RCPCH Annual Report 2005 by Royal College of Paediatrics and Child Health

Royal College of Paediatrics and Child Health

Annual Report 2005-2006

RCPCH Presidents

Professor Sir Roy Meadow 1996-1997

Professor David Baum 1997-1999

Professor Richard Cooke 1999-2000

Professor Sir David Hall 2000-2003

Royal College of Paediatrics and Child Health Annual Report 2005-2006 Copyright © 2006 Royal College of Paediatrics and Child Health Further copies available on request – contact publications@rcpch.ac.uk

Professor Sir Alan Craft 2003-2006

Dr Patricia Hamilton President Elect

Contents

President’s Report

Registrar’s Report

Education

Continuing Professional Development

Health Services

Research

Training and Assessment

International Affairs

The Devolved Countries

Running the College

Fund-raising

Structure of the College

Treasurer’s Report

Accounts

Response Form

From the Collegeâ&#x20AC;&#x2122;s Royal Charter The objects of the College shall be: (i)

to advance the art and science of Paediatrics;

(ii)

to raise the standard of medical care provided to children;

(iii) to educate and examine those concerned with the health of children; (iv) to advance the education of the public (and in particular medical practitioners) in child health, which means the protection of children, the prevention of illness and disease in children and safeguarding their optimal development.

President’s Report

There has been a clear recognition that the health of children is intimately associated with, and influenced by, social and educational factors.

Professor Sir Alan Craft, President

In 2005 the Royal College of Surgeons of Edinburgh celebrated their 500th anniversary – the oldest of the medical Royal Colleges. The Physicians of London are not far behind. We ourselves are ten years old and we are no longer the youngest College since the formation of the College of Emergency Medicine in 2005. A significant birthday is a time for reflection and for looking forward. The BPA was founded in 1928 and along with the Royal College of Physicians served the profession well until the 1960’s when the first suggestions were made that we should establish our own College. It took another 30 years to achieve this goal. Ten years on we can reflect as to whether it was worth the effort of our predecessors. George Frederic Still chaired the first meeting of the BPA in 1928, which was attended by only six of the 24 paediatricians invited. In his wildest dreams he could never have imagined a College for children with well over 8000 members. The major reason to become a College was for paediatricians to be in charge of their own destiny and to have a real voice for children. Our break from the ancient Colleges of Physicians was not easy and for a while there were some remaining tensions. In the first annual report of the College in 1997 the President wrote, “Paediatricians now enjoy similar authority and rights to those of other major medical disciplines. There is the opportunity for greater professional recognition of the importance of children, improved status of paediatrics and child health, and an enhanced role for paediatricians as advocates for children.” Ten years on we work closely with all four Royal Colleges of Physicians in the UK and Ireland. They recognise our strengths and we play a substantial role in the Academy of Medical Royal Colleges. We are now in charge of our own destiny.

Three years ago the Department of Health recognised the need to reform postgraduate medical education and challenged all Colleges to come up with plans to produce a workforce appropriately trained for 21st century medicine. We have taken up that challenge and redesigned our curriculum with clear objectives as to what needs to be achieved at all stages of training. In the past, time served in training posts was the major criterion for progression. The public now expects its doctors to be trained to an explicit standard and this has meant a move to a competencybased curriculum with methods having to be developed to test these competencies as they are acquired. There is no doubt that much of the work that we have been doing in this area has been at the forefront of educational thinking and our work has become a model aspired to by other Colleges. We have also needed to modernise our exam structures. Exams need to be fit for purpose and to be as objective as our subject allows. In the past the clinical part of the exam had been something of a lottery. What we need to do is to ensure that good candidates pass and others are given feedback as to how improve their chances in future. Once again we are at the forefront of development of medical exams in the UK. Increasingly we are being asked to deliver examinations overseas. Whilst in many ways this is an attractive proposition we have to be careful not to overstretch ourselves. Clinical spaces in the UK are just about at capacity and we have occasionally had to defer people to the next sitting. It would be attractive to hold more clinical exams overseas but each sitting takes 10 examiners and even if half are local examiners, finding the other half in today’s stretched NHS will be difficult.

President’s Report

Indeed finding sufficient time from busy NHS or University consultants to undertake College work is increasingly difficult. The new consultant contract with its very explicit work plan makes it hard to fit in outside activities. Most Trusts are very generous with their consultants’ time and we are grateful. However, we must ensure that the College has the staff and structures to properly support those paediatricians who volunteer to help the College. Ten years ago we modelled our structure on the traditional College model and philosophy. Most Colleges have realised over the last few years that this is unsustainable. We are now a moderatesized business and must act like such. We have an annual budget of almost £8m and nearly 100 employees. Len Tyler and his senior staff, along with officers, have spent the last year drawing up plans for a new structure that fits the 21st century. The NHS is a constantly changing organisation and the College has to be flexible enough to “go with the flow”. Even such seemingly immoveable objects as regional deanery boundaries have been constantly changed. The Strategic Health Authorities invented a few years back are now being amalgamated into what look strangely like the old Regional Health Authorities. Primary Care Trusts too are getting together to look like the old District Health Authorities. However, there does seem to have been a consistent move to decentralise the NHS and over the next three years all Trusts will become Foundation Trusts with a huge amount of autonomy. The College has to be nimble enough to react to these constant changes. There is little that we can do to influence political dogma but we can help paediatricians respond and adapt to the changes.

continued

There has been a clear recognition that the health of children is intimately associated with, and influenced by, social and educational factors. It seemed sensible, therefore, to bring health, social care and education together. At a central level the responsibility for children’s health has been split between DH and DfES and at a local level it is anticipated that Children’s Trusts (an amalgam of all those with an interest in children) will be the vehicle for the commissioning and organisation of services. However, there is a real danger of fragmentation of services as there is no mandatory model which has to be followed. In the new NHS there are at least six possible commissioners of services for children and no guarantee that they will cross geographical boundaries. What children need are networks of care which do not respect arbitrary boundaries. The College is pushing hard to achieve “network commissioning”. The last ten years has also seen the devolution of power to Scotland, Wales and to a lesser extent Northern Ireland. This has meant an increasing divergence in the way that the NHS is run in the four countries. The College has adapted by setting up offices in Cardiff and Edinburgh and our strengthened Welsh and Scottish committees are increasingly being called upon to give advice to politicians and the executive.

