Milestones - the magazine of the Royal College of Paediatrics and Child Health - winter 2023

I N S I DE

WINTER 202 3

The magazine of the Royal College of Paediatrics and Child Health

#ShiftTheDial RCPCH &Us members on climate anxiety Page 11

Applying Martha’s Rule in paediatrics Page 12

Therapy dogs: the impawtance of the MDT Page 22

Giving CYP the power to work for change Page 24

Contents

Winter 2023

Contact

23

We’d love to hear from you – get in touch at

14

13

milestones@ rcpch.ac.uk

THIS ISSUE

24 Powering Up A new initiative from the WHAM team

12 Martha's Rule The development and implications of Martha's Rule

13 Conflict management A new e-training programme to help prevent and manage conflict with families

27 Thoughts on retirement How one retired consultant is putting her skills to use

28 Find your power What empowers you?

14 Presidential election Statements from the five candidates for President

20 #ChoosePaediatrics at the Memcom Awards The campaign team reflect on its success

22 The impawtance of the MDT How therapy dog Henry is transforming experiences

27

23 Improving antimicrobial use

EVERY ISSUE 4 Update The latest from the President, news, opportunities and more

11 RCPCH &Us Climate anxiety explained

29 Wellbeing Dr Jess Morgan on the idea of psychological safety

30 Ash's baking school

A trainee's view on antimicrobial stewardship

Beat the winter blues with Ash's zesty orange polenta cake

Copyright of the Royal College of Paediatrics and Child Health. All rights reserved; no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical, photocopying, recording, or otherwise – without prior permission of the publishers. The views, opinions and policies expressed in Milestones do not necessarily reflect those of the College. While all reasonable efforts have been made to ensure the accuracy of the contents of this publication, no responsibility can be accepted for any error, inconsistency or omission. Products and services advertised in Milestones are also not recommended or endorsed by the College. Readers should exercise their own discretion and, where necessary, obtain appropriate independent advice about their suitability. Royal College of Paediatrics and Child Health is a registered charity in England and Wales (1057744) and in Scotland (SC038299).

Registered address: 5-11 Theobalds Road, Holborn, London WC1X 8SH. Design Manager: Christina Richmond Senior Editor: Lizzie Hufton Publisher: James Houston.

Milestones is published four times per year on behalf of the Royal College of Paediatrics and Child Health by James Pembroke Media, 90 Walcot Street, Bath, BA1 5BG. T: 01225 337777. Advertising: Alex Brown, Head of Corporate Partnerships advertising@rcpch.ac.uk

EDITORIAL Managing editor: Bintou Sy Editorial board: Dr Seb Gray @HLB27 Dr James Dearden

KEEP IN TOUCH

@drjamesdearden Dr Dita Aswani

@RCPCHTweets

@SebJGray Dr Hannah Baynes

@DrDita Dr Maddy Fogarty Hover

@RCPCH

@RCPCH

@I_am_spottacus

milestones@rcpch.ac.uk

Milestones WINTER 2023 3

The latest news and views

PRESIDENT’S UPDATE

W

elcome to the Winter edition of Milestones!

Where did the year go?

This edition of our College magazine is the perfect way to see out the year with Dr Camilla Kingdon the theme of Advocacy.

RCPCH President Advocating for child health @CamillaKingdon nationally and internationally is hardwired into our DNA as paediatricians. For some, it is about speaking up for the child and family you are seeing in clinic today. For others, advocacy is about shining a light on whole communities of children, be that children with disability, children with mental health concerns, children living in poverty and so on. All of us are advocates and honing that skill and finding our voices is part of growing and developing as a paediatrician wherever in the world we are working.

I trust that you will learn how the College is supporting you in your advocacy work as you flick through the pages of this edition. We are committed to amplifying your voices. In the UK this is going to be particularly important in 2024 as we prepare for a general election. Whatever your political persuasion, we want you to have the facts at your fingertips so you can think about how you can make the case for investment in a healthy childhood for all our children.

The final months of a year are always exciting for children – and most of us never lose that feeling! As the seasons change and the traditional religious festivals take place – as well as Halloween and Bonfire Night – there is much to be enjoyed. I think you will find that there is a lavish sprinkling of fairy dust in the pages of the Winter Milestones and I hope you have the time to enjoy reading it.

With my very best wishes to you all, and my thanks for all your hard work in 2023.

Camilla

4 WINTER 2023 Milestones

#ShiftTheDial on climate change THE 1987 Brundtland Report Our Common Future established the principles Dr Simon of sustainable Lenton development Co-Chair, as being British “development Association that fulfils for Child and the needs of Adolescent the present Public Health generation (BACAPH) without endangering the needs of future generations”. It stipulated that no environmental hazards, such as greenhouse gases, all forms of waste and pollution, coupled with the loss of natural resources and habitats, should be inherited by future generations – thus establishing the principle of intergenerational equity.

Many of these concerns have now come to fruition with an increasing frequency of fires, flooding, rising sea levels, species loss and droughts in some regions. They then all combine to have significant secondary impacts for human health by impacting food production, disease distribution and displaced person migration.

Climate change is not experienced equally with those populations being least responsible experiencing the greatest impacts. So too in rich nations, the impact of unsustainable development will

be experienced by those least responsible and with the least capacity to adapt. Children are particularly vulnerable, reflected in increased anxiety levels and their ability to influence decisions impacting their future lives.

It is essential for societal cohesion that climate change mitigation and adaption efforts benefit those most affected and least well-resourced in society and thereby contributing to the “levelling up” agenda to tackle increasing poverty and inequity that we see in the UK. With this in mind, RCPCH has produced a position statement and toolkit. The position statement outlines the evidence and the interactions between climate change and health inequalities. The statement calls for a Cabinet level Minister for children and a statutory obligation to undertake a child’s rights impact assessment in all future policies. The toolkit contains two tools, the first outlines how climate change impacts on child health and how paediatricians can help families. The second tool then takes a paediatrician’s role one step further on to how best to influence decision-making within their own organisations, with local integrated care partners and on occasions nationally to promote and protect the health of children and embed the concept of “today’s decisions for tomorrow’s children”.

Find out more at www.rcpch.ac.uk/ShifttheDialOnClimateChange

UPDATE

Invited Reviews – a new chapter A background to Invited Reviews Invited Reviews are RCPCH Project Manager, commissioned by Invited healthcare organisations Reviews requesting independent and objective expert advice on the clinical services they provide. Invited reviews provide this advice through reliable, trustworthy peer review processes, which support, but do not replace, existing procedures for managing performance of services.

In 2012, RCPCH Invited Reviews Service (IRS) was established as a quality assurance and improvement tool, utilising expert independent peer review to help assure patient safety, address issues of concern at the earliest opportunity, and help improve the quality of care in children and young people’s health services.

A number of other medical royal colleges also provide an invited review service, including the Royal College of Physicians, the Royal College of Anaesthetists, and the Royal College of Surgeons of England.

Sara Heverson

Moving forward During the COVID-19 pandemic, RCPCH IRS underwent several selfreflection activities, including an external service review and a revision of its processes.

In late 2022, the IRS began an exciting relaunch journey and in January 2023 the College introduced an improved service aimed at assisting healthcare organisations to take a proactive approach in seeking support to help ensure and improve the quality of healthcare provided for infants, children,

“In 2012, RCPCH Invited Reviews Service (IRS) was established as a quality assurance and improvement tool”

RCPCH FACTS

and young people. The relaunch of the IRS has been an extraordinary journey over the past 12 months, marked by significant achievements, including: Reworked processes to align with the Academy of Medical Royal Colleges’ ‘framework of operating principles for managing invited reviews within healthcare,’ and in response to recommendations following the external review of the IRS. Following an assessment of the previously available types of reviews offered being able to offer service reviews, case note reviews, or a blend to enable the terms of reference for the review to be addressed.

Successful training events for reviewers.

Completing several invited reviews and provision of constructive support to the healthcare organisations commissioning the reviews, including signposting where necessary.

Ongoing enhancement of IRS processes in parallel with the service’s growth.

Dr Mo Akindolie Consultant Paediatrician and Chair of the Invited Reviews Programme Board King’s College Hospital NHS Foundation Trust @MAkindolie

A message from Dr Mo Akindolie Chair of the Invited Reviews Programme Board “The Invited Review Service has undergone a transformative evolution in alignment with the changing landscape and context of Child Health Services.

We are delighted to offer a service which supports our colleagues in providing continually improving, high quality clinical care for the children and families they serve.”

If any members are interested in becoming a reviewer in the future, or would like to request a review, please contact the Invited Reviews team at invited.reviews@rcpch.ac.uk or visit www.rcpch.ac.uk/invitedreviews.

RCPCH &Us FOUNDED IN

2015 CHILDREN, YOUNG PEOPLE AND FAMILIES INVOLVED SINCE 2015

10,100

NUMBER OF CYP INVOLVED IN CLIMATE CHANGE IN LAST TWO YEARS

1,200

STATS FOR 2022-23 ACROSS THE UK

1,480+ HOURS VOLUNTEERED

1,080+

RCPCH &US VOLUNTEERS OVER

130 DIFFERENT SESSIONS

Milestones

WINTER 2023

5

UPDATE

PAFTA changes WE ARE OPENING regional winner submissions for the national Paediatric Awards For Training Achievements (PAFTA) 2024 round!

The annual national PAFTA recognise the very best in paediatric training in the UK and the College oversees the national PAFTA process to award: National Junior Trainee (ST 1-3), National Senior Trainee (ST 4-7) and National Educational Supervisor (ST8 trainees will be included in Senior Trainee category in the 2024 round).

