RCPCH news Royal College of Paediatrics and Child Health
Leading the way in children’s health
WINTER 2008
Royal opening of new College building 8-9
CEMACH Update 6 HENRY receives National Award 7
Court skills The evidence I shall give shall be the truth... 10
Editorials In the news
From the Registrar
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Be warned, this column is a personal view. If you don’t agree with me, please let me know. The problem with writing a regular column for a newsletter is that you keep having to do it, and you forget what you wrote last time, or what your predecessor wrote… The other problem is that of topicality – will what I write now, in mid-November, be relevant when you read this in some months time? I thought it might be of interest to reflect on today’s cuttings sent out by our efficient media team. So what follows are my unrefined thoughts on today’s stories – some new and some evolving. Baby P. I am sure this will mean something when you read this article. The initial is redolent with imagery already. He will I suspect, like Victoria Climbie, have far-reaching implications for our safeguarding (and broader child health) services. But what is it about a specific death that results in such intense media interest? Several children a week die as a result of child abuse and neglect, yet only a handful provokes such interest. RCPCH is doing much to improve standards in the medical contribution to child protection. Yet there are major dilemmas in what we do. How can we make clear the overlap between “over-reaction” and “failure” (their words, not mine)? Should we, and how do we, convey the difficult message that children die at the hands of their carers, not their professionals? Does this sound uncaring and arrogant? How do we balance the needs to protect with the desire to keep children with their families? And am I alone in thinking that the media interest could be seen as prurient, and that even the use of “Baby P” as a descriptor of the child, whose photographs have been widely published, might show a lack of respect to him and his short life? Does he not deserve the dignity of a name – who are we protecting? I am sure he will be with us, and influencing us, in the future. Locally I have been party to two high profile Part 8 Case Reviews, and their names continue to be relevant – Rikki Neave and Lauren Wright. Perhaps the purpose of the media scrutiny is to try and make some sense of the tragedy, and help systems improve, rather than to seek to attribute blame to professionals, who are mostly trying to do their best, often with limited resources and with difficult families. A brave young lady, Hannah Jones, declined the opportunity to have a heart transplant. Discussion today is about whether this will encourage others to decline such surgery. If a young person decides that she doesn’t want a treatment, and she is competent to take such a decision,
Media Update Paul Polani Research Fund 2009
5 CPD Update
6 CEMACH Update The Role of the Consultant with Subspecialty Training in Paediatric Emergency Medicine
7 Improving Paediatric Practice in Young People’s Health HENRY receives a National award
8-9 Royal opening of new College building
10 The evidence I shall give shall be the truth, the whole truth and nothing but the truth
11 The NHS and climate change Paediatricians make the case for a smacking ban
12 SASG news Health Informatics: an update
14 Trainees’ column NPSA/RCPCH - Safer Practice in Neonatal Care Project Neonatal Transport Survey
15 Meetings
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should we not respect this? I recently attended a seminar on emotional and psychological needs of children and families with heart disease, and came away realising that treatment is not always the best option. We need to consider quality as well as quantity of life. Meningitis lessons haven’t been heeded, says victim’s father. A story from Wales about a father who feels that health staff are still not sufficiently aware of the early signs of meningococcal infection. His personal tragedy rings clear – we need to take parents’ concerns seriously. But how does this balance with the problems of resources, pressure on paediatric admissions etc? Obesity is programmed before birth, or at least it is in rats. This may be some comfort to those of us with a BMI above the approved range, but the science is serious. Eating a high-fat diet in pregnancy may cause changes in the foetal brain that lead to overeating and obesity early in life. Rats born to mothers fed a high-fat diet had more brain cells specialised to produce appetite-stimulating proteins. What does this mean for us? Maybe an increased emphasis on health promotion and support in early pregnancy is an effective approach to reducing the “obesity epidemic”. Or are our children different from rats? And finally, the government is minded to over-rule an Expert Working Group that advises that donor opt-out for organ transplantation should not be supported. Not sure what I think, other than wondering why ask experts if you don’t take their advice: perhaps a bit like our own Council tinkering with documents written by expert working parties? Hopefully the health warning means you stayed with me to the end! As I said, please let me know what you think. Sorry if you find my wonderings shallow, but maybe they reflect how we approach our jobs in the context of a wider society. And perhaps they might be eligible for CPD points as reflective notes – writing this has made me think about the issues rather than just read about them. If you want to see the articles I refer to, ask Ella Wilson (Ella.Wilson@rcpch.ac.uk) our media affairs assistant for her Daily Cuttings email of 17th November 2008.
