and working in isolationrarely delivers this. As Paediatricians, weare too often reluctant to challenge – weneed to be more assertive in arguing forthe essential need for working acrossorganisations where it makes sense (andthis is usually the case for all but the mostcommon conditions or problems).

The other striking feature of this meetingwas the power of the contribution madeby parents. Parent participation isGovernment policy but leaving this aside,it makes sense (as of course does Childand Young Person Participation, which we continue to work on and published a guide to last year – Not Just a Phase).Parents are experts about their children,and mostly share a common interest withthe clinicians in getting things right for thechild. Where there is disagreement theproblem often lies in failure to understandthe issue from both perspectives.Sometimes there are complaints (with the most common root cause beingcommunication). The problem withcomplaints is they are adversarial – whatwe need is to encourage a culture thatmore routinely seeks participation fromparents, and acts on the results. If we hadimproved participation from parents, bothin strategic terms and in the more day-to-day issues, it is likely that services wouldbe designed in a more family appropriateway. Involving parents in networks andpolicy development is an important stepin achieving this. Importantly, with involvedparents, who are listened to, and take partin shaping services, are a huge ally inarguing for Children and their needs. OurPatient and Carers Advisory Committeeleads the College in this area, and inrecognition of the importance of parentparticipation, we have recently undertakenwork to strengthen their role and influencewithin our work.

DR DAVID VICKERSRegistrar

Registrar’sColumn

Notes

Recently I had the pleasure of taking part in an event onNetworks and Parent Participation in relation to Children’sPalliative Care organised as a consequence of the £30 millionallocated by Government in England to this area. What impressedme was firstly the enthusiasm of the clinicians present to developservices and networks in the field of practice and secondly thepowerful contribution made by parents.

The song says ‘What a difference a daymakes’ but what a difference a yearmakes and two years even more. In thespring newsletter for 2009 there was awonderful and heartening celebration of the College running the first clinicalexaminations for MRCPCH in Cairo. As I write, Egypt is immersed in violence.Our thoughts are with Dr Abla Al-Alfy,President of the Egyptian MedicalAssociation, and her colleagues who Iknow will be working hard, irrespectiveof the political backdrop, to bring thebest of care to Egyptian children.

In that same spring 2009 newsletter,Tony Waterston wrote a piece entitled‘Child health and the Gaza war: viewpoint’.In Gaza, two years seems to have madevery little difference. There seems to beno solution in sight and children in bothGaza and the West Bank, where theCollege does valuable work, continue tobe caught in both the metaphorical andliteral crossfire. Since becomingPresident I have visited both the WestBank and Egypt and I am immenselyproud of the work the College does therein conjunction with local paediatricians inimproving the training of child healthprofessionals through teaching andthrough high quality examinations.

The spring 2009 newsletter referred tothe European Working Time Directive.This is now a regulation rather than adirective and two winters have passedsince then with paediatricians puttingtheir shoulder to the wheel to ensure that children’s services continue todeliver despite many pressures. I ampleased to say that in our most recentsurvey in 2010, compliance of rotas hadimproved compared to our 2009 surveybut problems remain. Vacancies and out-of-programme activities account forabout a fifth of all middle grade posts.There is ongoing discussion aboutrenegotiating the European WorkingTime regulation but this is a huge piece

of EU wide legislation covering alloccupations and in truth I think the bestwe can hope for is a renegotiation of theSimap and Jaeger rulings which relate torest periods and out-of-hours activity.This would help considerably with theflexibility of rotas and if the BMA couldalso renegotiate the New Deal, whichmakes punitive financial penalties forTrusts that have even minor breaches ofjunior doctors’ contracts, then therewould be more room for manoeuvre.Given that the last attempt to reform the EWTD took 5 years and failed, it isunlikely that any new EU legislationwould be implemented into UKlegislation before 2016. Current UKHealth and Safety legislation suggeststhat the chief executive of a Trust inbreach of EWTD is potentially liable for a prison sentence. Therefore the allegednon-compliance in other EU countries,and the lack of EU sanctions, isinteresting but unhelpful. Junior doctorsare employed to both work and train andtherefore the EWTD applies to the wholeof their contract. Hence training timecannot be excluded other than ‘privatestudy time’.

Our College has been in the forefront ofarguing that excellent paediatricians canbe trained in 48 hours a week over 7 or 8years. However, it is increasingly difficultto provide a 24/7 service across all 218units which currently provide round theclock general paediatric and neonatalservices in the UK. With this newsletter,you will be receiving a hard copy of theservice standards document producedby the College entitled ‘Facing theFuture: Standards for Paediatric Services,December 2010’. I want to congratulateDavid Shortland and his colleagues inHealth Services at the College and alsothe College Council for the hard workwhich has been put into generating thesestandards. They are consensual as it is, ofcourse, impossible to find randomisedcontrol trials to substantiate these

standards. Nevertheless we have seenthe benefits when other colleges havecommitted themselves to qualitystandards. This gives them a tool tonegotiate with Trusts and withgovernment to argue for morespecialists. The argument againststandards is that not all College membersor their Trusts will meet them. However, it is only by committing ourselves to thestandards that we think are right forchildren in this country that we can drive up the quality of our services.