We have made some improvements to our national PAFTA process. From 2024 onwards, we will ask four questions to the regions about their winners. The questions are available on our guidance on the College website – www.rcpch. ac.uk. The regions must support their application with evidence; however, each evidence can only be scored once even if it is cited in more than one domain. Any unexplained acronyms and technical language should not be included in the application as the children and young people are also included in the scoring process. Our scoring panels will not score any applications which include a lot of unexplained acronyms and technical words that are not age appropriate.

We have also introduced a new scoring system.

The scoring panels will score each entry using scores of 0 – 2 – 6 – 10 only for each question. Therefore, the maximum score achievable from each scorer will be 40. The application which receives the highest mean score will win the national award.

Banu Altay

RCPCH Awards and Committee Coordinator

Making EDI everyone’s business I HOPE THAT many of you will have had the time to look over the new Equality Diversity and Inclusion strategy, published at the end of September. The EDI team will be delighted to hear your views as we actively welcome engagement with our members on these important issues. One of the asks within the Dr Bhanu Williams strategy document is for members to please share Consultant details on protected characteristics with RCPCH: Paediatrician we use the data to ensure we are shaping and Member inclusive practices and have an understanding Trustee of the make-up of our membership. You can complete the diversity monitoring form by following the link from your RCPCH account.

One of the key pillars of the new EDI strategy is around support for paediatricians. There is a lot of work being done on differential attainment across all specialties by the medical royal colleges, the GMC and NHSE. Within trusts, the medical education departments should be able to signpost towards resources to support trainees and trainers. For international medical graduates (IMGs), Soft Landings continues to do brilliant work in this area, and I certainly try to signpost colleagues towards this fantastic resource. Please do ask your education departments what induction, mentoring, support and shadowing periods are being offered to new IMGs and try to promote the GMC’s Welcome to UK Practice Induction Workshop.

I am hoping to run a session for educational supervisors at the annual conference in March 2024, on effective support and supervision for doctors in postgraduate training who have experienced challenges due to neurodiversity. There is a lot of new work in this area, so please do come along if you can.

Finally, I’d like to thank the outgoing EDI trainee rep, Dr Segn Nedd, for all her expertise and energy, especially around the RCPCH reciprocal mentoring programme and to welcome her successor, Dr Amile Inusa.

6 WINTER 2023 Milestones

Award winners will receive: Reimbursement of travel and subsistence within UK to/from conference (adhering to RCPCH expenses policy) Two nights’ stay (a double room) at the conference hotel including breakfast Complimentary RCPCH Conference attendance (three days) If you are a Head of School or a regional Trainees Committee representative and would like to submit your winners for the national PAFTA process, you can submit your regional winners on our website from now until 31 December 2023 10:30am. The winners will be announced at the RCPCH Conference on 25-27 March 2024.

If you have any questions, you can contact the Committees Team at awards@rcpch.ac.uk.

Ride for their Lives We are riding for their lives at the 2024 RCPCH Annual Conference at Centenary Square, Birmingham

Mandy Goldstein Consultant Paediatrician at Birmingham Women’s and Children’s NHS Trust, retired

URBAN INFRASTRUCTURE in the UK needs to be changed urgently for individual and planetary wellbeing.

This ride is to promote cleaner air and safe, green spaces for the children who will inherit our earth.

At the 2023 Annual Conference, Dr Maria Neira, Director of Environment, Climate Change and Health at the WHO, reminded

us that as healthcare professionals, we are advocates and leaders, and that every action to mitigate climate change has a health benefit. At the same conference, Dr Heather Lambert described Ride for their Lives as an international initiative that uses cycling to inspire action on air pollution and the climate crisis.

So, on the Sunday preceding the 2024 Annual Conference there will be cohorts of cyclists who will meet a children’s ride (Kidical Mass, kidsonbike.org), culminating in an address in Birmingham’s Centenary Square by the RCPCH President. Join in or bring any children you can. It will gladden your heart.

Photo: Sebastian Peter

Photo: Calvox Periche

UPDATE

“A single, ordinary person still can make a difference – and single, ordinary people are doing precisely that every day.”

— Chris Bohjalian “A boy and his grandfather walking along a beach saw hundreds of starfish washed up by a storm. ‘I want to put them back into the sea,’ said the boy. ‘Don’t be silly,’ said his grandfather, ‘there are far too many.’ ‘But,’ the boy said, ‘if I can’t save all the starfish and save just one it will make a difference to that one.’”

Dreamflight DREAMFLIGHT is a charity that takes children with serious illness or disability to Florida on the holiday of a lifetime. Twelve regional groups from across the UK come together to give 192 VICs (Very Important Children) aged 8-14 the opportunity to discover something that medicine Dr Phil cannot offer: independence, confidence and a Parslow new perspective on life. Each group of 16 VICs is Consultant accompanied by a volunteer team of medical and Paediatrician; non-medical helpers.

Clinical Lead I am inspired and learn so much from the for Paediatrics children, which makes me a better doctor and a Dorset County Hospital NHS better human. As a paediatrician, I have given Foundation the devastating news that a child has a lifeTrust threatening illness like leukaemia, a lifelong condition such as diabetes or life-limiting disease such as Duchenne’s. I see children and their families at the lowest

point in their lives, when the disease is winning and hope seems crushed beneath the weight of medications, therapy and lost dreams.

On Dreamflight I get to see another side to this story. I see children living with their conditions rather than being ruled by them. I learn about medical conditions I had never heard of and learn from the VICs what it is to live with conditions that I only know from guidelines.

For many VICs, the most impactful part of the trip is realising they are not alone. They are not the odd one out in having a significant medical problem. They are one of 192 very important children carefully chosen for this wonderful opportunity. Here they are part of a family when no matter how much care you need, there is always someone that you can care for – a kind word, a helping hand or a smile. This is where lives change.

Volunteer applications and child nominations for Dreamflight 2024 are due to open in February. For more details see www.dreamflight.org

Milestones

WINTER 2023

7

UPDATE

History taking: playing no games IN MEDICAL SCHOOL, the mythical MDT was drummed into us as a critical piece of our practice. I think more time was spent on interdisciplinary working than on cardiac Dr Richard anatomy. Which worked for Daniels me, because I met a lovely Paediatric dietician, but unfortunately Registrar still don’t know what a vena (OOP) cava is.

Radish I think this subconsciously @DrRDaniels set me up for a career in paediatrics, where the MDT is critical, and especially one role unique to us. The iPad wielding, brightly uniformed, globally underappreciated play therapists, who I’d like to dedicate this column to.

Previously, we’ve discussed the UN Convention on the Rights of a Child, which outlines the importance of Play, but there was little thought to this as a priority when children were admitted to hospital. The earliest roles set up for this role were the “Lady Greens” at St Bart’s & St Thomas’ in London in the late 1950s – so called because of the colour of their tunics. It was noted that, unsurprisingly, children were happier when they were kept occupied with fun activities.

In 1963, the now defunct Brook Hospital in Greenwich co-created a Hospital Play Scheme with Save the Children – a model that was then rolled out across several other hospitals nationally. This led to a government commission in 1972, which recommended all children’s wards employed play staff. In 1975, a formal training course was set up, now under the purview of the Hospital Play Staff Education Trust and the founders established the National Association of Hospital Play Staff to promote the growth of the actions, embedding MDT thinking from its inception by including doctors, nurses and lay members.

The endpoint is the innovative, creative profession we work alongside today, who find myriad ways to make our patients’ experiences as positive as possible. Mainly by training them to hammer their medical team at FIFA. Allegedly.

8 WINTER 2023 Milestones

JOURNAL: ADC UPDATE YOU’RE PROBABLY all familiar with the “specialist papers go to specialist journals” and “specialist new research should be presented at subspeciality meetings” school of thought I wouldn’t want to speculate too much on the reasons this myth has perpetuated, but surely the time has come to debunk it. To bolster my argument, Nick Brown I would maintain that keeping “information” Archives of factionalised denies the wider paediatric community Disease in from assessing. Is there an element of deliberate Childhood mystique to maintain the sought-after erudition ?

Editor-in-Chief The corollary that all paediatricians are specialists by @ADC_BMJ nature and any territorial lines are, therefore, rather arbitrary seems tangibly tenable.

At Archives, I’d like to think (and here I think I do have some concrete proof) that we have crossed this imagined boundary and are into new territory. Check out the hot-off-the-press specialist pieces on immunology, predictive modelling, infectious disease, respiratory paediatrics, global child health and neurology. Season with the new ethics and law for clinical practice and garnish with some rich history manuscripts – and, there you have it – a journal for both specialists and generalists. In fact for everyone. And, to cap it all, sprinkle with the new e-page turning facility! Enjoy!

JOURNAL: BMJ PAEDIATRICS OPEN UPDATE NUCLEAR POWER is a topical issue, with some people saying it can be considered as renewable energy, whereas others consider it dangerous to people and the environment. Irrespective of one’s personal views, one should be aware of the possible health hazards to children and pregnant women in particular.

Imti A review of the topic (Radioactive releases from the Choonara nuclear power sector and implications for child health) Former BMJ highlights the problems associated with nuclear Paediatrics energy. Uranium mining usually occurs in areas Open Editor-inChief where there is widespread poverty. Poverty is a major @BMJ_PO contributor to ill health in both pregnant women and children. Increased rates of congenital anomalies and diseases in areas near to uranium mining are often attributed to poverty rather than to radioactive substances.

Similarly, disposal of radioactive waste is likely to occur in areas where indigenous rural communities live. Research in these communities is unfortunately uncommon.