Dr David Vickers RCPCH REGISTRAR
RCPCH news
Editorials From the President This job occasionally gets me into challenging situations. Picture, for example, this recent one. I am at the annual dinner of the Royal College of Ophthalmologists and am seated between the President of the General Medical Council and the President of the Guide Dogs for the Blind Association. The latter is himself blind and has his guide dog with him which he introduces to me, adding, rather ominously, that the dog is due to retire soon and is “demob happy”. The round tables are slightly small for 8 people and there is not a great deal of room for the dog which rather strenuously inserts itself between me and its master. I shuffle as far to my left as possible but there is not much leeway. The dog continues to press for space and, as an added tactic, begins to nuzzle my leg. This presents me with a dilemma. It seems desperately incorrect on several levels to smack a guide dog across the chops, particularly in the presence of his illustrious master. On the other hand if I move any further to my left I will be sitting on the lap of the President of the GMC, which will no doubt call my registration into question – and quite possibly his too. I opt for a firm but fair “swimming swan” approach. Above the table I continue to smile and converse smoothly whilst below the table the dog and I vie for supremacy. We eventually reach an accommodation whereby the dog finds some space and falls asleep rather heavily across my feet. There are several instances where one needs to maintain apparent calm in stressful circumstances when in fact there is turmoil beneath the surface and a lot of activity expended in trying to put things right. The current workforce crisis is one such instance. We are under considerable stress with numerous gaps in the rotas and a shortfall in recruitment to more senior posts for which international medical graduates used to apply. We don’t want patients to suffer as a result, so teams are fully stretched in trying to deliver the service as usual. Consultants are spending more hours in the hospital or being resident and trainees are asked to do longer hours. We hope that patients don’t notice this desperate activity but they cannot be receiving the continuity of care that we value and aim to deliver. The SHAs certainly don’t seem to have noticed. During one of the many meetings in which I and others were highlighting these problems we were told that SHAs are not reporting any problems with WTD
compliance. I was amazed by this – but suspect what is happening is that posts are being reported as compliant despite the fact that the people in them are not. It would be important to ensure your trust knows of any difficulties in keeping the rota compliant, especially as August 2009 and the 48hour rule get ever closer. Your Chief Executive should be informed and asked to report difficulties to the SHA. It is crucial that we tell people at these levels, because if the SHAs are not reporting concerns to the Department of Health and the Workforce Directorate we have a much weaker case to present. As I write this, I am due to visit the Minister responsible for workforce next week and I hope that, as you read this I will have been able to report back via the e-mail bulletin. I can assure you the Secretary of State is also aware and we are also talking to the NHS Confederation. There have been rumours, as a result perhaps of an early feedback on the census that we will have to be cutting back on trainee numbers. This is not true. As a result of more sophisticated modelling we have found that trainees are taking longer to obtain their CCT and to take up consultant posts than we had predicted. We need to take into account flexible working, career breaks, maternity leave, change of career and delay in taking up posts at all levels whilst waiting for ideal geographical location. In addition we anticipate that we will need to increase consultant numbers to 6000 posts (about 4000 whole time equivalents) in order to deliver services as set out in Modelling the Future II (and III which is due out soon) and we will need more trainees to fill these posts. So we think we are probably at about the right level now and have no plans to reduce the numbers. We will need to keep this under review – the credit crunch might induce trainees to move more quickly to consultant posts and if we obtain the numbers of consultants we are fighting for there will be more consultant opportunities in every location so people can apply for the job they want in the place they want and this too should encourage swifter uptake of consultant posts. The “swimming swan” approach also applies to media issues and to ACCEA awards. A lot of activity goes on to prevent the College and paediatricians being featured in the media and clearly the work done in achieving that end is not visible.
As far as ACCEA is concerned, at the time of writing we are also expending a lot of activity and energy on the process for national higher awards. You may think this is a simple or even random process. In fact we invite nominations from regional committees via councillors, regional advisers, and specialty group conveners and accept self nominations. The senior officers, our lay representative and council representative non-award holder then individually assess and score each application (and this year we received over 130 of these) across each domain as defined by ACCEA. The scores are collated and each of those in the highest tranche – taken as just over the limit we are allowed to nominate - is discussed. Those that have not made that cut are discussed to see if any have been omitted unfairly. Then we write a citation for every successful nomination. We recently had a New Fellows’ Day. This is the first we have held and it was I think successful. We invited recently elected fellows to the college and talked about how the college works and what it can do for you. More importantly it set out what you can do for the college. We need tutors, examiners, committee members and chairs, officers and senior officers. We need people to respond to consultations and to read documents on behalf of Council to check that we are getting them right. We want you to self nominate or volunteer your colleagues. We realise that there are considerable pressures at work and that many trusts are reluctant to release people for college work. David Nicholson the Chief Executive of the NHS and Lord Darzi are committed to doctors having time made available to contribute to training and education and to the quality improvement agenda. So chief executives ought to be releasing people for national and regional work. Please let us know if you are being prevented from taking up any of these posts because of local pressures. You are the College and we cannot succeed without you.
Dr Patricia Hamilton RCPCH PRESIDENT
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News Media Update The Department of Health launched its MMR catch-up campaign in August and the RCPCH voiced it support stating ‘all children and young people should have the MMR vaccine. Overwhelming scientific evidence shows it is safe’. The RCPCH statement was quoted by the BBC website, Daily Telegraph, ITV News website, Daily Express and Guardian. David Elliman, RCPCH immunisation spokesperson also appeared on GMTV and BBC Breakfast News. Patricia Hamilton spoke to Health Service Journal (HSJ) about the importance of leadership in medical training, raising the point that ‘management and leadership skills are just as necessary for good outcomes and the safety of patients as having requisite clinical skills’. In late August the End Child Poverty Campaign produced a report about the health of children living in poverty. The RCPCH released a response to this report and was quoted in the Observer and Children & Young People Now. ‘Health inequalities in childhood lead to health inequalities in adulthood’ and the College supported the recommendations in the briefing. Adolescent health has also been in the news. The Conservatives have accused Labour of neglecting teen health, and an article in the Guardian included a mention of the Adolescent Health Project that was launched by Alan Johnson at the RCPCH the previous month. In September the HSJ published an article about adolescent health services, including details of the Adolescent Health Project and quoted Russell Viner. The British Paediatric Surveillance Unit (BPSU) released its 22nd Annual Report in September and Nursing Times and Medical News Today covered this. The BMJ printed an editorial about medical law and child protection in September which the Independent also reported. The article in the Independent included quotes from Patricia Hamilton and Rosalyn Proops about child protection and the role of paediatricians. In early October, the Children and Young Person’s Bill was debated in the House of Commons. As a supporter of the Children Are Unbeatable! Campaign, the RCPCH issued a new position statement on corporal punishment and was mentioned in The Times as one of the organisations backing the bid for children to be given the same protection against assault as adults. The GMC publicised the members of their reconstituted Council, who will take office in January 2009. RCPCH Vice President for Science and Research and President Elect, Terence Stephenson, and Former Officer for Ireland John Jenkins are among the appointed members and this was reported in Nottingham’s local press. In Mid-November the news was dominated by the Haringey safeguarding case – Baby P. The RCPCH jointly signed a media statement in response to the verdict, which was led by the Children’s Inter-Agency Group. Patricia Hamilton was quoted in the Society Guardian saying ‘frontline professionals need the time and support to carry out this difficult work’. Rosalyn Proops, the Officer for Child Protection, was interviewed by the BBC News website and The Guardian, where she explained the complexities of child protection work. Patricia Hamilton’s letter in response to the Observer’s article about Birmingham Children’s Hospital was also published in mid-November. She highlighted that ‘the reductions in the hours that doctors are permitted to work mean that our children’s workforce is under serious pressure’. To keep up-to-date with news articles that mention or quote the RCPCH, or to stay informed about what is going on within paediatrics and child health, visit the website for a regular summary of articles - www.rcpch.ac.uk/media Ella Wilson MEDIA AFFAIRS ASSISTANT
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British Academy of Childhood Disability
BACD Paul Polani Research Fund 2009 The Royal College of Paediatrics and Child Health (RCPCH) and the British Academy of Childhood Disability (BACD) are calling for applications to the Paul Polani Research Fund, which supports research in paediatric neurodisability in the UK. The Fund aims to encourage research and innovation in the field of Paediatric Neurodisability. Research to build a robust evidence-base is essential to provide optimal service to maintain and strengthen resources for Children and Young People with Disabilities and their families. Up to £7,500 is available to enable teams to pilot, undertake, or complete research projects based in paediatric neurodisability. Applications may be from teams or individuals (of any discipline).