At College level we will continue to argue for more paediatricians to providethis service and in the following monthsyou will be receiving a sequel to thedocument accompanying this newsletterwhich sets out in more detail an optionappraisal for the future. Essentially, giventhe current numbers of trainees in a 48hour working week, it seems unlikely thatwe can continue to run 220 services 24/7.The subsequent document will discussoptions for service redesign – it hasalready been seen by Council and,because of the implications forworkforce planning, by other majorstakeholders and once the text has beenfinalised, all College members will receivea copy. The current political philosophyin England at least is not to have top-down reorganisation (although that isexactly what the Health and SocialReform Bill is). Scotland, Wales andNorthern Ireland continue to have a‘command’ system NHS. In all fournations, I hope that the very carefulthought that has gone into using ourvery detailed census data to provideoptions for a sustainable, quality, 24 hour nationwide service for childrenwill be helpful.

PROFESSOR TERENCE STEPHENSONPresident, Royal College of Paediatricsand Child Health

A message from Terence Stephenson

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Notes

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Could you begin by giving us a bit ofinformation about yourself and yourbackground? What do you do whenyou’re not at the College?I’m slightly unusual in that I think I’m the first member of College staff whoactually qualified as a doctor and trainedin paediatrics. I studied medicine atEdinburgh, obtained my MRCP (paeds) in 1996, and a DTM&H in 1997, and thenwent to work as a paediatrician in a ruralmission hospital in Kenya. After Kenya, Ileft clinical practice and worked at theHealthcare Commission (now CQC) andalso did a PhD in theology. I joined theCollege a year ago in the policydepartment, but immediately before thathad been the international director for aChristian charity. Most of my spare timeis taken up with my wife, three childrenand my local church.

When did you take on the job of Head of International Operations? What doesit involve?I began the post in January 2011. It’s anew role, and my remit is to oversee all of the international work of the Collegeunder the direction of the InternationalOfficer, Professor Steve Allen, and inassociation with the David BaumInternational Foundation (DBIF). Formany years, the College has been runninga range of excellent international projects,many of them funded by DBIF, but thesehave tended to take place in isolationfrom one another. I’ve been appointed toact as a focus for the international workand to bring international activitiestogether as part of a coherent strategy.I’ve also been charged with developingour international work and seeking out new opportunities for the College and its members.

What are the goals of the RCPCH’sinternational work? The goals of our international work arethe goals of the whole College, butplayed out on the world stage. One ofthe College’s core objectives is to “raise

the standard of medical care to children.”Hence, the ultimate goal of all of ourinternational work is similarly to improvethe standard of healthcare for childrenacross the globe. In practice, we do thisthrough a combination of sharing ourexperience and expertise with overseasdoctors and nurses in their homecountries, training overseas paediatrictrainees in the UK (the IPTS scheme),sending doctors to developing countriesto develop skills and experience in globalchild health, through contributing toservices (the VSO scheme) and of courseexamining doctors in other countries, forthe MRCPCH in particular. The ultimategoal of all of this is raising standards inchild healthcare.

Why should UK members contribute 2%of their membership fees to this work?Can’t it be self-sustaining?

Because of the nature of the College andits reputation, we are a global organisation.The fact that already almost 20% of ourmembers are from overseas is evidenceof that, and that proportion is likely toincrease. The question that faces us,then, is not so much whether we want tobe a global organisation, but what kindof global organisation we want to be. Theinternational levy enables us to shape ourglobal influence according to thepriorities as we perceive them.

In practice, that means responding to thehuge need across the world by doingwhat we can to raise the standards ofhealthcare for children through training,education and assessment. Often, thesmall amount of funds that are generatedby the levy are used to pump-primeprojects which once they havedemonstrated their efficacy, then go onto be self-sustaining financially.

How does the RCPCH’s internationalwork avoid the charge that it’sduplicating what other charities such asMédecins Sans Frontieres are doing?

This is a very important question and as

we develop and expand our internationalwork it is imperative that the Collegedoes remain focussed on what it does best: the training, education andassessment of paediatricians. That is theunique contribution that we can make.Our primary remit is less about servicedelivery overseas and more related toassisting in the raising of standardsthrough education and training. Ourexperience is that what other countrieswant from us is assistance in this area of developing post-graduate trainingprograms for their paediatricians. There is simply no-one else in the UKthat could do that with the same degreeof experience and knowledge as ourselves.

Where would you like the RCPCH’sinternational work to be in five years’time? How will you measure its success?

Our ultimate goal is to work withpartners to raise the standard ofpaediatric healthcare across the globe. In that sense, success should really onlybe measured in terms of lives saved andquality of life improved. In practice ofcourse, that is very difficult to do at leastin terms of attributing such benefitsdirectly to College activities. We can use a range of proxy measures to assessthe extent to which our programmes aredelivering the expected benefits. Morespecifically, my goal in five years time is that the College will have a well-developed, coherent and comprehensiveinternational strategy that is beingsuccessfully implemented. I expect thatwe will have expanded significantly therange of projects and programs,supported through internationalpartnerships, including running the exam in new countries and regions of theworld. I also expect that we will havemore effectively supported our membersin both pursuing their own internationalprojects and partnerships.