We play a role in Europe by our membership of what is about to become the European Academy of Paediatrics, an amalgam of the CESP and the European Board. The EU allows more or less free movement of labour across its boundaries including the new accession states, some 25 in all. Being trained and on the specialist register in one country gives automatic entry on to the register of another. Yet there has been no standardisation of training or of qualifications. Over the past few years we have worked closely with our colleagues in Europe to define curricula for all of the major paediatric sub-specialties. Assessing progress through training and its completion is more problematic. Very few countries have examinations and a great reliance is placed on satisfactory completion of training posts, largely time served in a post. Visiting and accreditation of posts is being developed but there is little enthusiasm for a European examination, especially from the trainees. But we have successfully run a pilot MCQ based on our own membership exam. Progress in Europe is slow but there will have to be more integration, evaluation and accreditation of training. The UK is a very attractive place for professionals and we are seeing increasing numbers applying for posts here. The President’s report last year majored on our child protection initiatives. We recently launched the first module of a training package which has been developed in conjunction with the NSPCC and the Acute Life Support Group. We envisage that this one day programme of training will be taken by all trainees and will give them the fundamentals to make them basically competent and confident to take the first steps in recognising potential abuse and knowing how to take things forward.

The past year has also seen major developments in the field of medicines for children. It remains a fact that 90% of medicines given to newborns and at least 50% of those given to older children are untested in children and, therefore, unlicensed. Recent European legislation will give incentives to the pharmaceutical industry to test new products on children although how to deal with those already on the market is problematic. In 2004 the RCPCH produced a report, Better Medicines for Children, in which it made a number of important recommendations around increasing capacity in paediatric clinical pharmacology and clinical trials. The DH responded with a ÂŁ20m annual budget to develop a clinical trials network for children in order to take advantage of the opportunities afforded by the new legislation. The national co-ordinating centre has now been established in Liverpool with a number of regional networks.

In the meantime we continue to need to prescribe medicines for children and 2005 saw the production of the first edition of the British National Formulary for Children which is a natural successor to our former Medicines for Children. The BNF-C is being sent free of charge to most doctors in the UK and already considerable interest is being shown from other countries. This has been a major development over the last ten years and is a tribute to many people and in particular our collaboration with the Neonatal and Paediatric Pharmacists Group.

So my three years at the helm have ended and I pass over responsibility to Pat Hamilton at the Annual Meeting. My task as President would not have been possible without the support of the excellent College Officers and dedicated staff. I am also grateful to all of our members and fellows who have supported the College and the Officers in so many ways. I now return to the backbenches and will look on with interest and pride as we continue to build on the foundations established by Still, Spence, Paterson and their visionary colleagues in 1928.

Registrar’s Report

We are now looking forward to seeing much more involvement for young people in the College’s activities.

Dr Sheila Shribman, Registrar

By the time you are reading this I will have moved on to pastures new having taken up my new appointment as National Clinical Director for Children in England at the end of 2005. I have immensely enjoyed my time as Registrar and it has been a privilege to work closely with so many of you to take forward the College’s important work. It has been another very busy year for all of us and this is reflected once again in the number of publications, guidance documents and responses we have produced and in the increasing number of meetings and College organised events.

The 2006 Policy Conference is on the topic of ‘Modelling Children’s Services for the Future’ to discuss the work the College is undertaking to update our documents ‘The Next Ten Years’ and ‘Strengthening the Care of Children in the Community’. This is a major College project to examine which service models are the most appropriate for delivering the best care to children in the light of the recent changes, which have taken place. In particular, addressing the impact of the Children’s NSFs on our planning and thinking. It is planned to publish this work in the summer.

Child protection continued to have major prominence on the College’s agenda during the year. The Child Protection Companion is being published to assist all paediatricians and trainees in their day-to-day work in child protection. We appreciate the hard work that has gone into producing this document from colleagues. Dr Jean Price chairs the College’s Child Protection Committee, which has had another very active year addressing a number of important issues. Among this work undertaken by the RCPCH was an initiative for judges in local areas to give advice to paediatricians on how to present evidence in Court. In the Mersey region, for example, joint training has been established with the Family Law Bar Association to provide CPD, which is of mutual benefit for doctors and lawyers. The College has also set up the Mini-pupillage scheme, which is a regional system to allow trainees to accompany judges to court to learn about legal processes. The importance of cross-cutting child protection work was recognised by the appointment of an additional member of staff to co-ordinate our child protection activities which includes increasing links with other colleges.

An important issue that Council has addressed this year is how the College can improve the service it provides to Regional Committees and the communication they provide to the membership. We have revised and updated our guidance on Regional Committees and will circulate important Council documents to regional representatives in plenty of time for these to be discussed by members locally and their views. Communications with members will also be improved through further development of the website over the coming months including more links. We plan to include a section on Health Services issues and have improved information for parents and carers. In the longer term it is also planned to introduce e-learning. The College offices in Scotland and Wales continue to expand to meet the demands of the devolved governments there and additional members of staff have been appointed in Edinburgh and Cardiff. Activities in Ireland have also increased significantly widening the College’s influence both north and south of the border.