UPDATE

Staff spotlight Yvonne Savage Curriculum and Quality Manager, Retired AFTER THREATENING to retire for many years the time is actually now upon me. It’s a strange time of life and decisions were very difficult for me to make. Progress and now Progress+ have been such a big part of my life for the past eight years that it’s hard to think about life without them. But I have seen the implementation through and that was always my greatest wish. I hope that in the future when it is really embedded that people will remember me with a certain fondness.

When I came to the College I had just been through a period of burnout and physical and mental breakdown. But I arrived in the College and immediately felt that I had been wrapped in a huge duvet and that I was safe. Working at the college restored my selfesteem and confidence and I will always be very appreciative of that.

The college staff and

“The college staff and clinicians that I have worked with have been amazing and for some I know I have made lifelong friends”

clinicians that I have worked with have been amazing and for some I know I have made lifelong friends. I never intended to stay this long but it’s been so fab and enjoyable I got to almost eight years.

I have done some very daft things for the College, like coming into work on the Tube looking like a stick of pink rock or perhaps a candy floss. Or wearing pink sashes about Progress+ at conference looking like someone on a very dodgy hen party. BUT, as they say, it is paediatrics.

For the development of Progress, I worked with over 200 clinicians and have loved (almost) every minute. I have travelled the country, visiting children’s hospitals and departments and gave up counting Progress drafts at over 800. I sometimes feel that I am an honorary paediatrician.

So, it’s time to say “Bye for now” but no doubt I will follow the exploits of RCPCH on social media and would love to stay in touch.

Milestones

WINTER 2023

9

UPDATE

Paws for thought

Find out why Henry the therapy dog is a key member of the multidisciplinary team

p22

Diary dates Listed below are some of the up and coming courses and events, which are online unless otherwise stated. We will add to this list over the coming months, so keep an eye on our website.

Effective Educational Supervision 06 December MRCPCH Applied Knowledge in Practice Exam Preparation – online workshop 06 December How to Manage: FASD in Community Paediatric Services 11 January Statement and Report Writing – England/Wales (Level 3) – online 17 January Asthma Masterclass 17 January

Read more Find more dates at www.rcpch.ac.uk/ courses www.rcpch.ac.uk/ events

LIVE WEBINARS RCPCH-BPSU Webinar: Vision Impairment is a Sentinel Child Health Event: Findings from the British Childhood Vision Impairment Study

How to Manage: Common Cardiac Problems 24 January

How to Manage: Paediatric Allergy Training (PAT 2) 21 March

How to Manage: Emotional and Behavioural Problems 07 February

Effective Educational Supervision 08 April

Effective Educational Supervision 13 February

Statement and Report Writing – England/Wales (Level 3) – online 15 May

Statement and Report Writing – England/Wales (Level 3) – online 06 March

How to Manage: Paediatric Allergy Training (PAT 3) London 19 June

How to Manage: Gastroenterology London 11 March

30 January

PODCASTS The Paeds Round: Episode 1 – Neonatal Herpes Simplex Virus Disease – THANKS (Think Hands And No Kisses) Shift the Dial on Climate Change and Health Inequalities – a Conversation How to Build a Paediatrician

Hear more Listen to RCPCH Podcasts wherever you get your podcasts

Become an

RCPCH Ambassador Support the College’s national influencing to improve outcomes for children and access resources to help you drive local change

Find out more and apply www.rcpch.ac.uk/get-involved/volunteering/ambassadors 10 WINTER 2023 Milestones

RCPCH &US

Making a difference Climate change and the impact on Children and Young People’s mental health

C

LIMATE CHANGE is a pressing topic that needs to be talked about more due to an increase in mental health concerns among children and young people.

Many of us are hearing about climate change news in places such as in the car via the radio or at home through the TV for short increments of time. The information we hear is enough to create worry as the messages coming through are mostly negative.

This then turns into anxiety, especially if we have long-term health conditions, as we think about how it will impact our physical health and life in the long term.

Climate change anxiety is a real fear for many of us and all adults and doctors need to recognise this.

Both topics need to be mentioned consistently and talked about otherwise they get swept under the rug.

Aishwarya, Aisling, Ali, Hamnah, Shreya and Toby RCPCH &Us Volunteers

WHAT CAN YOU DO TO HELP CHILDREN AND YOUNG PEOPLE? Ask us if this is something we are worried about. Bring it up at the end of our health appointments and ask if we

Children and young people feel the burden of climate change anxiety

have any worries surrounding it.

The NHS could also develop a youth friendly and accessible leaflet to give out to us with local and national mental health organisations that offer support and counselling and climate change projects we could get involved with to take positive action. Finally, you could share positive climate change news stories in your clinics,

maybe in waiting areas.

You can read more about what matters to children and young people about climate change in the new report, showcasing the views of 95,000 under 25s, called “Preserving the World for Future Generations”, available from www.rcpch.ac.uk/ resources/preserving-the-world-forfuture-generations.

ABOUT RCPCH &Us: The Children and Young People’s Engagement Team delivers projects and programmes across the UK to support patients, siblings, families and under 25s, and gives them a voice in shaping services, health policy and practice. RCPCH &Us is a network of young voices who work with the College, providing information and advice on children’s rights and engagement.

KEEP IN TOUCH

@RCPCH_and_Us

@rcpch_and_us

@RCPCHandUs

and_us@rcpch.ac.uk

Milestones

WINTER 2023

11

FEATURE

Martha’s Rule in paediatrics What is it and what could it mean for paediatricians and families?

M

ARTHA MILLS died in 2021 aged 13. She had been admitted to hospital with pancreatic trauma.

Martha’s parents Dr Jan Dudley Officer for were concerned that Clinical her condition was Standards deteriorating and queried & Quality the possibility of sepsis Improvement with staff, but transfer to RCPCH the paediatric intensive care unit did not occur in time to save her. The coroner ruled that Martha would probably have survived had she been transferred sooner.1 Martha’s Rule stipulates a right to request a clinical review: in the event of a suspected deterioration or serious concern, a patient on a hospital ward, or their family or carer, would have the right to call for a rapid review from an ICU/HDU doctor within the same hospital.2 The Rule includes three recommendations for health services and its regulators (see below).

Patient/carer-activated reviews in healthcare Escalation systems for patients and carers in acute settings are already in place in the US (Condition H[elp])3, Australia (Ryan’s Rule4, REACH, Call for Help and HearMe5) and the UK (Call 4 Concern [C4C]6), with some evidence that they contribute to improved outcomes for patients. In C4C, patients and relatives can call a hospital’s in-house Critical Care Outreach Team if concerned that their care team is not recognising a change in condition. Over a seven-year period, 534 calls to C4C were made, and in 20% of these calls, ‘significant’ interventions were required.2 In paediatric healthcare, a minority of units have access to paediatric intensive care (PICU) or high dependency units (HDU).

Implementing a rapid review by a PICU/ HDU clinician from within the same hospital in all paediatric units therefore presents stark

12 WINTER 2023 Milestones

challenges. A system based on ‘Ryan’s Rule nurse’ reviews4, either face to face or remotely, may be achievable. This would require investment in recruitment and appropriate training of personnel, especially in children’s nursing, which is not currently reflected in the NHS Long Term Workforce Plan. Such investment would be imperative to prevent diversion of limited existing resources with unintended consequences on service delivery.

It is crucial that children are cared for by health professionals with paediatric training and competence.

What can we do now?

In the words of Merope Mills, “we need open, honest, ‘us’ and ‘us’ discussions involving doctors, nurses and patients and their families and carers.”2 Concerns from families must be captured in healthcare. The new inpatient Paediatric Early Warning System (PEWS) now includes parental concern as part of an escalation plan7 but we need to go beyond this and integrate this principle of ‘taking families with us’ in clinical decision making.

We are pleased to be in discussion with Martha’s family and NHS colleagues to ‘shape’ patient/carer-activated escalation systems, which will be a positive intervention for patient safety. The Patient Safety Commissioner has made her recommendations to government, noting the different structures in paediatrics.8 We agree that careful planning is required and consideration should be given to a staged rollout, with evidence gained at each stage informing further implementation. We must also consider a whole UK, rather than Englandonly approach. The College will stand ready to engage its membership on the shaping and implementation of Martha’s Rule.

Martha’s Rule recommendations Recommendation 1: NHS England should develop best practice guidance so that hospitals can adopt this system as soon as possible.

Recommendation 2: Hospitals should adopt Martha’s Rule as a matter of urgency and communicate it clearly to patients.

Recommendation 3: The Care Quality Commission, that inspects hospitals, should consider Martha’s Rule standard practice in inspections, and include their implementation in inspections.

References: 1. www.judiciary.uk/prevention-offuture-death-reports/jonathanstevens-prevention-of-futuredeaths-report 2. Demos.co.uk/wp-content/ uploads/2023/08/Marthas-Rule_ finalversion.pdf 3. www.researchgate.net/ publication/45286582_ Successful_implementation_ of_a_family_and_patient_ activated_rapid_response_team_ in_and_adult_level_1_trauma_ center 4. Clinicalexcellence.qld.gov.au/ priority-areas/safety-and-quality/ ryans-rule 5. Bucknall T, Quinney R, Booth L, McKinney A, Subbe CP, Odell M. When patients (and families) raise the alarm: Patient and family activated rapid response as a safety strategy for hospitals.

Future Healthcare J. 2021 Nov;8(3):e609-e612. Doi: 10.7861/ fhj.2021-0134. PMID: 34888450; PMCID: PMC8651329.