To Apply The Fund is administered by BACD. Download a copy of the application form from the BACD website (www.bacdis.org.uk) to describe the aims of the project, the methods to be used, and how the money will be spent. A review panel from the BACD Executive Committee will score applications using the following criteria: • Relevance to Neurodisability • Methodology • Relevance of Outcomes • Achievability • Multi-Disciplinary Approach The BACD Executive Committee will recommend the successful applicant to the RCPCH Academic Board for formal ratification. The winner will be announced at the BACD Annual Scientific Meeting on Friday 6th March 2009 and will be invited to present the findings of the project at the ASM in 2011 and will be supported in disseminating the results. This is your opportunity to start or finish that important piece of research to make a difference for your service and others. Closing Date: 5pm, Friday 5th February 2009. Applications must be submitted via email to kelly.robinson@rcpch.ac.uk For more information, please contact us on the above email.
Annual General Meeting 2009 In accordance with the Bye Laws the College wishes to serve notice to the membership that the next Annual General Meeting of the College will be held on Tuesday 31 March 2009 at 6.15pm at the University of York, during the College’s Spring Meeting. Motions and items of business should be submitted in writing to the College Registrar not less than 10 weeks before the date of the meeting (Tuesday 20 January 2009), accompanied by the signature of 15 Ordinary Members or Fellows.
RCPCH news
News
CPD Update
good quality or, indeed, any records remains worryingly low? This year just 53% of those requested for evidence of CPD were able to meet the requirements. This was despite 9 months of chasing, only requiring proof of 25 points of external CPD and setting the bar as low as practically any documentation related to the activity. In the future, the evidence bar must include internal and personal CPD and is likely to require evidence of learning contemporaneous notes, reflective records, presentations, guidelines and audit reports! Savings from abolition of the old plastic wallets have paid for a new and robust online record which we hope will lighten the load of recording CPD activity. This should be in place in time for the 2009 CPD year but what else must you do to meet your New Year Resolutions on CPD? Here are some suggestions: • If you have not already got one, write a PDP and get it signed by your appraiser. • Find a slot in your diary now to plan a system which will work for you.
This year the RCPCH Guidelines for CPD have been extensively revised so do have a careful look at them as soon as they appear on the College website. This revision has partly come about because, after 10 years, a rewrite seems timely and partly as an evolution towards harmonisation between colleges in the run up to Revalidation. Thanks to SASG member on the committee, Ned Rowlands, there is also now a single page summary. A new category, “Personal CPD”, already familiar to members of the RCS and RCP, has been introduced. This represents all those activities where you have to make your own assessment of the number of credits to claim. It neatly sweeps up activities listed as “other” in previous editions such as writing of clinical guidelines and preparing postgraduate teaching. Most paediatricians are familiar with using the College format of reflective notes to record informal learning from clinical interactions. The reflective note exemplifies personal CPD and you are encouraged to use this format to record learning from all personal CPD. Paediatricians are encouraged to aim for at least 10 credits per year in these valuable areas of learning. As previously, limits are set on some activities. This is to ensure a broad spectrum of CPD; thus the limit for personal CPD is 20 credits. However, these limits merely represent the maximum which may count
towards the annual minimum of 50 credits (or 250 over five years) so do not be discouraged from recording all activity in these areas. One important change for postgraduate examiners and tutors on advanced life support courses is that CPD should now be claimed per day – one credit for examining and two for life support courses. The old guideline simply gave an annual limit of 5 and 10 credits respectively. This was not equitable as, for instance, a single day or 5 days of examining could have resulted in the same claim of 5 credits. The 2009 Guidelines make frequent reference to “revalidation” – the process by which we will be required every five years not only to justify re-licensing with the GMC but also our continued qualification for specialty status. The Academy of Medical Royal Colleges (AoMRC) is currently developing the processes for re-validation but it is already certain that an adequate portfolio of CPD will be a requirement. The RCPCH CPD systems are, as members would expect, among the best developed and will be in the vanguard of this development. Paediatricians are, thus, unlikely to experience large changes in their CPD obligations. Change must still occur in the quality of recording CPD activities. The need for CPD is already accepted as the status quo: 97% of paediatricians are registered with the college CPD scheme. However, the prevalence of
• Get a ring binder for 2009 and make sure you, or your secretary, file in date order, everything related to each activity - study leave agreements, programs, notes. • If you keep electronic records, order these similarly in folders for each year and have them cross referenced in your paper record. Keep electronic records on your network or back them up elsewhere. • Whatever your resolutions know yourself and also set aside 20 minutes in your diary each month to catch up, tidy up and do your on line record. • Consider using the notes pages on your online record – you may record a reflective note directly here without the need for any additional note or even dictate this for your secretary to enter on your behalf. • Make sure that your department has a robust means for recording attendance at internal CPD meetings. From all in the CPD Office: Have a happy and fulfilling New CPD Year!