Notes

International

Q&ADr Justin Thacker is the new Head of International Operationsat the College. Graham Sleight asked him about his work.

We are now a few months into 2011 and last year the College was largelyfocussed on looking inwards, mainlygetting the staff structure right to takethe College forward. So, this year will beabout looking outwards so that we canwork towards building a betterorganisation.

We have three new Directors appointed:David Howley, Corporate Services, JuliaO’Sullivan, Education and Training andJacqueline Fitzgerald returns as the newDirector of Policy and Research. At thesame time Education and Training havecompleted their restructuring, theoutsourced facilities functions arenearing completion; we have a newinternational manager, Dr Justin Thacker;an adviser for taking forward examinationand assessment work, Graeme Muir; anew child protection post; Nick Libell,and a new brand. The new website is on target to be launched in the Spring.

The focus this year will be on our newMission, Vision and Values. We will drawup, with staff and Members, a three yearbusiness plan to which we will all work. Itwill concentrate on four areas –improving services to Members, generatingadditional income through fundraisingand 'marketing' our services, increasingour policy, research and education workand taking forward the commitmentmade in From Good to Great of buildingfresh opportunities for staff.

The aim – unashamedly – is to make thisthe finest Royal Medical College, wherepeople not only want to work, but towhich others look for best practiceacross all that we do.

It is the 15th anniversary of the College’s Royal Charter this year – agood opportunity on which to launch our fundraising and we’ve the promise ofan inspirational Annual Conference andthe chance to build upon some of thepolicy work that has been done in 2010.We are delighted that our Patron, HerRoyal Highness The Princess Royal willbe able to attend for part of this.

We aim to engage the CollegeMembership in all that we do and use your expertise to take the College forward.

DR CHRIS HANVEYCEO

Media Update – Spring 2011

OrganisationUpdate

The Times magazine featured theCollege’s President, TerenceStephenson, in their ‘Britain’s TopDocs’ supplement in mid-Novemberlast year. Other paediatric doctorsfeatured were Andrew Bush forrespiratory disease, Duncan Macrae for intensive care, Paul Veys at GOSHand Hamish Wallace for oncology.

In the same month, the President signeda joint letter with the RCP, FPH and UKCentre for Tobacco Control Studies,published in The Observer whichexpressed concerns at reports that ‘thegovernment is to water down plans toban tobacco displays in shops.’

Into December and Chris Hanvey had a letter published in the SocietyGuardian setting out the College’ssupport for early access to children’smental health services.

Another College letter was publishedin The Guardian – on the firstanniversary of the publication of theRCPCH joint statement calling on theGovernment to end the detention ofchildren. Signed by the Officer forChild Protection, Rosalyn Proops andother representatives of Royal Collegesit stated ‘We welcome Nick Clegg'spromise to release by Christmas atimetable for ending the detention ofchildren – and call on the governmentto bring this practice to an absoluteand final end as soon as possible.’

Also in December, Anne Milton, PublicHealth Minister, launched the new e-learning course on child protectionat the College. Children and YoungPeople Now magazine and the BMJreported on this event.

Just before the end of 2010, the BBCreported on an Archives of Disease inChildhood study that stated ‘alternativeremedies can be dangerous for childrenand can even prove fatal’. The studyfrom Australia was looked at by RCPCHMedicines spokesperson, William Van’tHoff and he was quoted on BBC online.

Flu cases rose in January and this wasthe first media opportunity of 2011.The College made a statement whichwas used in many news articles acrossthe UK – ‘we would encourage allchildren who are in an at risk group,such as reduced immunity, breathingdifficulties and diabetes – who havenot yet been vaccinated, to take upthe offer of the vaccination.’

Chris Hanvey wrote an opinion articlefor Children and Young People Now

about the challenges child health faces.

In mid January, the BMJ published apaper on breastfeeding that attracteda lot of media attention. Mary Fewtrellfrom the Institute of Child Health andher co-authors called for the nationalrecommendation to be changed in thelight of new evidence suggesting thatsolid food has a health benefit forbabies. The Department of Health saidthe Scientific Advisory Committee onNutrition was undertaking a review ofinfant feeding, and that any newresearch would be considered. TheCollege responded and was quoted inThe Times and BBC online stating that‘until there is a national consensusotherwise, we continue to recommendthe Department of Health's advice ofexclusive breastfeeding for the first 6months of life.'

In an attempt to increase mediacoverage in Scotland, Wales andNorthern Ireland, RCPCH Officer forScotland, Jim Beattie, was interviewedand quoted in the Daily Recordnewspaper on the back of a newgovernment campaign encouragingparents and children to be morehealthy and active.