During the past twelve months I have been involved in the work to modernise and restructure certain aspects of the College and its committees. Len Tyler deals with progress in his report (see section ‘Running the College’). The next stage is to review the terms of reference and work plans of all College committees to ensure they are focussed on the work assigned to them by Council. In future, there will be a greater emphasis on setting up short life working parties rather than establishing more committees. The Patient and Carers Advisory Group continues to play an important role in providing lay advice to College Committees. Mrs Carole Myer, who has chaired this Group since its inception in 2000, has now stepped down. We will miss her wisdom and enthusiasm and we thank her for an enormous contribution in this area of work. The College published during the summer ‘Coming Out of the Shadows: A Strategy to Promote Participation of Children and Young People in RCPCH Activity’. This was to take forward the policy agreed by Council to involve young people in the work of the College. The main recommendation of the report was to recruit a children’s participation manager and we have appointed Ms Sophie Auckland to take this work forward. We are now looking forward to seeing much more involvement for young people in the College’s activities. Following publication of the Kennedy Report last year, the College has been represented on the committee considering its implementation. In addition, Council agreed to set up a Kennedy Implementation Group to address how the report should be implemented and in particular, to produce a detailed job description for the SUDI paediatrician. This report will be published in the Spring.

The publications approved by Council and produced during the year included the Workforce Census 2003, a Framework of Competences for Core Higher Specialist Training in Paediatrics and a policy guidance document on Safe Cover Arrangements for Paediatric Departments Out of Hours. We also produced a new short briefing paper on revalidation on the website, with more guidance expected next year. It highlights the importance of CPD and the need for regular appraisals. It is expected that Colleges will be asked to play an increasing role in setting the standards for revalidation in the future. In addition to the production of reports and guidance the College responded to a wide range of consultation documents. These included: • The Ethics of prolonging life in Fetuses and the Newborn (Nuffield Council on Bioethics) • The GMC review on Good Medical Practice • The Acutely or Critically Sick or Injured Child in the District General Hospital: A Team Response – The Tanner Report (Department of Health) and a number of documents in relation to Working Together to Safeguard Children (Department for Education and Skills). I would like to thank the President, Officers, Members and College staff for all their hard work and the outstanding support provided to me during my period of office as Registrar. I look forward to maintaining close links with the College in my challenging, new role.

Education

These projects are varied but the common thread is that they aim to develop knowledge and expertise in areas that are important for all paediatricians.

Dr Chris Verity Vice-president, Education

The Education Department has continued with its mission to provide stimulating meetings and courses and expand the educational activities of the College. The Department consists of just seven hard working College staff members. They are greatly supported by the members of the Academic Board who ensure that these activities are of high quality and by the members of the CPD Sub-committee, who wrestle with the increasingly complex areas of postgraduate medical education and continuing professional development.

College meetings The Spring Meeting must continue to be a showcase for scientific excellence and the contribution of the specialty groups is crucial for this. They decide which of the submitted abstracts are forwarded to the Academic Board for consideration as plenary presentations. However the majority of papers are presented in the specialty sessions and it is essential that these reflect the needs and interests of their members. The Meeting must be attractive to sub-specialists as well as those with a general paediatric interest. Of course the College must speak for child health in general and therefore this aspect of the Meeting is most important. All sorts of educational activities take place and we are very grateful to those who provide the personal practice sessions, symposia and other sessions that make up this rich mixture. In 2005 there were excellent symposia on “Patient Safety: Children and Young People in the NHS”, and “Autism”.

Because the Meeting is a complex mixture of many simultaneous activities there are few suitable venues. This complexity puts up the costs and we do not receive any direct sponsorship, apart from the revenue from the trade exhibition, so the fees are higher than we would like them to be. However the Spring Meeting makes little profit for the College and we keep the costs and the venue under regular review. For the third year we distributed a CD “Highlights of the 8th Spring Meeting” to the 9,000 Fellows and Members of the College. The CD was prominently displayed on the front of the December newsletter. College members were encouraged to comment on the CD and so far the feedback has been extremely positive. We hope to produce a similar CD in 2006. The introduction of electronic submission of abstracts for the 2005 Meeting was very successful and we have been able to develop this system to facilitate adjudication of the papers. The introduction of on-line registration in 2005 provided a streamlined service to those booking to attend the meeting and cost savings which were directly proportionate to its up-take.

Other meetings The College organises joint meetings with the RSM twice a year. In October “Infectious Diseases: an Update for Paediatricians” was well attended. “What do we Know about Chronic Fatigue Syndrome/ME?” will take place at the RSM on 25 April 2006. There is an annual joint meeting with the Royal College of Physicians of Edinburgh. This year the title is “The Art and Science of Child Protection” and the meeting is scheduled in Edinburgh on 28 September 2006.

Dr Janet Anderson has played a most important role in supporting College Tutors by organising the planning of the yearly Annual Tutors Meeting and the first of a planned series of meetings for the “Induction of New Tutors”. The second of these meetings is being organised in June 2006. We have been working with the College Standing Committee on Child Protection and the Child Protection Special Interest Group to plan meetings about child protection, including a meeting on “The Role of Paediatric (NHS) Managers” which took place on 30 September 2005. We were very pleased to work with Dr Peter Sullivan, the David Baum Fellow (Officer for International Affairs), to help with the organisation of a College course for Iraqi, Palestinian and Jordanian paediatricians in Amman in December. This was the second such event, and comprised two courses: “Teaching Paediatrics and Child Health” and “Paediatric Life Support”.