Dr Rollo Clifford CPD OFFICER
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News
CEMACH Update failure to anticipate or recognise complications, ignoring of published guidance and poor safety-netting (discharge advice and follow-up). The sample of cases looked at by the study covered a broad range of illnesses: asthma, overdose, infection and intracranial haemorrhage, major trauma, meningitis. A data set was collected of all child deaths aged 28 days to 17 years 364 days in selected regions in 2006. Through multidisciplinary panel review, 31 cases were identified in which there was reason to think deaths night have been avoided (out of 119 cases with sufficient information). CEMACH believes that if this small study is expanded to a national scale, it would be very valuable for informing health policy. There are lots of important findings for paediatricians in the recently-published first report on Why Children Die of the Confidential Enquiry into Maternal and Child Health (CEMACH). This is the first report of the CEMACH Child Death Review. It considers whether the confidential enquiry approach can be used to identify avoidable factors in child deaths and to indicate potential areas for further study. In its search for avoidable factors in children’s deaths, the study found many examples of good care where the child nevertheless died. However, there were occasional examples of health care practitioners in primary care and in hospital who had difficulty in recognising serious illness in children. Examples of problems included assessment by doctors with little paediatric training, insufficient attention to history, inadequate examination and observation,
CEMACH recommends that: • hospital paediatric care should have a standardised identification system for detecting potential critical illness such as the adult MEWS score; • all health care professionals treating sick children should have appropriate training and supervision so that key skills and competencies can be demonstrated, and standards maintained. One resource for training purposes is the DVD produced by myself, Spotting the Sick Child (www.ocbmedia.com) This is twice cited in the CEMACH report, • observing national guidelines is essential; • parents and carers should be encouraged to seek further advice if a child’s condition fails to improve and to obtain a clear statement of deterioration. They should be informed whom they should contact for these purposes,
• improved detection of children with mental health problems is a priority. Self-harm in this age group requires multi—disciplinary assessment, led by CAMHS; • health services should proactively follow up children who miss medical appointments; • planning for future terminal care should consider if care at home or in hospice is better than in hospital; • a mechanism is needed for ongoing national epidemiological analysis of all child deaths to find avoidable factors; • coroners and local safeguarding children boards should be involved in this process, and death certificates need to reflect the cause of death and co-morbidity more accurately. For paediatricians, the following actions arise from the report: • to ensure colleagues within the organisation are aware of national guidelines such as NICE fever guidelines; • to evaluate and support liaison arrangements with their local Emergency Department; • to make rapid referral slots readily available to Emergency Departments and GPs; • to support outreach acute illness nursing follow-up; • to examine whether local clinical networks for mental health, head injury, terminal care, and paediatric intensive care are robust. Audits of individual patient journeys can be invaluable in this respect. Web link to the CEMACH Report: www.cemach.org.uk/getattachment/72d46ead -b529-466d-b0c3-4794d6a30203/WhyChildren-Die--A-pilot-study-(2006).aspx Dr Ffion Davies CHAIR, INTERCOLLEGIATE COMMITTEE – SERVICES FOR CHILDREN IN EMERGENCY DEPARTMENTS
The Role of the Consultant with Subspecialty Training in Paediatric Emergency Medicine The Intercollegiate Committee for Services for Children in Emergency Departments has produced a short document to assist in understanding the role of paediatric consultants with subspecialty training in Paediatric Emergency Medicine (PEM). The report shows how these consultants
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can improve the interfaces between emergency paediatric care, short stay inpatient care, outreach community care, child protection, and paediatric critical care. Examples of job plans are included. The publication will provide vital help to the Chief Executives of commissioner and
provider bodies, and Clinical Directors of Paediatrics and Emergency Departments, in planning for service change. To read the full report please visit www.rcpch.ac.uk/HealthServices/Emergency-Care
News
RCPCH news
Improving HENRY receives Paediatric a National award Practice in Young People’s Health
Young People’s Health Special Interest Group – successful first conference October 9-10th 2008 saw the first residential conference for paediatricians on young people’s health organised by YPHSIG. Keynote presentations included training in young people’s health/adolescent medicine, “you’re welcome” and developing inpatient services for young people. The majority of the conference was spent in experiential workshops including communication and consultation skills; consent, confidentiality and sexual health; young people with life limiting conditions; young people in challenging circumstances and substance misuse and participation. Materials from the conference are available on the YPHSIG website www.yphsig.org.uk We look forward to welcoming new members at our next meeting at the RCPCH Spring Meeting where we will be launching a £150 prize for the best medical student or trainee presentation on young people’s health. Our second two day conference will be in October 2009. Dr Gill Turner CHAIR OF YPHSIG
The College project HENRY – Health Exercise Nutrition for the Really Young – has been awarded the prestigious Best Practice Award for 2008 by the Association for the Study of Obesity. HENRY is an innovative programme that aims to tackle childhood obesity by skilling health and community practitioners to work more effectively with parents and carers of babies and toddlers. HENRY was conceived by Mary Rudolf and Candida Hunt in 2006 following a meeting of the RCPCH Obesity Research Group. Seed funding from the Child Growth Foundation led to the development of training and resources and in 2007 support for HENRY’s rollout came to the College from the Department of Health and the Department for Children, Schools and Families. With this funding HENRY is expanding far beyond the original vision. The pilot across Oxfordshire showed that trainees gained confidence in their work with families and made changes in their own lives. A review of Children’s Centres 3-6 months later showed that changes had been implemented within the Centres that managers attributed to HENRY. The Childhood Obesity and HENRY e-learning course was piloted on 535 learners, who reported that their skills had improved as well as their knowledge base; 98% said that they
would recommend the course to colleagues. HENRY is cited in three government documents, including the Child Health Promotion Programme. This has led to widespread interest: HENRY has captured the imagination of PCTs, Strategic Health Authorities and government regions across England. The overwhelming demand for HENRY training (60 training courses are already booked for September 2008-July 2009) demonstrates their recognition of the urgent need to skill practitioners working in the sensitive area of obesity. Developing HENRY has been exciting and challenging, and we are delighted that the ASO has recognised the special contribution HENRY is making to tackling childhood obesity. For details about HENRY go to www.henry.org.uk To sample the HENRY e-course go to www.ukvirtual-college.co.uk Contact Mary Rudolf if you are considering commissioning the course for colleagues and would like a complimentary login. Professor Mary Rudolf Ms Candida Hunt
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News
Royal opening of new College building On 16th October 2008, the RCPCH’s new building in Theobalds Road, London was officially opened by HRH The Princess Royal, the College’s Patron. The Princess’s visit began with a seminar on the College’s international activities, led by the David Baum Fellow, Dr Stephen Greene. She was then shown around the College’s new offices by the President, meeting all the staff who were present that day. Her extensive knowledge of the RCPCH’s activities was evident to those who met her, as was her interest in the College’s work. Finally, the Princess unveiled a plaque in the ground floor “Gallery” area marking the occasion, and was presented with flowers by two of the College’s younger helpers.