The Health and Social Care Bill waspresented to Parliament toward theend of January and TerenceStephenson was quoted in Childrenand Young People Now magazineabout the proposed NHS reforms. Hewarned that measures in the Healthand Social Care Bill threaten jointworking:

"If you are a child with Down'ssyndrome or cerebral palsy, you needa lot of input from different people,"he explained. "You need paediatricians,physiotherapists, speech therapists,geneticists, and sometimes a children'sheart or glands specialist. At themoment you would get that all-in-onepackage, ideally from one healthcentre or hospital. The big concern isthat when you introduce competitionyou tend to get less collaboration, andit may be that children can't get thatjoined-up service."

To keep up-to-date with news articlesthat mention or quote the RCPCH, orto stay informed about what is goingon within paediatrics and child health,visit the website for a regularsummary of articles –www.rcpch.ac.uk/media

CLAIRE BRUNERTHead of Media Affairs

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Notes

Notes

Coming of Age: Training inAdolescent Health in the UK

‘Safeguarding Childrenand Young People’ e-learning projectshortlisted at e-government awards event

Cont from front cover...

The project is led by Dr Nyokabi Musila of theKEMRI-Wellcome Trust Research Programmeand the other key partners are Prof Fred Were,Kenya Paediatric Association and Dr FrancoiseCluzeau, NICE International. The scoping visitwas funded by a start-up grant from the UKInternational Health Links Funding Schemewith RCPCH International supporting TonyAkobeng’s involvement.

The timetable was busy with meetings withstakeholders and drafting of a Memorandum ofUnderstanding. Discussions centred on thechallenges and constraints on the use ofevidence to inform clinical practice in theKenyan setting. There is already much localexperience of adapting and implementingWHO guidelines. In addition, The Ministry ofMedical Services has recently launchedevidence-informed “Basic Paediatric Protocols”that were developed with support from theKEMRI-Wellcome Trust Research Programme.The highlight for the UK visitors was a tour ofthe paediatric unit at Mbagathi DistrictHospital in Nairobi. We saw first-hand thatimplementing ETAT+ guidelines improvedclinical care despite the challenges of largenumbers of sick children and very limitedresources. This demonstrated the potential ofCPGs to improve care even in very challengingclinical environments. The challenge now is topool the expertise of the UK and Kenyapartners to finalise and submit a proposal forfunding for a substantial training andimplementation programme.

A full report of the scoping visit is availablefrom justin.thacker@rcpch.ac.uk

RCPCH International: Clinical PracticeGuidelines in Kenya

Cont from front cover...

The e-learning project covers Levels 1, 2 and 3for Safeguarding (Level 3 for consultantdoctors and career grade paediatricians only)as described in the recently releasedIntercollegiate Document (available throughthe RCPCH website –http://www.rcpch.ac.uk/Education/Projects-and-Programmes/Safeguarding-Children-and-Young-People).

In order to access these e-learning sessions,please register at the e-LfH websitehttp://www.e-lfh.org.uk/projects/safeguarding/register.html

JO LAWTONEducation Projects Leader, Project Leader,Healthy Child Programme

jo.lawton@rcpch.ac.uk

As the new National Champion for theRCPCH Adolescent Health Programme(AHP) I was keen to find out what ourtrainees feel about treating youngpeople (aged 11-19). A survey ofpaediatric trainees in the North WestDeanery identified a lack of trainingand communication issues as themajor barriers to providingdevelopmentally appropriatehealthcare for young people. 45% ofthese trainees rated their currentadolescent healthcare training asminimal or non-existent.

The need for training echoes findingsin the recent Kennedy Report (2010).Kennedy described the “pockets ofexcellent practice” in children’s servicesas “islands in a sea of mediocrity, orworse”. In six of Kennedy’srecommendations the need fortraining is highlighted.

Young people are a significant andimportant group accessing primary,secondary and tertiary healthservices. Their particular health needs, confidentiality, appropriatecommunication and consultation skillsand attention to transition to adultservices haven’t always been wellserved within paediatric, adult orgeneral practice. A UNICEF survey ofyoung people (2007) ranked the UKas lowest out of 21 industrialisedcountries, having more health-compromising behaviours and ratingtheir own perception of health as low.However, the UK is beginning to catchup through strong national leadershipfrom the RCPCH Young Person’sHealth Special Interest Group(YPHSIG) which is activelyencouraging cultural change acrossthe NHS. To support this changetraining is required.

The AHP, launched in 2008, written byexperts, provides health professionals

with training in the knowledge, skillsand attitudes required to improve their care of young people. The AHPreceived positive feedback from the North West paediatric trainees,expressing comments such as: “very interesting way of learning and changing practice”; “good focus on current issues”; “very helpful in clinical practice and exampreparation”; “interactive”; “flexible,can do whenever I like”; “really helpsto improve my understanding”.Trainees felt that it should be part of mandatory training.