6. www.fons.org/Resources/ Documents/Project%20Reports/ PFC4CFinalOct2010.pdf 7. rcpch.ac.uk/resources/paediatricearly-warning-system-england 8. www.patientsafetycommissioner. org.uk/wp-content/ uploads/2023/11/Correspondence -from-Patient-SafetyCommissioner-to-Secretary-ofState-for-Health-and-Social-CareOctober-2023.pdf

FEATURE

Conflict management Disagreements between healthcare professionals and patients’ families can be upsetting. Fiona Lynch has brought together key materials and resources to share best practice and learnings

A

S A SENIOR NURSE working in acute and specialist child healthcare settings, I have witnessed and managed conflict that has Fiona Lynch arisen between families CNO Senior Nurse Fellow and the healthcare teams.

Great Ormond This has left a lasting Street Hospital impact on me.

Over the past few years, there has been a perceived increase in disagreements between healthcare professionals (HCPs) and parents in the healthcare setting. A symptom of this has been several high-profile cases that have resulted in public scrutiny. Frequent, ‘low level’ episodes of conflict have also been reported in all areas of children and young people’s (CYP’s) healthcare, including primary, secondary and tertiary settings. Conflict is distressing for all involved: the team, the family and, on some occasions, the child. Conflict is seen to be inevitable in healthcare settings. Without appropriate and timely management, conflict can harm the staff, the healthcare setting, and, importantly, patients and their families (Lyons et al., 2021). Episodes of conflict, especially those requiring legal intervention for resolution, create a loss of trust between the family and HCPs, reputational damage, and significant financial costs.

There have been disputes between parents and HCPs where there has been abusive and threatening behaviour, death threats and service disruption. NHSE, the largest employer of people in England, is responsible for ensuring that employees work in a wellled environment with supportive and positive cultures (NHS Employers, 2022). It has a duty to keep staff safe, healthy, and well, both physically and psychologically (NHS, 2020).

The new platform should help to avoid conflict

Therefore, supporting the training, education, and wellbeing of those working in conflict situations is imperative.

I was fortunate to be awarded a CYP Chief Nursing Officer Fellowship to develop a repository of resources to support, educate and guide HCPs to recognise and manage conflict.

Building on the previous recommendations (Cass et al., 2020; Linney et al., 2019, Nuffield Council of Bioethics 2023), an e-platform of training resources, professional guidance, and signposting for family support was created.

Expert stakeholders representing nursing, medicine, psychology, charities, and parents have collaborated to curate content for this electronic repository. Medical Mediation Foundation (MMF) mediation experts have created a virtual training package for all HCPs. The programme provides training on the causes and impact of disputes, how to identify them, and strategies for managing conflict.

The e-platform Conflict Management: Understanding and Managing Conflict in Children’s Healthcare was launched at the RCPCH Conference in Glasgow. It is accessible to all UK health and social care workers. On the e-platform, you will find an interactive education programme delivered by MMF,

wellbeing resources, professional guidance, a framework for managing conflict and signposting for resources to support families.

This resource can minimise the risk of conflict in the first instance and provide support when disagreements happen.

The following steps for this work programme ensure that the e-platform is widely disseminated and, importantly, helpful.

NHSE has funded the appointment of seven regional Conflict Management Champions who will support embedding the e-platform and training program and being a source for advice and support. User feedback will be essential in evaluating and developing the e-platform.

I have thoroughly enjoyed leading this project, building on the work of the College, the national team, and those impacted by conflict.

I have learnt how to work collaboratively with stakeholders, navigate complexity in business planning and always look for a solution when meeting barriers. I now have added Tenacity to my middle name! I am so grateful to those who have worked on and supported this project.

They should be very proud of all that we have achieved, in developing this e-platform.

Find out more at www.e-lfh.org.uk

Milestones

WINTER 2023

13

PRESIDENTIAL CANDIDATES

Presidential Election 2023 Our President represents more than twenty thousand members in the UK and internationally. They work jointly with other senior leaders to shape policy and advance our mission by championing child health.

NOW IS THE TIME to cast your vote for the next College President.

Read manifestos from the five candidates standing in this year’s election. Next, login to our website to read their letters to children and young people and watch their election videos. Members can also read our frequently asked questions and learn more about the election process.

14 WINTER 2023 Milestones

Finally, cast your vote online via the voting platform until 11 December. Eligible members will have received an email from Civica Election Services on 30 October with instructions on how to vote. #RCPCHVote from 30 October to 11 December.

Visit our website for more information rcpch.ac.uk/membership/president-election

RCPCH’s president is a pivotal role for child health and paediatrician wellbeing.

I have the experience, enthusiasm and energy to pressurise Dr Simon Clark policymakers and fund holders into putting children’s services as a top priority for the UK’s four nations and those countries globally that RCPCH engages with.

I have had a period away from RCPCH duties, having finished as VP for policy two years ago. This has allowed me to observe the activities of RCPCH and its effectiveness. I believe that RCPCH needs to be better at ensuring children’s services are prioritised across the UK. This is essential as parts of the NHS management have had more redisorganisations forced on them by the various governments. Meanwhile there is a national paediatric early warning system in Scotland, but why is this not available across the UK? There is no difference in the physiology as you move over borders. Sadly, the waiting time for children needing behavioural reviews is incredibly long and many general paediatricians are having to become experts in mental health medicine, due to workforce crises in other areas. These are but two areas I would focus on if elected.

I would also promote to governments the concept of investment in child health and staff as the best way to decrease inequalities, improve long-term health, securing an adult population capable of working, paying taxes until retirement age and enjoying life along the way. This needs bespoke engagement for Northern Ireland, Scotland and Wales, where health is devolved, ensuring all are considered during policy development, focusing on workforce, training, engagement with civil servants and governments.

I was heavily involved in our UK pandemic response. Staff redeployment, physical space reductions and managerial/political decisions have adversely affected paediatricians and children. RCPCH worked tirelessly rectifying, publicising and promoting policies protecting children’s services.

This engagement and challenge must continue, protecting children and staff from direct and indirect harms in the post-pandemic, pre-next emergent threat.

I was RCPCH’s workforce officer.

I challenged workforce assumptions, increasing training and career grades. This must continue. RCPCH’s #ChoosePaediatrics campaign improved recruitment figures. However, there needs to be a massive increase in recruitment of doctors into paediatrics, to keep up with the changes in working patterns and in healthcare delivery. This includes more consultants and training grades, but especially staff, associate specialist and specialty doctor posts.

As when I sat on the RCPCH’s Staff, Associate Specialist and Specialty Doctor Committee, these key professionals are the stalwarts of many UK departments.

Health services depend on their staff.

Recent years have been challenging for many paediatricians. RCPCH must promote wellbeing across every career stage. We need to ensure that those with wisdom and experience are not hounded out of clinical practice by having to maintain acute on call until their last working day.

As a neonatal consultant in Sheffield, engaging in acute shifts, I understand the daily pressures we work under. I was the clinical lead for five years, achieving “Good” in all CQC domains.

I was Head of School for Paediatrics in Yorkshire and Humber, for five years, gaining valuable insights into the challenges and concerns of doctors in training. I managed 450 doctors in 23 training sites and created over 30 leadership secondments. I developed a six-monthly training rotation for

ST4/5s with Chogoria Hospital, Kenya, promoting RCPCH’s global health agenda. I have some concerns that Progress+ will not deliver the enhancement in training required.

This is mainly focused around staffing resilience of all units, but we must make sure that training truly prepares doctors for the reality of consultant level work.

RCPCH has scrutinised its equality, diversity and inclusion strategy. I will further promote this, ensuring every one of our members feels invited to lead and participate in RCPCH activities, making RCPCH an organisation truly reflecting our members and their interests.

RCPCH has reduced its carbon impact; but climate change is a real threat to the future of humanity. The pandemic demonstrated effective meetings can take place regardless of everyone’s locations. As president of RCPCH, I would aim for carbon neutrality as a minimum. Our leadership by example is crucial to winning over policymakers.

I would be keen to explore the need for maintaining a large building in central London. This would be with a view to reducing our carbon footprint and your membership fees.

I believe I can be the credible, strong voice for paediatricians and children, holding politicians, policymakers, and managers accountable, arguing for improvements in child health and staff wellbeing.

Milestones

WINTER 2023

PRESIDENTIAL CANDIDATES

DR SIMON CLARK

15

PRESIDENTIAL CANDIDATES

PROFESSOR STEVE TURNER Hello. I am really honoured and excited to be a candidate for our College’s presidency.

I am from Blackburn, Lancashire, went to medical school Professor Steve Turner in Newcastle, and did my paediatric training in North East England, New Zealand and Australia. I have been a general paediatrician in Aberdeen since 2003. I am also a respiratory paediatrician and have been a university professor since 2017 so have insight into subspecialty work and clinical research. My recent papers include systematic reviews of interventions which reduce emergency admissions and a description of a new model for delivering a paediatric outpatients service – relevant issues for many members. I have been your College Registrar since 2021 and was RCPCH Scottish Officer 2016-2021. I have hosted the clinical RCPCH exam since 2007. I am president of the Scottish Paediatric Society and Chair the Academy of Medical Royal Colleges and Faculties in Scotland. In the last few weeks, I have represented our College at meetings with two UK governments.

WHY DO I WANT TO BE YOUR PRESIDENT? I have worked with four presidents so have good insight into what the job involves. Whoever is appointed faces a number of challenges. Members across the UK are under huge pressures today – we have strikes, big workforce pressures and often cannot provide the service we want for our patients. The Lucy Letby verdict and Martha’s Rule are two examples of a bright spotlight currently shining on our specialty.

Our president needs to lead, inspire and enable change to the benefit of our members and patients. I believe I can do this. Our College has members across the nations of the British Isles and beyond,

16 WINTER 2023 Milestones

and as president I will be aware of the diversity of our membership. I have the experience, enthusiasm and track record of getting things done, and can lead our College through the next three years and pass on the baton to the next president.