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RCPCH news
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News The evidence I shall give shall be the truth, the whole truth and nothing but the truth: The RCPCH Court Skills Course I have never had to give evidence in court before. I have seen plenty of alleged assault cases and potential child protection cases at work but, up until now, my statements have always been accepted and never challenged by any of the parties involved. I’ve often wondered what happens to my statements once I have written them. How does the court deal with them? What weight is placed upon them? What would it really be like to have to appear in front of a court and give evidence and be cross examined? When I heard about the Court Skills for Paediatricians Course, organised by the Royal College of Paediatrics and Child Health, I thought that this sounded like the perfect opportunity to learn more about the court process and the law involved. The course aimed to increase the interest, knowledge, confidence and skills of participants in undertaking court work in all jurisdictions affecting children. There were sessions on relevant legal frameworks as well as an introduction to the process of accepting instructions and planning and undertaking assessments in both civil and criminal cases. As I am approaching my CCT I thought that this course would be ideal to try and consolidate my clinical child protection experience and to explore some of the more legal aspects of this work. Little did I then know that on the last afternoon of the course I would be sat in a mock-court in front of two experienced barristers to cross examine me for 15 minutes on a statement I had written a mere 48 hours beforehand. As I sat waiting for my turn I realised that my mouth was dry and my pulse was racing, and this was just a mock exercise! I survived my grilling intact and, despite my initial nervousness, I found the whole process fascinating as well as very enjoyable. I left the course thinking that I wanted to learn more and see some of the techniques and skills in practise in a real-life situation. The Court of Appeal Judge who attended our course to discuss areas of interest with us suggested that we might like to consider minipupillages and our course tutor, the RCPCH Child Protection Officer, was only too happy to help me arrange to make contact with a Judge in my own area of the country. I had an incredibly enthusiastic e-mail from the Judge a couple of days later. Why don’t you come and see me in court and we
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can discuss any questions you might have and you can see what we do here? So, a few weeks later I found myself outside of the Court Room waiting for the day’s business to begin. An usher came to meet me and I was escorted through to the secure side of the court rooms where the Judges’ Chambers are found. I was met by the Judge with the same enthusiasm as the initial e-mail had indicated. It was to be a busy three days and the Judge spent a lot of time telling me about the legal processes involved in each of the cases we were to see that day as well as giving me access to the relevant reports that would be discussed in Court throughout the rest of the week. The first case was an adoption. The ruling had been given earlier and the family were returning to the court to receive the relevant official documents. The Judge had a great interaction with the children and family involved. The family had asked if it was possible to take some photographs in the court room and the Judge was enthusiastic about donning robes and having photographs taken with the children. Chocolate and crayons were produced from under the robes and the children were allowed to sit in the Judge’s chair and have their photograph taken as a record of the event for the family. The whole session gave me an insight into the work that the judiciary try and do with families in these kind of situations – it was clear that the Judge had taken a lot of time to learn some of the background about the family who were going to be the adoptive parents, and I felt that the family went away with some positive memories that they will be able to look back on over future years. The rest of the three days were not always as informal as the first session. When the time came for the next case, I had already had an opportunity to look through the case files and discuss the medical evidence with the Judge and to learn the kind of information that the court finds helpful. As we went along the corridor to the next court room, it was only after I had gone through the door that I realised the Judge had taken me to the bench and had arranged for a seat to be placed next to the Judge’s chair. I was a little taken aback to find rows of barristers and solicitors facing me, and I was a little unsure about in which direction I was supposed to bow! Sitting on the bench with the Judge, in some cases in the High Court, gave me a
fantastic insight into the whole court process. I was able to see written evidence at first hand as well as to directly observe cross examinations of witnesses as well as to discuss, in between cases, relevant points of interest or law with the Judge concerned. The Judge had gone to a lot of effort to arrange for me to see as many cases as possible, and meet as many Judicial colleagues as possible, to give me a broad experience of the kind of work they do, within a relatively short period of time of three days. This was an incredibly valuable experience that I would heartily recommend to any paediatrician who may be involved in child protection work, or legal work involving children, in the future. The next time someone says to that they have a “court order” I will hopefully remember the difference between a Special Guardianship Order, a Care Order, a Residence Order, an Interim Care Order and a Supervision Order, as well as, importantly, who has parental responsibility in each of these cases and how that affects who can consent for treatment I may wish to offer an individual patient. The next time I’m preparing a statement I will know what phrases to avoid and how the manner in which I write my statement can affect my future involvement in a case and influence whether a court appearance may be necessary. I will have a greater understanding of some of the published medical evidence concerning child protection matters and what the courts find helpful. I came away with a much greater understanding of the Children Act as well as some of the other legislation which is used in Civil and Criminal Cases involving children. My confidence at dealing with some of the issues which are raised in legal child protection work has increased since attending court and sitting with Judges. I can understand the considerable anxieties that some paediatricians have concerning child protection work – the last thing any of us wants is to be criticised by the court process or to get something wrong with potentially disastrous effects on a child and family – but I found that the Judges I met were extremely knowledgeable, experienced and really valued the contributions that medical staff make to the court and to their cases. They were all enthusiastic about paediatricians coming to see them at work. I had an extremely beneficial three days and am
RCPCH news really pleased that I organised this minipupillage. I had unrestricted access to the Judiciary, in both formal and informal settings, who were dealing with a whole host of different cases and this was an excellent opportunity to ask questions, to discuss cases and to remove some of the mystery of what goes on behind closed doors in court. Next week I have been unexpectedly
called to The High Court in connection with a patient I saw in the Emergency Department over a year ago. This time it will be me giving evidence in the witness box but having seen what goes on during my mini-pupillage I feel much more prepared for this experience than I did a few months ago… For further details of the RCPCH Court
The NHS and climate change Together with the BMJ and Faculty of Public Health, the College co-hosted a groundbreaking conference in its new building in June on the NHS and climate change: how to reduce the carbon footprint of the health sector. The first task was to make sure that we practiced what we preached, and hence no plastic disposables were to be seen on the day, and fashionable cotton bags were used for the handouts (all printed back to back). And no-one flew to the meeting, which was just as well as Fiona Godlee (Editor of the BMJ) brought along copies of the Journal of that week (28th June 2008), which highlighted the carbon load of large medical conferences. Highlights of the well-attended meeting for me were the opening talk by David Pencheon, chief executive of the NHS sustainable development unit; the work of the Carbon Trust; the session on conferencing from a distance, by Hugh Montgomery and Monty Mythen; and the accounts by several speakers on effecting change within organisations. Alan Maryon-Davis (President of FPH) presented data on the reality of climate change