For adolescent health to developfurther in the UK more specific training is required. The RCPCH hasbeen working with YPHSIG not only to develop generic competences inadolescent health for all paediatrictrainees but also a Special StudyModule which is designed for generalpaediatric and community traineeswishing to gain additional expertise inthis area during their ST6-8 years. It ishoped that trainees undertaking thismodule will go on to provide strongleadership on young people’s healthissues in their consultant posts,encouraging better adolescentservices to be developed and remain a priority in the NHS. These initiativesin training are supported by thecontent of the AHP.

So finally, we must ask ourselves, “Istraining in adolescent health comingof age in the UK?” Through the AHPand the development of specifictraining we are making importantsteps in the right direction and with it the ability to overcome culturalbarriers in the NHS to better meetyoung people’s needs now and in the future.

DR HELENA GLEESONAHP National Champion

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Keynote speakers

Make sure you’re part of the 2011conference, when we return toWarwick University with aninspiring and exciting programmedesigned to interest everyone inpaediatrics and child health.

Keynote lectures

George Fredric StillMemorial Lecture (presented by Professor Lord Winston)

Personal practice sessions

Speciality groups

Hot-topics

Commercial exhibition

Networking

Register online: www.rcpch.ac.uk/conference-2011

DoctorJoy Lawn

ProfessorCatherine Law

Professor Roger Soll

Professor Lord Winston

Professor Howard Bauchner

Sir Michael Rawlins

Conference Highlights

RCPCH Annual ConferencePaediatrics and child health for the next 15 years

5-7 April 2011 Warwick University

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Notes

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The RCPCH annual CPD Audit will beginat the end of April. Approximately200 paediatricians who are on theCollege’s CPD Scheme will be selectedto participate – this represents 5 percent of our current CPD membership.Doctors will be asked to provideevidence to support their on-line CPDrecords for 2010. The College willaudit this documentation to validatethe CPD credits claimed in 2010.

The audit is one of the requirementson the College of the Ten Principles ofCPD agreed by the Academy of MedicalRoyal Colleges. Principle 8 requiresthat the College verifies that claimedactivities have been undertaken andthat therefore doctors must keepevidence of their CPD activities.Additionally, with the approach ofRevalidation, the RCPCH is nowimplementing Principle 10 whichrequires re-audit and endorsement ofthe annual statement in the case ofinadequate evidence. Members whodid not comply with the CPD auditlast year should be aware that theywill therefore be recalled for audit thisyear. Results of audit, including non-participation, will be recorded on theannual CPD certificate and will remainthere for 5 years. Non-participationmay also affect a doctor’s GoodStanding with the RCPCH.

All members are reminded that theyshould be keeping CPD recordswhich, as far as possible, demonstrateevidence of learning and attendance.Most members should be able to bothclaim and provide evidence for thefollowing during the previous 12 months:

• 40 Clinical CPD credits

• 25 External CPD credits

• 50 CPD credits overall

However, the interpretation of auditresults will depend upon an individualpaediatrician’s circumstances andprecise job plan, informed by the CPDGuidelines. For this reason, results aredisplayed on the annual certificate ina way which allows this interpretationbut does not provide a “pass/fail”grading. Full information onpaediatricians with specialcircumstances and 5 yearrequirements for CPD are included inthe CPD Guidelines.

The College has put together newresources to help those who areselected for audit. To find out moreinformation about the audit and whatyou are expected to do, please visitour CPD resources webpage.

Name Membership Type Admission Date Town

Dame Barbara Clayton Honorary Fellow 1963 SWANAGE

Dr Neil S Gordon Honorary Fellow 1966 WILMSLOW

Dr Peter Greenfield Honorary Fellow 1991 ROBERTSBRIDGE

Emeritus Professor I

Colin Normand Honorary Fellow 1969 WINCHESTER

Dr Christopher Henry Nourse Honorary Fellow 1968 IPSWICH

Dr Gillian Sleigh Senior Fellow 1981 OXFORD

Professor John

Conrad Waterlow Honorary Fellow 1978 LONDON

Children’s Food Campaign

Get ready for the CPD Annual AuditAttention all members, if you are on the College’s CPD Scheme you may be called for Audit.

The Children’s Food Campaign worksto improve children’s dietary healthand well-being by calling better foodand food education in schools, andprotection for children from junk foodmarketing. With childhood obesitylevels continuing to rise, we urge thegovernment and food companies totake steps to create a more positivefood environment in which children cangrow up. In recent years, our work hashelped to secure strong legislation toprotect children from productplacement of junk food in UK TVprogrammes and from junk food

advertising during children’s TV, toencourage major food manufacturersto reformulate their unhealthiestproducts and to persuade localcouncils to install water fountains inpublic parks. We are proud to besupported by the Royal College ofPaediatrics and Child Health and itsmembers. In the current challengingpolitical and economic climate we needyour support more now than ever. Toregister your individual support for thecampaign and receive monthly emailupdates, please sign up atwww.childrensfood.org.uk.

2011 Annual ConferenceChorus and Orchestra

DeathsThe College notes with sadness the deaths of the following members in late2010/early 2011.

This year the College Orchestra andChoir concert at our AnnualConference will be on Wednesday 6April. The concert will be just beforethe Annual Dinner allowing thoseattending the dinner to enjoy somesuperb amateur music beforehand. Ifyou are not celebrating at the dinnercome to us instead!