So, what would I do as president? Our College represents both paediatricians and children, and our president is a champion for members and our patients.

As your president I will: 1. Use my energy, communication and teamworking skills, and my clinical, research and influencing experience to help paediatricians and children in the UK and overseas.

2. Work with the College team, including officers, staff, members and our young person’s group. I have been a College officer for seven years. I have written a Viewpoint article about how the College works (“Being involved”). I have strong relationships with current officers and staff.

I understand the College’s role alongside other organisations such as NHS, GMC, BMA and Academy of Medical Royal Colleges. I can hit the ground sprinting!

3. Prioritise supporting the paediatric workforce. Through my work with the Invited Reviews team I know the challenges faced by members across the UK. As Scottish Officer I saw how workforce data can be used to successfully argue the case for an increase in number of trainees. In addition to supporting the workforce through an evidencebase, I will promote programmes such as Stepping Up and Thrive.

The College’s “Facing the Future” document will be updated soon and gives us a chance to ask what is the role of the paediatrician or consultant in today’s NHS? And how do we change practice?

4. I will listen to members and my actions will be based on what I hear. I have been heavily involved in creating

the College membership strategy; this will be launched shortly and will put the College in an ever-stronger listening position. As Registrar I hear the experiences and wisdom of members, e.g. English Area Officers and on committees. You and I are among the College’s 22,000 members and I would like to hear even more voices. A healthy membership organisation such as ours welcomes feedback and challenge from its members. I want to hear from our 4,000 international members and our SAS members (projected to be the largest proportion of our members by 2030). I hope to continue harnessing the expertise and wisdom of our senior members by listening to them.

So for these reasons I believe I am a worthy candidate to be your president and a champion for paediatricians and children. Thanks to my wife, family and all the colleagues in Aberdeen and across the UK who have supported me in this nomination. Finally, thanks to you for taking time to read this (and the other candidates’ statements).

If it is true ‘there can be no keener revelation of a society’s soul than the way it treats its children’, then we in the UK have much to do.

The children Dr Mike McKean and young people (CYP) we serve face unprecedented challenges with climatechange, the pandemic, cost-of-living crisis, polarisation of political ideologies, wars, and the disconnect between the UK and Europe. As the UK has tried to navigate these turbulent times, I believe it has ‘taken its eye off the ball’ when it comes to our most precious members of society: our children. At times, UK policy displays a flagrant disregard for children’s safety and wellbeing. There are now over 4.5 million children living in poverty in the UK – this is a national disgrace. The increasing numbers of children suffering serious mental health issues and poor access to sometimes basic healthcare are crises which cannot be ignored. Add to this, recent devastating deaths of children in hospital where either staff, CYP and parent/ carers have not felt listened to and it is clear this cannot be allowed to continue.

If elected, I will strengthen our common purpose: to improve the lives of all CYP, whether suffering minor, serious, short, or long-term illnesses, no matter their background. Why is this so important? The simple truth is that a healthy child is more likely to be a healthy adult, something forgotten by many national leaders. As President I will be relentless in reminding them of this fact.

I will champion crucial issues for child health: our trainees and workforce; compassionate leadership; the voice of CYP (focusing on co-production, access, and rights); partnerships across health, education, and social care (focusing on prevention and mental health); and increasing child health research that

seeks out innovations that will shape our future.

Crucially, we must strengthen our workforce across hospital services for neonatal and intensive care, general and subspecialty paediatrics, and the too often forgotten community services, where waiting times for community paediatric and therapy services are so far behind those for adults. We can do this together with more focus on out of hospital care and integration of services particularly for children with complex care needs.

Under our current President, the College has worked tirelessly to champion equality and diversity, and creating a focus on health inequalities and climate change. If elected, I will strengthen and embed these workstreams in all we do.

WHY CHOOSE ME? I HAVE BEEN FORTUNATE TO EXPERIENCE A BREADTH OF LEADERSHIP ROLES. • As RCPCH UK Vice President for Policy since 2022 I have: 1. led our contribution to national policies and programmes.

2. worked with national media to raise the profile of children’s health.

3. supported key portfolios, including safeguarding, health inequalities, mental health, and policy programmes across the four UK nations.

• As senior advisor for NHSE Northeast and Yorkshire, I shaped strategic and operational programmes across children’s long-term conditions and elective recovery. I know how the levers in systems operate, what success looks like but also how children’s voices are drowned out by adult need.

• I established and led the first integrated care Child Health and Wellbeing Network for the Northeast and North Cumbria and centred CYP’s voices within it. The network connects statutory, voluntary and community

services to tackle the malign effects of poverty on child health and wellbeing so prevalent in my region.

• As a respiratory paediatrician for 21 years, I developed leadership through teamwork and training as Training Programme Director.

• For seven years, as clinical director of the Great North Children’s Hospital, I supported clinical teams working under tremendous pressures, including the pandemic challenges.

• I am especially proud of establishing the Great North Children’s Research Community, our GNCH Foundation and running the Great North Run for them 13 times.

These experiences have deepened my commitment to compassionate leadership and to governance that includes, listens, and empowers.

I am proud to have three wonderful daughters who, as they explore this uncertain world, teach me so much. My chief mentor, my partner Cristina, as a professor of child speech-and-language therapy, continues to open my eyes to what is possible for children.

Paediatricians are committed, compassionate, tenacious and talented.

We have resources ready to galvanise our trainees and workforce. These include expert clinical teachers, networks of paediatric leaders, RCPCH &Us engagement, growing reach into research institutions, and strengthened links with partner organisations.

With your support, I will harness these resources to strengthen our community, our voice and the voice of the CYP we serve to address the challenges they face.

Milestones

WINTER 2023

PRESIDENTIAL CANDIDATES

DR MIKE MCKEAN

17

PRESIDENTIAL CANDIDATES

DR JAN DUDLEY UNITED WE STAND. These are challenging times.

Limited resources, NHS strikes, Brexit, high profile legal cases and rising parental Dr Jan Dudley expectations impact our time, clinical support services and research infrastructure. The climate crisis, COVID-19, obesity, vaping, air pollution and childhood poverty (30% of UK children) is our current landscape.

• It has never been more important to work effectively, efficiently, and collaboratively to improve outcomes for the children and young people that we serve.

We have a ‘battered’ workforce.

• Deteriorating working conditions and inadequate pay have led to early retirements. Competent trainees are looking elsewhere for their skills to be valued.

• Staff vacancies (especially consultant, staff grade and associate specialist), rising demand (consider the impact of the exponential increase in autism and ADHD diagnoses on Community child health services) and long waits are added stresses causing exhaustion and, ultimately, fragility.

• International medical graduates (IMG) struggle to navigate a new culture and access necessary support to secure training posts.

• We can do more to integrate IMG into our teams.

• Conflict between parents / carers and paediatricians damages relationships, consumes resources and impacts our resilience further.

• In this climate we need a greater spotlight on strategies to pre-empt and mitigate disagreement between parents / carers and paediatricians and support colleagues in dealing with these situations.

• We can do more to promote a culture of physical and psychological safety

18 WINTER 2023 Milestones

through embedding shared decision making in training and practice.

• We can do more to support each other through implementation of mediation frameworks.

Academia is under threat.

• Few consultant paediatricians have recognised time in job plans for research.

• There is a year-on-year decline in clinical academic numbers as substantially fewer younger clinical academics replace those retiring.

The health of children and young people is an afterthought.

• The aftermath of the phrase ‘children are not small adults’ has too often seen children and young people (CYP) omitted from policies, guidelines, trials, quality improvement and quality of life studies, with lack of access to medications, medical devices, and appropriate standards for care. This portends poorer outcomes for CYP. • Avoidable childhood mortality is almost the highest in Western Europe.

• The Government’s Major Conditions Strategy does not set out clear plans for the health of our children.

• Our college is leading the campaign to appoint a UK minister for CYP. The patient journey is fragmented.

• Ongoing segregation between primary and secondary healthcare systems can delay diagnosis leading to poorer outcomes for CYP. The adolescent faces a ‘precipice’ at 18.

Too many adolescents ‘lose their way’ following transfer to adult services.

Transition is too often considered a niche area, rather than everyone’s responsibility.

If given the privilege to serve as President, I would: 1. Progress the campaign for the UK Government to adopt a ‘conception to cremation’ approach, to include child health in all policy development.

2. Promote closer relations between primary

and secondary care, and support inclusion of communications’ initiatives (e.g., NHSE advice and guidance) within job plans.

3. Sustain the College voice in highlighting the climate emergency.

4. Strive to ensure that the voice of paediatricians is heard at every level in the College.

5. Support paediatricians to develop and share national resources, including audit, guidelines and information, to reduce inefficiencies and unwarranted variations in care.

6. Embed shared decision making and consolidate safety and quality in training and practice.

7. Work with colleagues through College Speciality Advisory Committees to promote protected research time in job plans and explore linkage of paediatricadult academic hubs.

8. Explore a ‘mediation framework’ to support paediatricians experiencing disagreements in the workplace.

About me: • I am a consultant paediatric nephrologist of 21 years. I care for children and young people with life-threatening and lifelimiting conditions from before birth to 18, care that cuts across all areas of paediatrics.

• I have / had leadership and advisory roles in RCPCH (officer), NICE (committee chair), NHS Blood and Transplant (chair), Care Quality Commission (advisor), Parliamentary Health Services Ombudsman (advisor), British Association for Paediatric Nephrology (president), UK Kidney Association (vice president). I have navigated key issues with national policymakers, taking ‘stakeholders’ with me.

• I have led on RCPCH initiatives for nine out of the last 14 years and represent the College in many national workstreams.