and the enormity of its impact on health, particularly in the third world and on vulnerable groups such as children. No-one need doubt now that this is the number one public health threat and we all have a part in tackling it. David Pencheon spoke stirringly of the NHS role in climate change – both in looking after those affected (35,000 died prematurely as a result of Europe’s heat wave in 2003) and in contributing to the problems (the Carbon footprint of the NHS in England is 18 million tonnes of CO2 per annum). He described the health, financial and moral benefits of reducing carbon outputs and where cuts can easily be made. Areas for action have been spelled out in the paper from the SDU Saving Carbon, Improving lives which is highly readable. Website www.sdu.nhs.uk/page.php?area_id=7 The Carbon Trust gives free advice and has an NHS carbon management programme. Salford Royal University Teaching Hospital shows what can be done: annual savings of £284,000 out of energy costs of £2 million, and 25% saving in CO2 through lighting controls, fitting inverters to various motors, and using
Paediatricians make the case for a smacking ban Following the piece in the summer newsletter on prospects for an amendment to the law to give children the same protection as adults against violence and assault, the matter came to the House of Commons on 8th October. In the lead up to this debate, many paediatricians wrote or spoke to their MP to encourage them to vote in favour of the amendment, which would remove the clause in the Children Act which allows a defence of reasonable chastisement if a parent is accused of violence against their child. The Children are Unbeatable Alliance (CAUA), of which the RCPCH is a member, were very active in distributing
postcards to be sent to MPs and in holding regional meetings for members. They considered that if a free vote was allowed, then a majority of Labour MPs would vote for the equal protection of children. The RCPCH President wrote to Ed Balls, Secretary of State for children, families and schools to request that there be a free vote on this important matter. The main objection from some MPs to voting for equal protection seemed to be the misguided view that parents would be criminalised, might be reported by their children and could be refused jobs following a CRB check. Experience from Sweden is that the change in
Skills for Paediatricians Course to be held on 11th and 12th May 2009 please contact Julia Sharp (Julia.Sharp@rcpch.ac.uk). Dr Andrew Rowland Specialist Registrar in Paediatric Emergency Medicine at Alder Hey Children’s NHS Foundation Trust
metering to allow departmental targets to be set. Any Trust wanting to cut its carbon and save money, should call in the Carbon Trust now! www.carbontrust.co.uk/nhs For many the best and most relevant part of the programme was the demonstration of video conferencing, which is a walkover in the new RCPCH building. Why fly half way round the world when you can hear the speaker round the corner? Yes, you miss out on the networking. But can we justify an international meeting whose footprint is greater than the annual output of an African country? The simple version of conferencing demonstrated by BT, can be carried out from any home or office computer. Using Web-Ex, a group of up to 20 can share material on their screens whilst talking together over the phone. Please try this out for your meetings: just think of the travel time you can save. The afternoon workshops covered sustainable transport, health procurement and the use of high tech approaches. All these and more are on the website – together with a ten point plan for medics that you can start on today! Dr Tony Waterston CHAIR, RCPCH ADVOCACY COMMITTEE
climate in relation to the use of violence in the home is not associated with more parents being charged with an offence. After a meeting with paediatricians, my MP said that he would in fact vote in favour whereas before I think he might have abstained. In the event, no vote was held as the amendment was talked out owing to the economic crisis. It was very disappointing that children missed out once again, but with the strong leadership of the CAUA and the solid advocacy of paediatricians, it is just a matter of time before they receive equal protection under the law. A big thank you to all members who wrote to their MP – we shall make a difference eventually. Dr Tony Waterston CHAIR, RCPCH ADVOCACY COMMITTEE
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News SASG news The RCPCH SASG committee are currently trying to strengthen our links with the other RCPCH committees who focus on issues of particular relevance to SASG doctors. We have SASG representatives linking with the CPD committee, the membership committee, the training committee and the Article 14 committee. Over the next year I hope to include in this column issues relevant to our group discussed in these committees. This time I would like to focus on CPD. Dr Rowlands an associate specialist from Blackpool attends this committee on our behalf. He would like to remind us that revalidation is to begin in the Autumn of 2009 and amongst other things CPD will be very
important in this process. The SASG committee would recommend that all SASG doctors register with the College CPD Scheme. New Guidelines will be published in the near future and there will be an updated online system for recording CPD activities. All doctors will need to keep hard evidence in the form of certificates or relevant paper work. During audits carried out by the College it has become apparent that evidence for internal CPD has been the hardest for members to produce. We should all encourage our departments to devise systems for confirming attendance at internal meetings. In addition, for those applying to PMETB for CESR evidence of appropriate
Health Informatics: an update This title will either make you yawn or hit the wall in frustration. However I do believe that the information elephant is on the move and that finally clinicians have a voice. The RCPCH Health Informatics committee of which I am Chair exists both in reality and as an email discussion. Its members represent the College on national committees influencing Connecting for Health. The Committee has cross representation with other organisations such as the BACCH Informatics Group and acts as a coordinator for information knowledge to enter the College. Lord Darzi’s report whilst re-establishing quality as the vision for the NHS has the constant theme of information which he sees will enable providers of care, patient and public to make
choices, clinicians to improve and managers and researchers to monitor performance. What does this mean for Child Health? The Child Health Programme [CfH] under the leadership of Dr Roddy McFaul has identified information requirements based on agreed process of care. We are thankful to many of you for your important contributions to this valuable tool which we will be using to influence IT specifications. It also reinforced the desperate need for an electronic summary child health record of which the PCHR is a prototype. The Academy of Medical Royal Colleges has approved standards for the structure and content of health records, a project coordinated by the RCP. RCPCH felt that the
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CPD is essential so the effort involved will be well worthwhile. We continue to work on strengthening our network of regional representatives. Dr Wilkinson an associate specialist from Glasgow and the deputy chair of the SASG committee is leading this project for us. The aim is that each region should have a SASG rep who forms a strong link between the SASG paediatricians in their region and the SASG committee. A list of current vacancies is available on the RCPCH website on the RCPCH nominations page, and on the flyer circulated with this newsletter. At the time of writing this column we are busy preparing for our SASG information day at the end of November. I will be able to tell you more about this next time. Dr Natalie Lyth CHAIR OF THE RCPCH SASG COMMITTEE
particular requirements for children could be accommodated within the generic structure but this needed further development which we are taking forward. I have just been appointed as National Clinical Lead for Paediatrics and Child Health [CfH] to join 17 other clinicians in Connecting for Health. A key objective is to ensure that existing and future IT systems are fit for purpose for children. It is now an opportune time for Health Informatics to develop a higher profile both in the College and amongst members. This is a huge task. We are currently creating an RCPCH Health Informatics web section for access to information and how to get involved. You can also contact me directly: david.low@swbh.nhs.uk and visit www.connectingforhealth.nhs.uk/engagement
Dr David Low CHAIR, RCPCH HEALTH INFORMATICS COMMITTEE
Published by the Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London WC1X 8SH. Tel: 020 7092 6000, Fax: 020 7092 6001 Website: www.rcpch.ac.uk Email: enquiries@rcpch.ac.uk The College is a registered charity: no. 1057744 Š 2008 Royal College of Paediatrics and Child Health. The views expressed in this newsletter do not necessarily reflect the official positions of the RCPCH.