We will present both choral andinstrumental pieces with the final line-up to be announced at the Conference.As usual a retiring collection will be held for charities chosen by the performers.

Also, given the ‘scratch’ nature of theperformance, it is not too late foranyone keen to be involved eithersinging or playing to either registerinterest by e-mailing John Pettitt at theCollege (john.pettitt@rcpch.ac.uk) orby coming to one of the rehearsals thatwe will hold on Tuesday 5 April at theConference – details will be available atthe Conference. Every year we enjoymusic-making and raise money forcharity while we do it so this year why not get involved!

Notes

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Clinical Champions to raise awarenessof brain tumour symptoms in children

The Tony Jackson Prize essay

The Brain Pathways Team are thrilledthat 21 UK neuro oncology units haveprovided lead ‘Clinical Champions’ to be ambassadors for their raisingawareness campaign. Our new ClinicalChampions have agreed to submitsymptom interval data for auditpurposes to help measure the successof the Brain Pathways campaign.

The 'Brain Pathways: Promoting EarlierDiagnosis of Brain Tumours in Children'is a two year project, which aims toenhance the awareness of symptomsindicative of brain tumours to both thepublic and healthcare professionals.Children in the UK wait up to three timeslonger for diagnosis than children inCanada and the United States.

The Brain Pathways Team held theirfirst ‘Brain Pathways Working GroupMeeting’ in Bristol in January 2011. Thismeeting set the foundations foreffective collaboration to reduce thelength of time it takes to diagnose braintumours in children. The meeting wassuperbly attended by clinicians fromseveral neuro oncology units, andmanagers and policy leads from acrossthe country.

The meeting consisted of a number ofshort presentations by the BrainPathways Team on the importance ofsymptom interval data collection and

the value of the campaign. Dr PeterLachman, Consultant Paediatrician andHealth Foundation Fellow, delivered an interesting session on qualityimprovement. Jennifer Benjamin, Headof the National Awareness and EarlyDiagnosis Initiative, Cancer WaitingTimes and Informatics (Department of Health) delivered an informativepresentation explaining how the BrainPathways project fits with the newgovernment strategy, ‘ImprovingOutcomes: A strategy for Cancer’,published on the same day.

Symptom interval data collection hasalready begun and each of the neurooncology units will continue to provideselected data throughout the project.Standardized dissemination guidelineswill be available to each unit to helpdisseminate information and raiseawareness of the project amongst our colleagues in primary andsecondary care.

The Brain Pathways Campaign will belaunched in late May / early June 2011,consisting of a new website, symptomcards and an ongoing nationalpromotion. Baseline symptom intervalresults will be published prior to thecampaign launch.

If you would like to learn more aboutthis important project you’ll find the

team at the RCPCH Annual Conferencein April 2011. Professor David Walkerand Dr Sophie Wilne will be presentinga Personal Practice Session on the‘Diagnosis of Brain Tumours inChildren’ guidelines. We hope you canjoin us!

We wish to thank the neuro oncologyunits that have joined our campaignfor their enthusiasm and futuresupport. The Brain Pathways Projectsis a partnership between theUniversity of Nottingham, RoyalCollege of Paediatrics & Child Healthand the Samantha Dickson BrainTumour Trust, and sponsored byHealth Foundation.

For further information about theproject please visithttp://www.rcpch.ac.uk/Education/Projects-and-Programmes/BrainPathwaysProject

Contact Lucie Clough, ProjectManager for the Brain PathwaysProject lucie.clough@rcpch.ac.uk or020 7092 6156

For further information on symptominterval data collection or to volunteera Clinical Champion, please contact Dr Sophie Wilne onSophie.Wilne@nuh.nhs.uk

In the summer before my penultimateyear at medical school, I had theprivilege of working for 6 weeks in anorphanage in Addis Ababa calledAsco, involved in the medical andpastoral care of HIV positive children.On first impressions, the orphanageemanated a serenity and joyful energy.However as my time working thereprogressed, I was reminded of thetragic reality of these children’sexistence. Each child was not onlyorphaned but also confirmed HIV

positive – an orphan living withHIV/AIDS (OLHA). Up until 1995, adiagnosis of HIV for a child in Ethiopiaheld a poor prognosis. But the advent of ART (anti-retroviral therapy)dramatically increased survival.Orphanages like Asco now confronted new challenges in the care of these children.

Not only did they have to paymeticulous attention to the children’smedical needs; daily ART regimensrequiring strict adherence, blood test

monitoring and the treatment ofopportunistic infections. But carerswere also being forced to addressissues of emerging sexuality,disclosure, stigma and independentadulthood as the children grew up. Inaddition, these children had addedemotional vulnerability from beingorphaned. The experience thereforehighlighted a multifaceted set of needsamong these orphans but alsoprompted me to scrutinise orphanagesin caring for these children.