• I mentor, support and galvanise colleagues and trainees locally and nationally.

We are a cohesive, innovative, collaborative community. Together we can be heard, and effect change for the better.

LEADERSHIP IS ABOUT CREATING AN ENVIRONMENT WHERE EVERYBODY AROUND YOU CAN THRIVE So said Bob Klaber Dr Jonathan Darling in his inspirational plenary talk at this year’s annual conference (watch it on the RCPCH website). He made a compelling case for us all to embrace a different kind of leadership, for a new emphasis on the relational approach, alongside the rational.

This is the kind of leadership our College continues to need. This is the kind of leadership I would bring.

Such leadership is not a soft, ‘anything goes’ approach. It is strong, courageous and determined. It does not shirk difficult conversations yet by acknowledging and embracing the relational, it more effectively delivers sustainable solutions and change.

CHALLENGES AHEAD FOR RCPCH A. Areas within our control: • The College must listen more intently to its members, in order to be the College we need (both UK and international). This should include a programme of regional visits by the president, senior officers and staff. Our aim should be to co-create a ‘redefined’ College with higher member engagement irrespective of career stage, delivering even better services for all membership groups.

• Our international strategy is part of this challenge. We have increasing international membership, and a raft of other international activities including exams. We need a more coherent international strategy to maximise impact, to clarify what we do (and don’t do) and make best use of resources and expertise. All our members should feel engaged and proud to be part of the RCPCH.

• We need to ensure that Progress+ beds in and really supports the delivery of flexible and bespoke training for each individual.

B. Areas where we have influence: • The most pressing area is our workforce. Rota gaps erode morale and need addressing. With the predicted demographic shift to an ‘older’ population, the College must persuasively advocate for the provision of an appropriate workforce to deliver optimal child health services. We need to change the workplace environment so that everyone in the child health workforce can thrive throughout our careers.

Our ‘Thrive: Paediatrics’ programme is an important beginning. Pay is not part of the College’s remit, but we must use our influence for a positive resolution on industrial action.

• We must work to eradicate racism and discrimination in our health services. Each of us can be an ally. We need to provide bystander training to equip us to speak out. We must build on our work in equality, diversity and inclusion. I am proud that RCPCH is a leader among medical Colleges in this area.

• We are similarly (and appropriately) leading in work on climate change. For renewed impetus, look up Ben Okri’s poem “Earth cries”. He reminds us that this ‘is what we are called to do.

That’s our destiny in these times’. He makes the familiar data a powerful cry.

• The College plays a vital role in advocacy for our most vulnerable children. Health inequalities and poverty are increasing, with disastrous impact on child health. Obesity and mental health issues are increasing.

We need to press for change and preventative approaches.

WHY ME? • Born in India to Northern Irish parents, brought up in Lancashire,

now in Yorkshire: Proud of each part of my heritage. Training: Manchester/ Oxford/London/Melbourne/Leeds.

• Consultant general paediatrician in Leeds (25 years) – I understand frontline challenges.

• Clinical Associate Professor in Paediatrics and Child Health/Medical Education, Chair of Health and Conduct Committee (University of Leeds) – I have relevant expertise.

• Director of Student Support Leeds School of Medicine 2017-2022 – I know the importance of wellbeing and support.

• Designated Doctor for Safeguarding Children (eight years) – Paediatricians sometimes carry heavy burdens – we need leaders who understand.

• International perspective through two years international child health research (one in Tanzania), and six months in ambulatory/ community paediatrics in Australia.

• Medical educator. Scholarship on standard setting, and voice of the child in assessment; co-author “Lecture Notes: Paediatrics”; previously Convenor of PEdSIG (Paediatric Educators’ Special Interest Group).

• Research – on leadership teams for: Clean Air in schools trial; My First 1000 Days; new CHORAL £5m research platform (Child Health Outcomes Research At Leeds).

• RCPCH Vice President (from 2021) for Education and Professional Development – my brief covers many key areas of College work, from recruitment, to workforce, to education, CPD and Conference.

PRESIDENTIAL CANDIDATES

DR JONATHAN DARLING

A common feature of many of my key roles is that I am trusted to provide compassionate leadership in complex situations.

I would be honoured if you would consider me for RCPCH president. Let’s together create an environment where everybody working in paediatrics and child health can thrive.

Milestones

WINTER 2023

19

FEATURE

Excellence award for #ChoosePaediatrics campaign In October, RCPCH was presented with the Memcom Excellence Award for Best Engagement or Recruitment Strategy at a ceremony in London

I

T IS A GREAT HONOUR to be involved in the #ChoosePaediatrics programme and to see it deservedly win the Memcom Dr Simon Broughton Excellence award for RCPCH Officer Best Engagement or for Recruitment Recruitment Strategy. @broughton7777 Over the last five years at the College we have evolved our recruitment strategy to be as far reaching and impactful as possible. We now use social media, podcasts, webinars, online content, short videos and have a big presence at the annual RCPCH Conference. Every year, it feels that the recruitment process slightly changes and we make great efforts to communicate these changes widely and to advocate for our applicants and future paediatricians. This is particularly important for the impact of Progress+ where we have gone from an eight-year training programme to a more individually focused seven-year programme.

The success of this programme is down to the fantastic, enthusiastic RCPCH staff (big shout out to Henna Dave!) and the seamless work with the trainee committee and the recruitment and lifelong careers board.

Our priority is always to strongly advocate for our workforce from medical students to retiring consultants! #ChoosePaediatrics is one of the most important components, and we have seen applicants double in the last five years, for which the #ChoosePaediatrics programme is probably the key factor.

It of course, leaves me to end with #ChoosePaediatrics! For the most fulfilling career, working with children, families, young people and great colleagues!

20 WINTER 2023 Milestones

Some of the staff involved gathered for a photo to celebrate the win

I

T HAS BEEN a highlight of my time as trainee representative for recruitment being involved in the #ChoosePaediatrics Dr Blanche Lumb programme. I am RCPCH Trainee not surprised to see Representative it recognised for its for Recruitment success. Choosing a medical career after completing university can often seem like an overwhelming task made even worse by sometimes having little to no experience in the specialty you are choosing to commit your whole career to.

The #ChoosePaediatrics programme does a fantastic job of both demystifying paediatrics as a career and helping doctors and medical students understand what a career in paediatrics involves. It not only increased numbers of applicants, but also helps people find the right path for them to have a successful and fulfilling career form the start.

Supporting the attendance of medical students at the RCPCH Conference has helped countless students get a taste for paediatrics but also supports them in meeting people at multiple stages in their careers (all the way up to the College President!) to help inspire them into what a career in paediatrics could mean. Every session I have been involved in with the #ChoosePaediatrics programme has taught me something and the quality of students attending conference and entering the Tony Jackson Prize, with some insightful reflections around paediatrics practice, shows what a great future there is for the paediatricians of tomorrow. #ChoosePaediatrics has introduced me to students who have gone from not even considering applying to paediatrics to being passionate about their future careers and it has been a lot of fun along the way.

Most importantly #ChoosePaediatrics helps me to remember why I chose paediatrics in the first place, why I loved it as a specialty when I applied and why I still love it now coming to the end of my training.

FEATURE

The impawtance of the MDT Animals can be a huge help in reducing children’s stress during hospital stays and medical treatment. Here, we meet Henry the therapy dog

T

HERAPY DOG HENRY has been lighting up the wards here at Salisbury District Hospital, bringing joy to patients, Julia Hall parents and staff Paediatric Registrar alike. Henry will play, University distract or climb onto Hospital a child’s bed to allow Southampton them to forget about being in hospital for a short while. Research shows that spending time with a therapy dog can help to reduce anxiety, lower heart rate and blood pressure, and help to alleviate depression.

For example, sessions with farm animals for those with post-traumatic stress disorder have been shown to help with anxiety and attachment, and structured sessions with therapy dogs improve motivation and progress with physiotherapy as well as having a positive effect on mental health. Visits by animals to care homes, hospitals and hospices can improve mood and decrease pain. There have even been suggestions that using animals in virtual reality interventions can have a positive effect on physical and mental health disorders.

Henry’s work ranges from helping anxious children to have their bloods taken to supporting patients in their last few days and hours of life. A quote from Henry’s ‘mum’, Michele, highlights the incredible work that he does: “Henry put a smile on a young girl’s face, who was terminally ill. She hadn’t smiled in weeks, he jumped on her bed and the beaming smile across her face was something I will never forget.”

With Henry visiting the ward on a regular basis, he is also able to support the recovery of longer term patients. Recently, he has been visiting a teenager who has been struggling with their mental health. Every

22 WINTER 2023 Milestones

Henry and the team at Salisbury District Hospital

time he visits the ward, he snuggles up to the teenager and they have developed a real bond. In his latest visit, the teenager was able to take Henry for a walk and play ball with him outside. During this time, the teenager was visibly relaxed and happy, which was real progress from their initial admission.

Most recently, Henry has joined our fantastic play therapy team and has been supporting Play Specialist, Tash, in calming and distracting children having

blood tests and burns dressings. He’s even become the star of his own film, showing children that ‘If Henry can do it, you can do it too’. As Michele says, there is no need for children to be traumatised by medical procedures, it’s about parents being informed and prepared so that they can help their children. With Henry being part of this process, we hope to make hospital stays a much more pleasant experience for children and their families.

FEATURE

Improving antimicrobial use and UK-PAS: A trainee’s view There are lots of useful resources available to help us all take more responsibility for antimicrobial stewardship, says Dr Sam Channon-Wells

Deciding when to prescribe antibiotics can be difficult

A

S THE WINTER season approaches, my mind comes around to thinking about Dr Sam antibiotics, as we ponder Channon-Wells which of the many Clinical PhD feverish kids coming Fellow in through the doors Paediatric should be prescribed Infectious antibiotics – and who Disease Imperial doesn’t need them!