The development of courses and teaching sessions We ran the third Diploma Course on Paediatric Nutrition in May 2005 and this was attended by 13 participants/candidates, all of whom had previously completed the InterCollegiate Course on Human Nutrition. The next course will take place 15-19 May 2006 in Southampton. The College and the steering committee are taking forward negotiations for a formal partnership with the University of Southampton that would lead to external accreditation for the Diploma. This provides a possible model for the development of other courses by the College. Other educational activities are well under way. The Child in Mind Project is developing three teaching modules for paediatric trainees, all aiming to enhance their appreciation of the complex emotional and behavioural issues that confront paediatricians in their practice.

A teaching package for junior trainees entitled “Safeguarding children – recognition and response in child protection” has just been launched and we are using a donation from the Johnson and Johnson Pediatric Institute to develop a more advanced child protection course for senior trainees and career grade paediatricians. We are also planning a series of linked days for paediatricians who are interested in improving their performance as teachers of the art of paediatrics. These projects are varied but the common thread is that they aim to develop knowledge and expertise in areas that are important for all paediatricians. We hope to expand such educational activities and we are exploring the possibility of producing web-based learning packages to support these educational initiatives.

Continuing Professional Development 2005 was a progressive year for CPD.

Continuing Professional Development (CPD) is a systematic process of lifelong learning and professional development. Its aim is to enable paediatricians to maintain and enhance their knowledge, skills and competence for effective clinical practice to meet the needs of children. The Directors of CPD Sub-Committee (DoCPD) of the Academy of Medical Royal Colleges ratified the 2005 updating of the document â&#x20AC;&#x153;(Ten) Principles for College/Faculty CPD Schemes: A Framework for Continuing Professional Developmentâ&#x20AC;?. The RCPCH scheme already conforms to these principles.

Dr Alistair Thomson Officer for CPD

The CPD Sub-Committee of the Academic Board have substantially edited the CPD guidelines for 2006 at their meeting in September 2005, reducing reduplication and eliminating inconsistencies and contradictions. 2005 was a progressive year for CPD with the launch of the online website at the 9th Annual Spring Meeting. The online system enables participants to enter and monitor their returns online, print out point summaries and maintain a detailed record of activities diary. Use of the website is not compulsory, however the response to its launch has been excellent. Within the first month of its launch 540 participants registered to use the website, and on the 3rd January 2006 there were 1482 participants registered to use the online system. Improvements are currently being made to make the website more user friendly and a diverse range of facilities available. The New Year will see the addition of the facility of being able to add reflective notes online.

The launch of the online website uncovered a discrepancy between the apparent participation rate of Paediatricians on the CPD scheme and the true participation rate. Statistics are generated for the RCPCH Council and RCPCH Executive Committee meetings. These show the number of doctors eligible to participate in CPD and those that are participating. All previous statistics had been generated on the assumption that all doctors registered on the scheme were actually eligible. The new website highlighted that this was not the case. There were 1100 paediatricians participating on the scheme who were registered but not eligible. Possible reasons for these participation status are: retired from practice and not yet removed from the scheme, inappropriate grade, change of grade since registration or RCPCH membership lapsed. Since this has been discovered the data has been cleaned and procedures established to ensure the standard of the data is maintained. The current participation rate is 79.4%. An annual audit of 5% of the RCPCH CPD participants is carried out. The results to date show a significant number of doctors who have insufficient evidence to support 25 points claimed for 2004 and no Personal Development Plan completed for 2004. The participants were asked to complete a questionnaire regarding the possibility of auditing internal CPD in the future and the evidence they could produce. The initial replies show a trend of doctors concerned about the increased workload relating to collecting of internal evidence.

Health services

It promises to be a challenging year but one in which the RCPCH can play an active role both in influencing the wider agenda and supporting its membership. Dr Simon Lenton Vice-President for Health Services

The prediction, made in last year's Annual Report, that change in health services would continue to accelerate, has proved to be correct. The introduction of Foundation Hospitals, Independent Sector Treatment Centres, Payment by Results (PBR), the separation of commissioning and provision in a “Patient Led NHS”, the evolution of NPfIT to Connecting for Health, and the expected White Paper following the public consultation on “your health, your say, your care” all signal more change for 2006. Recent ministerial speeches are setting a fairly clear future agenda. (see http:// www.dh.gov.uk/NewsHome/Speeches/ SpeechesList/fs/en). While there has been unprecedented investment in health services over the last 10 years, and although many targets have been achieved, overall this has not led to the degree of improvement expected. Consequently, there will be a focus on increasing choice, competition and contestability, strengthening of commissioning, and increased regulation/ inspection. Each of these elements requires better data capture, information and knowledge, and much will depend on the success of the many Connecting for Health projects. Given the enormity of the agenda, the Health Services Committee (HSC) and Paediatricians in Medical Management Group (PIMM) have spent some time revising their remit and work plans, to complement one another, with Health Services taking a more strategic view, and the Medical Management group a more operational approach. The intention is to develop a more proactive approach to the health policy agenda, with application in the four nations, while simultaneously providing more support to paediatricians in leading roles and those involved in medical management.

Given the importance of the information agenda, the e-mail Informatics Forum has been complemented with a College Child Health Informatics Working Group, consisting of members who represent the College on outside groups or committees. The external agenda this year has focused on the information sharing, Choose and Book, and the work of the Care Records Development Board. In addition, the Department of Health is about to have its first meeting to consider the implementation of the NSF Information Strategy. Future workforce estimates continue to be a major preoccupation and made more difficult by all the changes in postgraduate medical education, the changing workforce agenda and, in particular, the potential for role substitution between professions as competency-based approaches are rolled out through the health service. During 2005 the College Workforce Team reported on the 2003 census, highlighting problems in the community and academic paediatric workforce, and the growth of non-standard trust grade doctors. A further census of career grade doctors and SHOs is now under way, alongside an SpR career intentions survey in order to inform the DH modelling process. The Workforce Team have supported both HSC and PIMM in undertaking surveys on the new consultant contract, treatment centres and designated and named doctors for child protection as well as contributing to the DH sponsored National Child Health Mapping Project. Increasingly, services are being delivered by teams working within wider networks, which will require even better working relationships between the various professional groups involved, and this in turn needs to be supported by the organisations representing those groups through closer working relationships.