Every year, the College awards a prize in memory of Dr Tony Jackson, supported by agenerous bequest from his estate. The prize is for the best essay reflecting upon paediatric/child health practice in the UK or abroad. This year’s winner was Dr James Church, and an excerpt from his essay is published below. The full essay can be read online athttp://www.rcpch.ac.uk/Education/Fellowships--Prizes/The-Tony-Jackson-Memorial-Prize,where more details can also be found about the prize.

Notes

SSASG News

RCPCH to run the National Paediatric Diabetes Audit

SSASG Update Meeting, RCPCH AnnualConference, Warwick UniversityWednesday 6th April 2011, 1230 – 1400Following your online Survey feedback,the Keynote Presentation at this year’smeeting will be “SSASGs as LeadClinicians”. Registration for this Meetingand the College Conference is open nowon the RCPCH Website. We are lookingforward to seeing you there.

“Facing the Future – Standards forPaediatric Services”In my last SSASG News column, I hadmentioned the RCPCH “ServiceStandards” consultation which has beenongoing for some time. The College hasnow published, Dr David Shortland’sPaper “Facing the Future- Standards forPaediatric Services”.

The Introduction states:

“All children and young people ... shouldreceive high quality care, delivered bytrained and competent professionals in atimely manner and in appropriatesettings. The purpose of this document isto set out a series of service standardsthat will ensure that such excellentpaediatric care is provided”

Please take some time to read thisdocument as it contains importantguidance on which health professionalsshould be available in Acute PaediatricUnits to deliver care to children. The rolesof SSASG Paediatricians are discussed insome detail. It is available on the RCPCHwebsite – keywords “Facing the Future”.

Although this Paper deals with AcutePaediatric Units, College has started tolook at producing similar guidelines forthe care of children in the CommunityPaediatric setting. We would be veryinterested to hear your views on SSASGroles within both Acute and CommunityPaediatrics.

SSASG CareersThese are times of challenge and changewithin the UK Health Service. SSASGPaediatricians can provide a stable,experienced Paediatric workforce atmiddle and senior levels. With SeniorCollege Officers, the SSASG Committeeis looking at SSASG Paediatric roles andcareers and how these might bedeveloped for the future. We would bevery interested to hear your views onhow you see these roles developing.Please email me via Serean Williamson,SSASG Committee Administratorserean.williamson@rcpch.ac.uk

Joint Royal Colleges SAS GroupThe JRC SAS Group of SAS CommitteeChairs meets twice yearly. The Groupaims to provide education, careersupport and channels of communicationfor SSAS Doctors and to encourage themto participate fully in the activities oftheir respective Colleges. The Academyof Medical Royal Colleges is currentlygiving consideration to extendingaffiliation to the JRC SAS Group. Wehave agreed to share best practice andrun a biennial educational conference.The next Joint Royal Colleges SAS

Conference will take place on Friday27th January 2012 at the Royal Collegeof Physicians, London

SSASG Regional RepresentativeVacancies

Finally, can I draw your attention toRegions where we need SSASG RegionalRepresentatives.

MerseyNorth, North East and East ScotlandNorth East ThamesNorth West ThamesNorthernOxfordSouth WesternWest MidlandsWessex

If you live in any of these areas, pleasethink about becoming a RCPCH SSASGRepresentative for SSASG Paediatriciansin your area. SSASG Reps. sit on theirlocal RCPCH Regional Committees andattend the SSASG Committee annually.Contact serean.williamson@rcpch.ac.uk

DR JANE WILKINSONChair, RCPCH SSASG Committee

From May 2011, the paediatric component ofthe National Diabetes Audit (NDA) will movefrom the NHS Information Centre to the RoyalCollege of Paediatrics and Child Health. Thisprovides the RCPCH with an excitingopportunity to reinvigorate this high profilenational audit in collaboration with keyorganisations. We aim to build on theexperiences of the current joint adult andpaediatric NDA to improve clinician, public andpatient awareness and engagement in thenational diabetes audit programme. Our mainpriorities for the National Paediatric DiabetesAudit (NPDA) include the following:

• Use of innovative approaches to embed thecollection of routine audit data into the local,network and national quality improvementcycles as well as the research agenda todeliver real improvements in patient care.

• To consult and engage with clinicians tocollect a more clinically meaningful dataset

• To increase the unit and patient participationrate by using a regional network approach todata collection

• To support clinicians to develop local actionplans to use audit data to improve quality ofcare and patient outcomes

• To capture the patient experience via apatient reported experience measure

• To maximise the use and availability of datafor research

• To work with the suppliers of the adultdiabetes audit to capture information andoutcomes around the important time oftransition to adult care

• Timely and regular reporting combined withmore user-friendly tools which can be usedby various audiences to drill down torelevant findings on quality of diabetes care.

• Explore extending the audit to the rest ofthe UK

Key to success will be close working with therelevant organisations involved in the care ofchildren and young people with diabetes. Thisimportant three year project will therefore berun in close collaboration with the British

Society for Paediatric Endocrinology andDiabetes (BSPED), the Association of Children’sDiabetes Clinicians (ACDC), NHS Diabetes,Diabetes UK, Imperial College London, anumber of other stakeholder organisations,regional networks, children and young peoplewith diabetes and their families.