College London For a junior @sam-channon paediatrician like me, it’s all too common for certain patient management decisions, including antibiotic prescribing, to fall to senior colleagues. But it’s still everyone’s responsibility to engage with Antimicrobial

Stewardship (AMS). Fortunately, getting involved doesn’t have to be complex or timeconsuming, and there are plenty of fantastic free resources I want to share that can help everyone incorporate just a little bit of AMS into their daily practice this winter.

My first port of call would be the UK Paediatric Antimicrobial Stewardship network (UK-PAS)/British Society for Antimicrobial Chemotherapy (BSAC) paediatric “common infection” interactive cases. These fun short interactive cases provide an evidence-based approach to treating some of the most common hospital presentations in children, with some excellent nuggets to supplement your AMS armoury.

We all love our trusty local guidelines, but

evidence has shown that local antimicrobial prescribing guidelines in the UK sometimes fall short.1 Luckily, the National Paediatric Antimicrobial Prescribing Summary comes to the rescue. This comprehensive, regularly updated, and evidence-based resource has been developed by a multidisciplinary team within UK-PAS, and is freely available from their website. And for trainees looking for a QI project, why not compare these to your hospital’s guidelines and see if they are due a refresh?

UK-PAS also runs monthly webinars featuring diverse speakers who explore recent updates in paediatric AMS. These webinars serve as an ongoing educational resource, and are full of great ideas for projects to improve AMS practice in your hospital. The UK-PAS website hosts loads of other valuable resources, including previous webinar recordings, a free eBook on AMS from BSAC, and other relevant guidelines for managing infections in children.

Availability of formal Paediatric AMS programmes in the UK are sadly limited, but we can all do our part together to ensure that children and young people receive the most effective and judicious antibiotic treatments, safeguarding their health for years to come.

Antimicrobial Stewardship is not just a responsibility; it’s our collective commitment to the wellbeing of the next generation.

References: 1. Shears A, Hoskyns L, Flinders P, Conry R, McMaster P, Committee U-P. Paediatric hospital antimicrobial guidelines: a national UK review. Arch Dis Child 2023.

Find out more at uk-pas.co.uk; bsac.org.uk/paediatricpathways

Milestones

WINTER 2023

23

FEATURE

Powering Up

The journey to better, fairer healthcare

T Dr Guddi Singh Consultant in Neurodevelopmental & Social Paediatrics and Director of WHAM @DrGuddiSingh

24 WINTER 2023 Milestones

HIS WAS NOT meant to happen to me. As an immigrant brown girl growing up in a working-class town in the north-east of England, I was told that people like me don’t amount to very much. The idea that I might be in charge of anything – of leading my own team, planning my own projects, and handling money – was for other people. People not like me.

But here we are. WHAM – the Wellbeing & Heath Action Movement, our little organisation that empowers clinicians through education and community to address health inequalities – has not only grown in 2023, but also just won one of the Health Foundation’s Q Exchange awards for our project, “Powering Up”.

Not bad for a two-year-old.

If WHAM is about using tools such as quality improvement to

translate individual action into transformation of the medical profession for social justice, “Powering Up” is our attempt to learn how to meaningfully put young people at the front and centre of that journey, such that they can help to address health inequalities, both in their own lives and in health systems, all

through a process of creative co-production.

This is important because adolescent health is often overlooked – even by paediatricians. Clinicians cite this group as daunting to connect with (Patton 2010). Adolescent DNA (did not attend) rates are as high as 15% (Campbell 2015)

Powering Up’s First meeting: Dr Guddi Singh and Dr Mary Salama of Birmingham’s Children’s Hospital finally able to cause havoc in the same room together

FEATURE

CASE STUDY 1 From frustration to power

Rhea Burman I am a 21-yearold, final year Biomedical Science student at the University of Surrey.

Outside of my degree, I enjoy participating in different kinds of sports, travelling and spending time with my friends.

By Rhea Burman Powering Up Project Coordinator Hi, I’m Rhea and I’m 21 years old. Here’s a sneak peek into my secret life six years into my journey with arthritis.

One word to sum it all up?

Frustration.

Frustration that I must be ten steps ahead, to avoid falling behind. Frustration that arthritis will always have to be considered in my social life, career, and future. Frustration that I must manage my health alongside life when no one else around me has to. Frustration that I find it hard to tell my friends why they haven’t seen me in the last few days, when I have flares. Frustration that I

and strongly correlated with deprivation (Bouraoui 2022).

In Powering Up, young people with long-term conditions from deprived areas are going to work as equals with their clinicians to help make health better. It’s about genuine collaboration and partnership while using film, music, and dance to express it.

It’s about empowering young people while upskilling ourselves to do better. It’s about shifting power and levelling hierarchies.

It’s flippin’ exciting.

But I’m bricking it.

Because now, I’m on the hook.

It’s not about ‘success’, whatever that is. No, much more important than outputs or products for me is the HOW: the values that permeate the project from inception to completion. It’s not

appear flaky when I physically cannot get myself out of bed.

Frustration that I can’t date like my peers because it’s an ‘awkward’ topic that puts me in a vulnerable position.

Frustration because I have to work so much harder than my peers to get to the same place or to live a ‘normal’ life, when I’m exhausted.

The frustration never stops.

But I fight every day to take back the bits of me that had been stolen. Arthritis may have chipped away at parts of what make me ‘me’, but it has also made me stronger.

It makes me fight harder for every small thing that I put my mind to, just to say I did it despite my arthritis. It doesn’t stop me anymore, it drives me to achieve, because I’m already doing the hard part by living with a hidden autoimmune disease. I’ve finally reached remission,

which was unimaginable 6 years ago, by being treated by doctors who genuinely cared about me and wanted the best for me. They helped me carry the weight that was making me crumble. I never thought I’d have that power.

As Powering Up’s Project Coordinator, I have been given the unbelievable opportunity to work alongside the people that worked hard for me to see the light at the end of the tunnel. It has been inspiring to see how dedicated the people who treat me are to empowering patients but also to listen to my story, experience and opinions in the hope of evolving today’s current practice to reduce health inequality. These strong women also carry the weight for doctors in training; shouldering the burden until you to become powerful enough to carry it on your own.

Team Powering Up (from left to right): Rhea Burman (YoungSTAR and Project Co-ordinator); Dr Hannah Zhu (Consultant Paediatrician), Dr Mary Salama (Consultant Paediatrician), Dr Guddi Singh (Consultant Paediatrician); Dr Aicha Bouraoui (Adult Rheumatology Registrar); Dr Tami Benzaken (Paediatric Registrar); Judi Alston (CEO and film maker at One-to-One Development Trust); and Ruth Harvey-Regan (UCLH Improvement Team)

Milestones

WINTER 2023

25

FEATURE enough to espouse ideals of equality on paper only to fail where it really matters – in practice, in the everyday reality of our lives.

Which is why I am delighted that Powering Up is not just for young people, but genuinely by young people. We have already employed two young people – or YoungSTARS – who have been part of our process since Day One. They are helping to shape every aspect of this project – from vision to implementation – and I have never been more stretched or learned as much in my life.

I am not sure I will ever believe that I am meant to be doing this. But for now, I have no choice. For the young people who now work alongside me, and for the young people we are hoping to engage, the only way is up. We just need to find the power to get there.

True to the values of the project, I am

not going to take up any more space, and instead allow you to hear direct from our YoungSTARS (Rhea and Aisha) in Team Powering Up about why this work matters.

You can find out more about the project specifics here: q.health.org.uk/idea/2023/ powering-up-co-producing-solutions-tohealth-inequality-with-young-people

Stay connected!

We would love for you to stay tuned as Powering Up unfolds in the coming months.

Three things you can do to help Powering Up now: 1. Join WHAM: www.whamproject.co.uk 2. Follow Powering Up on Instagram @PoweringUpProject 3. Write to us if you think you can help: PoweringUpProject@gmail.com And tell a friend to do the same!

CASE STUDY 2 Facing chronic illness: one young person’s view from the other side Aisha Shah I am 19 years old and study Cancer Sciences at the University of Nottingham

By Aisha Shah Powering Up YoungSTAR My health in the last few years has been up and down. On paper, it has got harder to manage – I’ve gone from no chronic conditions to two that affect me daily. However, in reality, I feel more positive and comfortable in how my health is being managed overall. How? My health conditions are chronic and complex. They will inevitably impact my future.

That might seem like a scary and depressing thought for most teenagers, and it can be, but I no longer see it that way, and that is due to the support and help that I have received from doctors, and other health professionals. Instead of dreading appointments, I now view them as a useful check-in point, an opportunity to discuss

26 WINTER 2023 Milestones

and explore what is not going well, and a chance to try and fix – or at least minimise – what is having a negative impact on my life. As a result, I have seen and experienced a massive difference: I feel my health is being genuinely addressed.

That does not mean that we have discovered some magical cure, instead it means that I feel like I am being listened to and that my feelings are valid. I feel as though the doctor and I are on the same page. I feel like a plan has been thought out, even if that plan is to wait. Making a patient feel these things when looking at any health condition is vital, especially if it is a condition that is likely to impact the patient in multiple ways.

Never underestimate how much difference a doctor can make to their patients. Several doctors have said or implied the same things in the past, but how I am left feeling is dependent on how that is delivered. The doctors that have made the biggest difference

References 1. Patton GC, Viner RM, Ameratunga S, Fatusi AO, Ferguson BJ, & Patel V (2010).

Mapping a global agenda for adolescent health. Journal of Adolescent Health, 47(5), 427-432.