RCPCH Spring Meeting
2009 30 March -2 April 2009 The RCPCH’s Annual Spring Meeting will again be held at the University of York from the end of March 2009. The Spring Meeting is the College’s main forum for the presentation of basic and clinical science, together with updates in clinical practice. It is attended by over 2,000 participants, including paediatricians, trainees and those involved in child health. In 2009 the Academic Board has planned a rejuvenated programme. The meeting will open on Monday afternoon with a ‘3 x 5 Hot Topics’ CPD session. By popular demand, the plenary sessions will move to mornings on Tuesday, Wednesday and Thursday. There will be more parallel sessions organised jointly between specialty groups, more posters and a clearly signposted CPD pathway through the week. The Annual Dinner will be held on Wednesday evening, with black-tie optional, to encourage Fellows, Members and guests to attend.
Find more information at www.rcpch.ac.uk/springmeeting
Trainees Trainees’ column The Trainees’ Committee continues to work hard on behalf of paediatric trainees address key issues and to ensure that trainees receive the highest quality of training in the UK.
Workforce Issues We are currently addressing some critical workforce issues that have arisen and will dominate the later part of 2008 and 2009. Following the introduction of the EWTD in 2004, paediatrics saw a necessary expansion in the number of middle grade posts. The fallout from this expansion is now a mismatch between the number of trainees obtaining CCT and the number of available consultant posts. Paradoxically, we are addressing the significant gaps that have arisen in staffing, particularly on middle grade rotas. We have been involved in lengthy discussions with senior members of the College to try and establish innovative ways in which this crisis can be alleviated. As the delivery of paediatric care evolves, we foresee a move towards consultantdelivered care, ultimately requiring expansion in consultant numbers and a change in the role of a new consultant. The report ‘Modelling the Future II’, available on the RCPCH website (www.rcpch.ac.uk/Policy/ServiceReconfigur ation/Modelling-the-Future) examines the options available to address these issues, and consulted paediatricians on the best way forward.
appropriate advice from senior colleagues and the child protection services in all cases of child abuse, and ensure that the necessary professionals are involved and the child is followed up. Safeguarding children courses supported by ALSG are available to trainees, to receive the appropriate training in this area. In addition, some regions have set up one day mini-pupillages for trainees to gain experience in court proceedings in cases of child abuse.
National Trainees’ Forum 2009 The RCPCH Spring Meeting 2009 will see the launch of the National Trainees’ Forum. The National Trainees’ Forum is an opportunity for Trainees to meet and discuss issues central to training and the health service. We have already secured a keynote speaker, and will have a number of excellent presentations in this new and exciting forum.
Assessments survey The Trainees’ Committee has recently released an assessments survey. This survey sets out to determine trainees experience and views of the recent introduction of the assessments process. All trainees should have received a link to the survey online via their e-portfolio. We plan to continue to gain trainee opinion using this method. I would encourage all trainees to voice their opinions so that we can best serve the needs and problems of paediatric trainees.
States and a new Vice Chair to the Trainees’ Committee. On behalf of the Trainees’ Committee, I would like to congratulate Dr. Rajesh Sharma on his recent appointment. I am sure 2009 will bring us many important issues to deal with.
Seats on the Trainees’ Committee We have recently had a number of regional representatives stand down from the Trainees’ Committee as they have served their 3 years on the Committee or are approaching CCT. I would like to thank them for their hard work and input to the Committee. I would like to encourage all trainees around the country to stand to become a regional representative on the committee. As a representative you would be involved in many of the key decisions regarding paediatric training and you would be central to gathering and disseminating vital information within your region. Places are open to trainees from ST1-8. As a member of the College you should receive a nomination list in the post. Visit the College website at www.rcpch.ac.uk/nominations to download nomination forms. Available seats will be released shortly.
Happy Christmas On behalf of the Trainees’ Committee I would like to wish you all a very Happy Christmas and all the very best for 2009!