Over the next few months, we will becontacting units to update them on thechanges and what to do next. In the meantime,we are inviting all eligible paediatric services in the UK to register for updates by emailing:npda@rcpch.ac.uk. Everyone who registers will receive a copy of the project newsletter.

It is hoped that this project alongside otherinitiatives will contribute to the ongoingimprovement of care for children and youngpeople with diabetes and their families.

RITA RANMALClinical Standards, RCPCH

npda@rcpch.ac.uk

10

Notes

Standard 1 Every child who is admitted to apaediatric department with an acutemedical problem must be seen by apaediatrician on the middle grade orconsultant rota within 4 hours of admission.

Standard 2Every child who is admitted to apaediatric department with an acutemedical problem must be seen by aconsultant paediatrician (or equivalentstaff, speciality and associate specialistgrade doctor who is trained and assessedas competent in acute paediatric care)within the first twenty four hours.

Standard 6A paediatric consultant should bepresent in the hospital during times ofpeak activity.

Standard 8All general acute paediatric rotasshould be made up of at least 10 WTEs,all of whom must be WTD compliant.

The full set of standards can be foundat http://www.rcpch.ac.uk/Policy

Individuals and units will be mixed onwhether these standards are relevant

and useful for paediatrics. They certainlywill not be currently achieved in alldepartments (or otherwise they wouldbe redundant in improving the qualityof paediatric care) but their applicationif enforced and implemented willradically alter the configuration ofsome services. They do not implyresident consultant working for all, butwill require trainees to think carefullyabout the consultant role they wish toadopt and the type of workingenvironment they wish to be in. Theywould undoubtedly improve training byrequiring an appropriate number ortrainees on each rota and relevant (butnot overly protective) consultant cover.

As I have written before, Trainees mustreally “Face the Future” regardingreconfiguration and their futureconsultant path. Despite the grossshortage of trainees at middle gradelevel there remains an overall bulge oftrainees in the system compared tofuture consultant numbers. Without theoverhaul these standards necessitatethere will not be the type of job, orpotentially any job, for trainees tomove into. The Trainees’ Committeehopes to publish a short description of

this workforce dilemma by the timethis newsletter reaches you.

On other matters I hope everyone hashad a chance to digest the implicationsof the introduction of STARC(Previously ST7 Assessment)http://www.rcpch.ac.uk/Training/Assessment/Assessment-ST7A and thealteration in timings of the clinicalmembership exam for 2011. By the timethis article is published the WarwickMeeting will be upon us, and I hope toreport the findings of the NationalTrainees Meeting in the next bulletin.

As always feel free to contact me

Damian

DR. DAMIAN ROLANDChair of the RCPCH Trainees'Committee

Contacting the Trainees’ Committee

Please e-mailtrainees.committee@rcpch.ac.uk forany training queries you may have.Your regional representative may befound at www.deaneries.rcpch.ac.ukand will be able to assist with local issues.

Court Skills in Child ProtectionDate: 5 – 6 May 2011

Venue: RCPCH, London

Fee: £300 (RCPCH members) and£375 (non RCPCH members)

Court Skills in Child Protection isdeveloped for Consultants andtrainees. The course covers family andcriminal law in England and Wales,discussions with medical and legalexperts, and includes a mock exercisecoached by senior barristers.

Who should attend?Community Paediatrician, trainee or Consultant

Outline of the course1) Two day course delivered at the

RCPCH, London2) Report writing workshop on day one3) Court Skills group exercise on day

two (prep work required for exercise)

More details athttp://www.rcpch.ac.uk/Education/Events_and_Courses/RCPCH-Events

Paediatric EducatorsProgrammeDate: 3 – 4 November 2011

Venue: RCPCH, London

Fee: £450.00

The aim of the Paediatric Educator'sProgramme (PEP) is to equipPaediatricians with the knowledge andskills required to deliver high qualitytraining and education to health careprofessionals in Paediatrics and Child Health.

Outline of the course

1) Two day course delivered at the RCPCH, London

2) Two regionally based learning groupmeetings held about 6 and 12 weeksafter the core days.

More details athttp://www.rcpch.ac.uk/Education/Events_and_Courses/RCPCH-Events

The news over the New Year was awash with the terms “White Paper”, “GP Commissioning” and thepotential irrevocable damage they may cause to the NHS. But what did this all mean for paediatricTraining? The consultation “Liberating the NHS: developing the health care workforce” is just one partof the changes planned for the delivery of healthcare in England. It was not the easiest document fortrainees to engage with, something the Department of Health have acknowledged they will try toaddress in the future. It spoke mainly about how the future workforce will be managed and there wasvery little direct reference to education. However this does not mean that workforce planning has littlerelevance to training. In December the College produced a set of standards relevant to training andservice delivery. I reproduce some of these below for those who have not had a chance to read them.

RCPCH Courses

11

Notes

Training Matters

Encouraging the safe, effective and appropriate use of medicines wherever children are treated

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