2. Campbell K, Millard A, McCartney G, & McCullough S (2015). Who is least likely to attend? An analysis of outpatient appointment ‘did not attend’ (DNA) data in Scotland. NHS Health Scotland, 1-25 3. Bouraoui A, Bai M, Fisher C, et al, 1871 Aligning national and local data to predict clinic nonattendance in adolescent and young adult rheumatology using machine learning model. BMJ Paediatrics Open 2022;**6:**doi: 10.1136/bmjpo-2022-RCPCH.3

are the ones who have let me feel supported and who have looked and listened to everything holistically. They are the ones who leave me feeling empowered and confident that my health is in my own control and is something that can be managed and will be with their help.

To tomorrow’s doctors, ask yourselves this: 1. How will the way in which I give this patient information impact them?

2. Do I feel like I understand what matters to this patient and what their main concerns are? a. If yes, how can I work with my patient to help? b. If no, how can I understand what matters to my patients to help them?

3. Is the plan and information that I have given the patient clear?

It’s not rocket science, but so often the most important things are the simplest.

FEATURE

Thoughts on retirement Retired paediatric consultant Mary Rossiter uses her paediatric skills to help other vulnerable groups

S

AD THINGS TO LOSE: Colleagues, fulfilment, clinical experience, being needed, being listened Mary Rossiter to, also height, Retired Consultant strength, dignity and Paediatrician, North Middlesex one’s marbles.

Hospital Good things to lose: Monday mornings, responsibility, timetables.

Good things to gain: Freedom pass, a seat on the tube, not worrying about being fashionable, time to do other things (not just gardening and long walks).

An opportunity to offer transferable skills, listening, experience, organisational skills, leadership, advocacy, teaching, and especially volunteering.

Volunteering: I have inadvertently transferred my paediatric skills to the elderly. My brother warned when I retired to learn to say “No”. So, when I was approached about a singing group for people with memory loss I said “Maybe, perhaps once a month” which was relayed as “Mary showed enormous enthusiasm for...” and I became the organiser of a weekly activity.

“Singing for the Mind”, originally “Singing for the Brain”, was set up in

“I have inadvertently transferred my paediatric skills to the elderly”

There’s more to retirement than just gardening and long walks

partnership with Alzheimer’s Society in 2011. We meet for two hours every Thursday afternoon with an hour of singing, bookended by chat and refreshments. Most participants come with a relative, friend or carer. We have an expert singing leader.

It is more than a sing-a-long. There is a scientific basis to the interactive programme of songs which include known, new, rounds, two or three at once, usually with actions, then with percussion instruments and dancing, finally using our song-book. There is usually a magic moment when a forgotten ability appears, often the “open mic” section when someone sings a solo.

What have I gained? Thursdays. Also

do-gooding”, magic moments, adapting previous experience, CPD (empathy, boundaries, the importance of detail), a non-judgmental environment, being valued again, making new friends and being silly.

Not second childhood but second adolescence

Milestones

WINTER 2023

27

FEATURE

Find your power What empowers you and enables you to do your best?

I Dr Shona Johnston Post-CCT paediatrician ICF-trained coach Currently lives in Netherlands with husband, who is in the RAF

N THE CURRENT pressure of the NHS, it is easy to feel disempowered – lack of control over endless workloads, insufficient staff, public and media expectations, and a government that seemingly doesn’t listen to or value the workforce.

Who wouldn’t feel (at least sometimes) disempowered with all that?

So, what does empower you?

Pause for a moment and reflect on that question before reading on.

According to Daniel Pink (author of Drive), we have “an innate drive to be autonomous, self-determined, and connected”. Let’s look at these to see where you might find your inner power: Autonomy Having a sense of control in our working lives is associated with higher productivity, less burnout, and more psychological wellbeing. Find the things you CAN control (hint – usually something to do with your responses and actions).

Competence leading to mastery We all have a need to feel we know what we’re doing, and for education, selfdevelopment and a sense of purpose. Feeling a bit “meh”? – consider what is lacking for you and what you could do to upskill.

Connection Being around people who you relate to and who’ve got your back can both empower and

28 WINTER 2023 Milestones

Feeling empowered gives you the freedom to reach your full potential

enable you to do your best. Who are your allies, coaches and cheerleaders?

What about context?

Our environment plays a part too. Working in an empowering (non-toxic, encouraging) department that provides psychological safety (the ability to speak up) and meets your basic psychological needs (autonomy, belonging, and competence) as well as your

basic physical needs for rest, sustenance and appropriate financial recompense helps enable you to do your best.

And – action!

Empowerment is an action, as well as a feeling. Use your power to make a difference.

Take a stand in line with your values and purpose. What are you going to do differently now?

WELLBEING

Wellbeing

Psychological safety – it’s not fluffy stuff Dr Jess Morgan, one of the Dinwoodie RCPCH Fellows working on the Thrive Paediatrics project, explores what it means to create a psychologically safe working environment and how we can achieve that in today’s NHS

U Dr Jess Morgan Dinwoodie Clinical Fellow for Lifelong Careers RCPCH

P UNTIL A FEW YEARS AGO, I was a paediatric trainee. Then life happened. I stepped out of medicine for a while and in doing so, I found myself lost. For so long, I had been Jess the paediatrician.

Who was I without that?

Colleagues who have had time off sick and others in the early days of retirement have described a similar feeling – like being a doctor is part of our identity. From as early as medical school, we begin to adopt the professional behaviours of a doctor. I’m not talking here about knowledge or skills, more about the social and emotional journey we go on over the course of our careers that contribute to forging this sense of “medical self”. And with this identity comes belonging. Belonging to a medical tribe. One with shared experiences and understanding. An unwritten language.

This sense of belonging is a fundamental human need: lasting relationships that offer us meaning and connection. With irregular shifts, hybrid working, frequent rotations, it can be hard to foster that sense of team. And yet we must. With true belonging comes authenticity, an ability to be our true human selves. Vulnerable. But

how do we create environments where this is possible?

Professor Amy Edmonson coined the term psychological safety, one that I have heard used in different, and not always accurate contexts recently. Her definition is described below. It’s not soft fluffy stuff, a hand on the shoulder or a cup of tea, nor is it about being liked by colleagues.

Psychological safety is an evidencebased leadership strategy that creates environments where we can be honest, make mistakes and take risks. It enables us to be our true selves at work, in the knowledge that we will be accepted. Inclusion, respect and belonging breed creativity and innovation, better team cohesion and importantly, safer patient care. So how do we achieve this in healthcare?

The Thrive Paediatrics Team have been hearing your stories and experiences of psychological safety at work, examples of civility campaigns, employee participation groups that address racism and harassment, Schwarz rounds giving people space to explore thoughts and feelings. But

not all your stories involve high level change. Conversations with colleagues who show an interest and understanding of our lives outside of medicine, senior leaders role modelling vulnerability and owning up to mistakes, others overtly encouraging and welcoming challenge. There are countless ways in which we can create a culture of belonging and psychological safety.

As part of Thrive Paediatrics, we are creating regional communities of paediatricians and allied health professionals who come together to share stories and collaborate to improve their working lives.

Spaces for everyone’s voice to be heard where meaningful change can happen. We are thrilled to announce that our first pilot region in Southeast Scotland is doing some great work, ensuring that all professional groups are represented no matter the job role, specialty, or personal background. We will continue to work closely with this network as they share their experiences, learn from each other, and draw on RCPCH resources to help activate change.

For more information on Thrive Paediatrics visit www.rcpch.ac.uk/work-we-do/thrive-paediatrics and email thrive@rcpch.ac.uk to get involved

Milestones

WINTER 2023

29

ASH’S BAKING SCHOOL

Orange polenta cake Try this zesty bake to add some zing to your breaks

I Dr Ashish Patel ST8 Paediatric Nephrology & Sim Fellow Birmingham Children’s Hospital @DrKidneyAsh

RECENTLY CAME across our patron Nigella’s lemon polenta cake. At first I was sceptical about using polenta instead of flour but boy was I mistaken. I have never tasted cake that was so moist yet crumbly. The polenta simply soaks up all the wet ingredients making this cake just melt in your mouth. I tried it out with another firm favourite flavour of mine, orange, and my tastebuds were blown even further. The best kind of oranges to use are Seville oranges because they bring an intense aromatic orange flavour. Keep an eye out in the New Year as they only stay in season until mid-February. You won’t even realise that this cake is glutenfree. It certainly helped to settle my baking promise to Asma, the play worker in my wonderful team!

30 WINTER 2023 Milestones

INGREDIENTS 175 ml light olive oil 3 medium eggs 250 g caster sugar 1-2 oranges 1 lime 200 g ground almonds 100 g polenta 1½ teaspoon baking powder

INSTRUCTIONS 1. Preheat your oven to 170˚C (160˚C if fan assisted). Lightly grease and line a 9-inch springform cake tin with baking paper.

2. Using a stand mixer/electric hand-held mixer, beat the eggs with 175 g caster sugar until the mixture is well combined, light and fluffy. Whisk in the olive oil and the zest of one orange and one lime.

3. Add the almonds, polenta, baking powder and a pinch of salt, and mix together until well combined. Tip into the tin and bake for 40-50 minutes.

4. Whilst the cake bakes, make the orange syrup. Squeeze out the juice the orange and lime into a small saucepan along with the remaining 75 g caster sugar. Place on the hob, allow the sugar to melt and then simmer for 3 minutes until syrupy. Set aside to cool.

5. When the cake is golden and a skewer comes out clean, remove it from the oven.

Prick the top of the cake all over with a toothpick and spoon over the cooled syrup.

Top with more orange zest and allow to cool.

Voila!