The Quality of Practice Committee continues to appraise and produce distillates of the best evidence and the future focus will be to find ways that this best evidence can be put into practice at a local level. This fits well with the improvement agenda, and the potential future role of professional bodies to support both individuals and systems to deliver best possible care.

It promises to be a challenging year but one in which the RCPCH can play an active role both in influencing the wider agenda and supporting its membership with practical responses to the various policy initiatives.

The major piece of work for 2006 is provisionally entitled “Modelling the Future”. The remit is to initially produce a document that “proposes models of service delivery for children and families and examines their applicability in a range of settings, covering small, medium and large populations; both in urban, rural and remote areas”. The medical workforce implications of the various models, recognising the importance of teamwork and the competencies of other professional groups will then be examined.

Research

A number of important research activities have been initiated and completed this year.

Professor Neil McIntosh Vice President, Science and Research

This year has been both successful and eventful for the College’s Research Division! The year began with the launch of the first RCPCH evidence-based guidelines: on the management of CFS/ME. This was organised by our collaborators, the patient support group AYME (Association of Young People with ME), at the Houses of Parliament. The guidelines have been well received and we hope that they will make a contribution to improved standards of care for children with this puzzling yet debilitating condition. In May we re-located to new offices around the corner from 50 Hallam Street. This move, which was in part due to the general pressure on office accommodation in the headquarters building, also offered an opportunity for the College to demonstrate its commitment to evidencebased paediatric practice by subletting some of the new space to the NICE Collaborating Centre for Women’s and Children’s Health. Co-locating the Research Division with the NICE children’s team, led by Dr Monica Lakhanpaul, a paediatrician from Leicester, offers exciting potential for closer collaboration between the two units in the future. In June 2005 the Research Division organised one of the most colourful and enjoyable events I have attended at the College to mark the end of the 2-year project to develop a children’s participation strategy. This work involved consultations with over 70 children as well as staff and members and the report “Coming out of the Shadows” made recommendations for the RCPCH about how to encourage and support children’s participation. For the event, the College building was festooned with balloons and both children and adults were entertained by clown doctors and an improvisational theatre group. Professor Al Aynsley-Green attended as a guest speaker.

We believe we are the first medical Royal College to develop a participation strategy targeted at children and young people and I am pleased to report that at the time of writing the main recommendation of the report, the appointment of a Children’s Participation Manager has already been delivered. A number of important research activities have been initiated and completed this year. The team has been working on two new RCPCH evidence-based guidelines. The first is to update the 1995 guidelines for the screening and treatment of Retinopathy of Prematurity (jointly with the Royal College of Ophthalmologists) and work has been continuing on reviewing the evidence for the physical signs of child sex abuse. The latter project, which is being undertaken with the Association of Forensic Practitioners and the Royal College of Physicians (RCP) will result in a clinical handbook to replace the RCP book last printed in 1997. 2005 has also seen some changes to the clinical effectiveness programme run by the Research Division. At the beginning of the year we had three new staff and the autumn saw the departure of Dr Harry Baumer, who has chaired the Quality of Practice committee (QPC), integral to this programme, for the last 5 years. It was largely due to Harry that the RCPCH’s guideline appraisal programme, which has now delivered over 25 appraised guidelines, was initiated. We are extremely grateful to him for his unfailing commitment and hard work on behalf of the College to promote evidence-based practice. His role has been taken over by Dr Edward Wozniak and we look forward to an exciting new era of evidence-based work under his direction which is likely to see gradual shift in focus from appraising guidelines to providing implementation and audit tools to support members.

Supporting doctors in child protection continues to be high priority on the College agenda and the Research Division is helping to deliver this. In 2005 the 2004 survey of members about complaints in child protection was followed by a qualitative interview study by Dr Jackie Turton to identify why paediatricians are vulnerable to complaints in child protection. Over 70 paediatricians were interviewed and preliminary findings indicated how stressful the experience had been for many. Factors that appeared to trigger a complaint included diagnostic uncertainty, the way in which the possible diagnosis was communicated to families, failures in multi-disciplinary working, lack of expertise or failure to follow good practice and a lack of resources such as space, time and skilled staff, especially out of hours. A full report of the research findings will be available in early 2006. Obesity has been another College priority and RD work in this area includes facilitating the development of an obesity research initiative. A multi-disciplinary group of experts has developed a research proposal to evaluate interventions to influence early nutrition, dietary, physical activity patterns in infancy based on health visitor education. In 2005 the RD also completed 13 months surveillance on nontype 1 diabetes through the BPSU partly funded by Diabetes UK. Preliminary findings suggest an incidence of non-type 1 diabetes in under 17â&#x20AC;&#x2122;s of 1.16/100,000 and 0.43/100,000 for type 2 diabetes with over 87 cases of obesity-related type 2 diabetes notified over the period. A second BPSU study by research staff, on early-onset eating disorders, in collaboration with the Royal College of Psychiatrists, began in May 2005 and in the same year funding was received from the Department of Health for a pilot study in collaboration with the Scottish Neonatal and Paediatric Pharmacy Group to test the feasibility of national surveillance of adverse drug reactions (ADRs) in children which will begin in 2006.