Child Protection Recently, the news has been dominated by the tragic death of Baby P. Trainees are advised to be diligent when examining all children for signs of abuse. All trainees should seek
Appointment of the New Vice Chair of the Trainees’ Committee In the last two months, we have seen the election of a new President of the United
Dr Paul Dimitri CHAIR, TRAINEES’ COMMITTEE pauldimitri@hotmail.com
NPSA/RCPCH - Safer Practice in Neonatal Care Project Neonatal Transport Survey The Project Team would like to convey their very grateful thanks to all neonatal units that responded to the Transport Group’s Neonatal Transport Survey. We appreciate the time given up from your busy work schedules to complete the form. You have provided an 80% response which will provide valuable information on which to base further work and inform the Department of Health’s Work Stream for neonatal transfers. Results of the survey will be included in the Project’s final report which will be disseminated early in 2009 to all units. Clare Litherland PROJECT COORDINATOR
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RCPCH news
Meetings Forthcoming Events UK meetings and courses 2009 7-9 January 2009 Children’s Mental Health Venue: Cardiff University, Heath Park, Cardiff Contact: Chisako Okada Tel: 02920 744562 Email: okadac@cardiff.ac.uk Website: www.courses.cardiff.ac.uk/ postgraduate/course/detail/840.html 7-8 January 2009 Endovascular Eneurysm Repair Planning (ST1-2) Venue: Royal College of Surgeons, London Contact: Farhana Jilani Tel: 020 7869 6328 Email: fjilani@rcseng.ac.uk 8-9 January 2009 Intermediate Cardiac Surgery (ST3-6) Venue: Evelina Children’s Hospital, London Contact: Dr Owen Miller Email: owen.miller@gstt.nhs.uk 8-9 January 2009 Foundation Course in Paediatric Echocardiography Venue: Royal College of Surgeons, London Contact: Farhana Jilani Tel: 020 7869 6328 Email: fjilani@rcseng.ac.uk 11-12 January 2009 Intermediate Obstetric Ultrasound (Theroy & Practical) Venue: Addenbrooke’s Hospital, Cambridge Contact: Mrs Julie Graham Telephone: 01223 274419 Email: jlg37@medschl.cam.ac.uk Website: www.addenbrookes-pgmc.org.uk 12 January 2009 The First UK Paediatric Neuropsychology Symposium - Part 1: Development of sensory, motor and cognitive neural systems Venue: The Institute of Child Health, London Contact: Kathryn Gresty Telephone: 020 7905 2135 Email: k.gresty@ich.ucl.ac.uk 12 January 2009 Basic Obstetric Ultrasound (Theroy) Venue: Addenbrooke’s Hospital, Cambridge Contact: Mrs Julie Graham Tel: 01223 274419 Email: jlg37@medschl.cam.ac.uk Website: www.addenbrookes-pgmc.org.uk 12-14 January 2009 19th Annual Course in Paediatric Gastroenterology and IBD/Endoscopy Venue: The Atrium, Royal Free Hospital, London Contact: Mrs Rivka Persoff Tel: 020 7830 2779 Email: r.persoff@medsch.ucl.ac.uk
12-13 January 2009 Speciality Skills in Vascular Surgery (ST1-2) Venue: Royal College of Surgeons, London Contact: Farhana Jilani Tel: 020 7869 6328 Email: fjilani@rcseng.ac.uk 13-16 January 2009 Basic Obstetric Ultrasound (Practical) Venue: Addenbrooke’s Hospital, Cambridge Contact: Mrs Julie Graham Tel: 01223 274419 Email: jlg37@medschl.cam.ac.uk Website: www.addenbrookes-pgmc.org.uk 15-16 January 2009 Operative Skills in Neonatal and Paediatric Surgery (Formerly known as ‘Core Skills in Paediatric Surgery’) Venue: The Royal College of Surgeons of England, London Telephone: 020 7869 6331/6332 Email: paediatric@rcseng.ac.uk Website: www.rcseng.ac.uk/education/courses/ specialty/paedcourses.html 19 January 2009 The First UK Paediatric Neuropsychology Symposium - Part 2: Developmental disorders and neuropsychological profiles Venue: The Institute of Child Health, London Contact: Cristina Lai Tel: 020 7829 8692 Email: cristina@ichevents.com Website: www.ich.ucl.ac.uk/education/short_ courses/courses/2S44 19 January 2009 British Society for Paediatric and Adolescent Gynaecology Training Day- Joint RCOG/BritSPAG Meeting Venue: RCOG, London Tel: 020 7772 6245 Email: conference@rcog.org.uk Website: www.rcog.org.uk/index.asp?PageID= 101&ConferenceID=370
20-22 January 2009 Advanced Paediatric Intensive Care Simulation (APICS) Course Venue: Bristol Medical Simulation Centre, Bristol Contact: James Fraser/ David Grant Telephone: 0117 342 8843 Email: James.Fraser@UHBristol.nhs.uk David.Grant@UHBristol.nhs.uk 21 January 2009 5th Northwest Neonatal Study Day Venue: The Ramada Jarvis Hotel, Bolton Contact: Amanda Graham Telephone: 01438 730883 Email: amanda@cfsevents.co.uk 22 January 2009 Advanced and Outcomes in Neonatology Venue: UBHT Education Centre, Bristol Contact: Joyce Achampong Tel: 020 7290 2980 Email: egions@rsm.ac.uk Website: www.rsm.ac.uk/diary 22 January 2009 Neonatal Opthalmology Venue: Addenbrooke’s Hospital, Cambridge Contact: Mrs Julie Graham Tel: 01223 274419 Email: jlg37@medschl.cam.ac.uk Website: www.addenbrookes-pgmc.org.uk
22-23 January 2009 Paediatric and Adolescent Obesity Course for Paediatricians Venue: RCPCH Office, London Contact: Aaron Barham Tel: 020 7092 6105 Email: aaron.barham@rcpch.ac.uk Website: www.rcpch.ac.uk
19-20 January 2009 Paediatric Clinical Trials conference Venue: Copthorne Tara Hotel, London Contact: Charlotte Johnson Telephone: 0870 9090 711 Email: cjohnson@smi-online.co.uk Website: www.smi-online.co.uk/09paediatric1.asp
Worldwide meetings and courses 2009
20 January 2009 British Society for Paediatric and Adolescent Gynaecology Annual Meeting Venue: Nuffield Hall, RCOG,London Contact: Carol Northey Telephone: 07939 855851 Email: cnorthey@blueyonder.co.uk Website: www.britspag.org
6-9 February 2009 World Forum of Paediatrics Basic Science & Clinical Management Venue: Dubai, United Arab Emirates Telephone: 7-495 735 1414 (Russia) Email: Abstracts congress2009@mail.ru Registration, Accommodation & Tours Website: www.wipoped.org
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