The workforce team, under the direction of the Officer for Workforce Planning, Dr Sue Hobbins, published the results of the 2003 census early in 2005. Although numbers of paediatric consultants continue to rise, the census revealed concerns about the numbers of community and academic staff, as well as significant growth in non-standard Trust grade doctor posts. The 2005 census is now under way and results are expected during 2006. A report on the career intentions of final year SpRs also showed that more than 40% of trainees aspire to work part-time on becoming consultants. The imminent introduction of MMC and the run-through grade has meant the workforce team has worked closely with colleagues in Training and the NHS Workforce Review Team to plan the numbers of trainees needed to support future needs. The forthcoming year is a particularly exciting one for the BPSU and marks our 20th year of surveillance. Over this period the unit has facilitated surveillance of over 60 conditions, identifying more than 20,000 cases, data from which has leant itself to over 300 publications and presentations. To recognise this achievement the Unit will be holding a symposium at the ICH London in May 2006. We are also launching a new BPSU website and would urge you to visit the site and also ask your Trust webmasters to add a link to it at http://bpsu.inopsu.com.

remains over 90% though this is down nearly 2% on 2004 so we do urge all who receive cards to return them. On the international front the BPSU continues to serve as the link between the International Units and will be hosting the fourth INoPSU conference in London in 2006. Finally there have been several changes on the Executive. Professor Mike Preece is stepping down as chair after nearly five years, Mike Richardson and Bill McGuire after five years also stepped down from the committee, we thank them all for their invaluable contribution. As always the success of the BPSU is wholly dependent on the contribution of the paediatric community, and on behalf of our investigators we thank you. Finally, it is very exciting to report that in November the RD secured the award of a 2-year contract from the Healthcare Commission to develop and implement a national programme of audit of neonatal intensive care. The project will start in January 2006 and involves a web-based collection of a minimum audit dataset, already developed with substantial clinical and parental input. It is hoped that this audit will encourage neonatal units to participate in a quality improvement programme.

The past year has seen the BPSU Executive consider seven preliminary and three full applications for new studies, with three studies, MRSA, scleroderma and early onset eating disorders commencing in 2005. The Sir Peter Tizard bursary for 2005 was awarded to Dr Shamez Ladhani and his study on Malaria commenced in January 2006. With five studies ending in 2005 we have spaces available on the orange card, so may I take this opportunity to encourage those with ideas for a surveillance project to contact the BPSU. The return rate for the orange card 17

Training and Assessment

We have come up with a programme that will enable the trainees of the future to acquire all the competences they need in the breadth and depth that is suitable to their chosen career.

Dr Patricia Hamilton Vice President, Training and Assessment

It has been another extremely busy year for the Training and Exams Departments. We have been trying to keep up with all the challenges posed to us by the Postgraduate Medical Education and Training Board (PMETB) and Modernising Medical Careers (MMC). We have further developed the curriculum and have now, we hope, finalised our training programme, ensuring that we are happy with the quality and suitability of the content, whilst also conforming to the pressures placed on us by MMC. We feel that we have come up with a programme that will enable the trainees of the future to acquire all the competences they need in the breadth and depth that is suitable to their chosen career. We feel that the programme is truly competence-based and has built into it sufficient flexibility to allow trainees to progress through it according to their competence, their confidence, and the context in which they are training towards their chosen eventual specialisation, whether this be in general paediatrics or in one of our subspecialties. We have worked hard to accommodate the needs of academic trainees and have had discussions with our Academic Panel on how best to incorporate their needs. We have done a lot of thinking about how we will select trainees from Foundation years into a run-through grade for our specialty. We talked with the GPs and other Colleges about having a common first year with them but have come to the conclusion that we would like to select into the first year those who are really enthusiastic about paediatrics. We must of course cater for those who are undecided or change their minds and so are working on mapping our common competences with those of, for example, the GPs. We will need careful workforce planning to accommodate trainees into the new grades. With considerable hard work from our Education Adviser, Kim Brown, we have finalised the next stage of our competence

framework, and published the competences for core higher specialist training. We have also made considerable progress on the post-core training curriculum. Clearly there need to be 14 of these to incorporate all our subspecialties, including the new subspecialties of Paediatric Neurodisability and Paediatric Accident & Emergency Medicine. Each of them will have a common, generic curriculum, suitable for all who will become paediatric consultants, as well as detailing the depth of the subspecialty experience in training that they will need. We had another successful year of running the NTN Grid. This is an immensely complex process, whereby we ensure that trainees are appropriately placed in accredited programmes for subspecialty training. This inevitably involves some of them moving regions in order to get the experience they need, and the Deans have been extremely accommodating in allowing us to do this and in helping to facilitate the process. We hope that most trainees will get their first choice of subspecialty and geography, and we do our best to ensure that this happens. Competence-based training means that we need to have robust assessment processes. Our first assessment is, of course, our examination, of which we are extremely proud. The Examinations Department, led by Graeme Muir, and our Examinations Officer, Tom Lissauer, have continued to do a superb job in delivering, around the UK, an exam which is mapped to our competence framework, and which has been rigorously evaluated. The new multistation clinical examination has been a success and we are very pleased with it. Sadly, one of our evaluation processes has identified instances of cheating in the written papers. We were extremely disappointed to find this and have had to develop a policy to deal with this and any potential future offenders. We have made progress on updating the DCH clinical exam and have established an exams

office in Scotland as well as continuing to deliver the examination abroad. Workplace-based assessment has occupied us greatly this year. Mary McGraw, our Officer for Higher Specialist Training, and Claire Smith, our Donald Court Fellow, have both done a huge amount of work to facilitate hard-pressed paediatricians in delivering workplace-based assessment. Helena Davies and her team at Sheffield have been of immense help to us with rolling out and evaluating the multi-source feedback (SPRAT) to core and post-core SpRs. Rachel Howells has helped us to develop a video assessment tool for clinic consultations, which can be adapted for use with individuals, particularly those who need further help in such situations. We will continue to look at other assessment tools and map these to our competence framework next year. Claire Smith and Mary McGraw have had to cope with the changes that PMETB is proposing on the visiting process and have led the responses to the many questions that PMETB has proposed. The chairs of the College Speciality Advisory Groups have continued to do invaluable work with the specialist visits and the National Grid process.

Alix Clark and her team at the College have put an enormous amount of work into developing our response to Article 14, together with Wilson Bolsover and Penny Dison. The processes of application for admission to the Specialist Register via Article 14 are immensely complicated, and we have had to take part in numerous consultations and devise College-specific criteria for those who wish to apply via this route. We are doing our best to help Staff and Associate Specialist Grade doctors who are eligible to get through the process. Fran Ackland has been instrumental in helping us to produce a careers brochure, which should be available soon for use at careers fairs, and to encourage those currently in medical school or foundation training to choose paediatrics as a career. We have been delighted to see the Safeguarding Children basic training programme come to fruition and Neela Shabde, who has led on this in conjunction with the NSPCC and the ALSG, has done an enormous amount of work.

successfully piloted. The mini-pupillage scheme, which aims to deliver some training and experience in family justice courts, was developed further and we hope to roll this out next year. Janet Anderson has put in a lot of work into supporting tutors and has run successful training days for them. We hope to expand this into a course for â&#x20AC;&#x153;educating the educatorsâ&#x20AC;? in future. Barbara Golden has run the international training scheme which continues to attract applicants from abroad who then take their expertise back to their home country. Many other people have contributed to the hard work and success of the Training and Assessment department, and as this is my last report as Vice-President, Iâ&#x20AC;&#x2122;d like to record my thanks to all of those mentioned above and also to all of those it has not been possible to name individually, which especially includes all the Tutors, Regional Advisers, and Examiners, who have served the College so well over the last year.

Similarly Avril Washington and her team have worked hard on the Child In Mind project, the first phase of which is now complete and the second has been 19

International Affairs

The College is committed to try to influence governments to move child health higher on their agenda.

Why must the Royal College of Paediatric and Child Health maintain an international dimension? Because, as paediatricians, we want to help create conditions that will improve the lives of children. Because we recognise that it is in those areas of our world with least resources that children’s health is most severely under threat. Because we recognise that as a Royal College…a College of Paediatricians…we are rich in resources. We have “know how” that, when put together with a relatively small amount of money, can accomplish a great deal. And finally, because British paediatrics is regarded (especially in Commonwealth countries) as a benchmark for excellence. The College is amongst organizations that are calling for the next decade (the

Dr Peter Sullivan David Baum Fellow (International Affairs)

Figure 1. East African delegates from the “Best Evidence” course funded by DBIF and run by Dr Mike English (top right) in June 2005 in Nairobi, Kenya Figure 2. Delegates on the College’s Trainingthe-Trainers course exploring small group teaching in Dar es Salaam, Tanzania (October 2005)

countdown to 2015: the deadline for the Millennium Development goals to be achieved) to be “the Decade of the Child”. The College is committed to try to influence governments to move child health higher on their agenda over this period. Over the last six years we have developed an international strategy underpinned by a designated budget for international affairs and an excellent administrative infrastructure. The focus of our strategy is the education and training of paediatricians in order to improve child health. The David Baum International Foundation (DBIF), guided by an energetic Trustees Advisory Group, has gone from strength to strength and has funded numerous educational projects around the world.

The College’s programme of international work spans many countries in 4 continents: In the Balkans we have helped promote the formation of the Kosovan Paediatric Association. The College has signed Memoranda of Understanding with the University of West Indies, the West African College of Physicians, the Indian Academy of Pediatrics and the Pakistan Pediatric Association to promote mutual benefit and ongoing collaboration with paediatric institutions abroad. In South Africa we have helped set up a review of nursing provision at the Red Cross Hospital in Cape Town. We have run evidencebased training courses in India, Brazil and Kenya. In Tanzania we have directly supported post-graduate paediatric education at the Universities of Tumaini and Muhimbili. Also in Tanzania we are assisting the World Health Organization to set up training courses for paediatricians from throughout East Africa to improve case management of children with severe malnutrition. One of our most important areas of work has been in the Middle East. Dr Tony Waterston and his team have patiently persevered through many difficulties to deliver an excellent training programme for Palestinian paediatricians. In a joint venture with the Jordanian Paediatric Society, we have provided training courses for paediatricians from all the major paediatric centres in Iraq.

Figure 3. Professor Luay Al-Nouri from Iraq receiving a copy of James Spence’s “The Purpose and Practice of Medicine” from the David Baum Fellow at the closing ceremony of the course in December 2005 in Amman, Jordan.

Many other College activities and groups have an international dimension such as the International Child Health Group, the International Paediatric Training Scheme, the VSO programme, the International Scholarship schemes, the Membership Panel and, in particular, the work of the Exams Department which oversees the running of examinations in 17 countries around the world.

This is my final report as the first David Baum Fellow. I now hand over the reins to Dr Stephen Greene, who will be assisted by Miss Shanaz Islam in the International Office and by three new Associate International Directors with special responsibility for South Asia, Africa and the Middle East. I wish them every success in their efforts to maintain the College’s international dimension.

The Devolved Countries Wales We have seen some changes in the RCPCH Welsh Committee this year. I have taken over from Jo Sibert as Officer for Wales and Michael Maguire has replaced David Tuthill as the Committee Secretary. John Barton has also finished his term as Regional Advisor and been replaced by Robert Evans. They are a hard act for us to follow and I know we would all like to thank them for their hard work on behalf of the College over the last few years. We have also settled into the (now not so) new Office in Cardiff Bay, where our administrator Siobhan Conway deals with

Scotland I have enjoyed my first nine months as Scottish Officer and I am starting to get my feet under the table. I am pleased to report some of the highlights of 2005. Office Expansion In May 2005 the office expansion meant a move from the first floor of the RCPE to the Second Floor where we now have two meeting rooms and two offices with a small kitchen and toilet facility. New Staff Claire Burnett joined us in June 2005 as a full time Administrative Assistant. Claire supports the Scottish Officer and the Office Manager. Daniel Crane joined us from the London Office in October as the full time Examinations Coordinator for Scotland.

Ireland The Ireland Committee meets in Belfast in January, in York at the Spring AGM meeting and in Dublin prior to the Faculty of Paediatrics RCPI AGM. Dr Alun Elias-Jones represented the RCPCH at all meetings. 2005 was a relatively quiet year for the Committee. We met in January with the 22

the running of the College affairs in Wales assisted by Elen Evans. Although not a Welsh speaker myself, I am pleased we have someone in the Office who can speak the language. The Welsh Assembly Government has produced a document called Designed for Life, to help achieve the ambition of “worldclass healthcare and social services in a healthy, dynamic country by 2015”. This is likely to see changes in the way the NHS works in Wales and therefore changes in Paediatrics and will probably provide quite a challenge for us. We are seeking the views of members to ensure that children’s needs are considered by those responsible

Scottish Committee In line with the Executive Committee of RCPCH the Scottish Committee is seeking to streamline in 2006. This effort will save both professional time and expense and will allow us to hold our committee meetings in our new offices at 12 Queen Street, Edinburgh. There is also great enthusiasm for videoconferencing facilities to be installed in the new office and are seen as an essential component for efficient professional interfacing. We welcomed Dr Peter Fowlie as our new Honorary Secretary in April 2005. Regional Representatives/Regional Advisers Since 2004 there have been more Regional Representatives in Scotland and the Scottish Committee is looking at active and constructive ways of using this group of

Commissioner for Children in Northern Ireland, Mr Nigel Williams and with Ms Emily Logan, Ombudsman for Children in the Republic. Both people have statutory and reactive responsibilities concerning children. Both people emphasised their advocacy roles. Paediatricians in both jurisdictions complained about gaps in services, inadequate consultation with government and failure to prioritise children’s needs in health budgets.

for suggesting changes. To that end I have also met with some of the Assembly members during the year, including the Health Minister and the Minister for Children. The National Service Framework was formally launched by the First Minister in September, with the support of all the parties and although there is no allocated funding for it, we hope it will help improve the health (and other) services that children in Wales receive. The first stage of the Children’s Hospital for Wales was opened on St David’s Day this year. It includes medical wards and an oncology ward and out-patients area. Fundraising is continuing for the second

individuals. This may mean that they will attend regional meetings as opposed to the Scottish Committee in future. Regional Advisers continue to meet regularly and are involved along with the Scottish Officer in National Planning and NTN Grid Meetings. Development of Examinations in Scotland As part of the ongoing process of taking over the running of the MRCPCH in Scotland Daniel Crane was appointed as Examinations Co-ordinator in Scotland in August 2005. As of January 2006 RCPCH in Scotland will be entirely responsible for the running of both clinical and written examinations. Dr Alan Houston remains the Principal Regional Examiner for the West of Scotland and we have appointed a new

The BNF for Children has been distributed to paediatric units in Northern Ireland (NI). A reply is awaited from the Health Services Executive in the Republic (ROI). There has been no change in the MRCPCH examination situation. There has been relatively little cross border movement due to a frustrating combination of factors. SpRs in paediatrics are able to avail of training days in the ROI and NI.

phase which will include surgical beds and theatres. On the academic front in Wales, Sailesh Kotecha has taken up the post of Professor of Child Health and John Gregory has been deservedly awarded a personal Chair. A few years ago Wales had one Professor in Paediatrics, now we can boast four. The All Wales Child Health Network (LINK) goes from strength to strength, having recently appointed a part time administrator and been successful in a joint application (with Children in Wales and the Paediatric Palliative Care Network) to obtain funding to set up a Child Health Research Network. We are

PRE for the South East – Dr Christopher Steer (Kirkcaldy) and a new PRE for the North, North East & East – Dr Steve Turner (Aberdeen). We are very grateful to Drs Tom Turner and Tom Marshall for their hard work in exams in Scotland in the past and for Tom Marshall for his continuing contribution. Thanks also to Graeme Muir, Head of Examinations in London, for his lecture at the Policy Conference in October and his help and support in this period of change in Scotland. RCPCH Scottish Policy Conference The Policy Conference was held on 28 October 2005 in the Stirling Management Centre and looked at Improving Child Health and the Way Forward in Implementation of the National

The ROI now ranks seventeenth in BPSU monthly returns and NI third. The IPSU card for 2006 will include 3 cross border studies on childhood stroke, peanut allergy and on non-CF bronchiectasis. The number of paediatricians in ROI and NI has expanded and it is hoped that all new appointees will become members of RCPCH. Paediatricians in the ROI have benefitted greatly, and will continue to do so, from RCPCH activities and publications such as the

also a pilot site for the CEMACH childhood death survey, reporting of which has been added to the Welsh Paediatric Surveillance Unit green card. On a more social front the St David’s Day Lecture this year was held in Cardiff with a wonderful talk from, the then President of the Royal College of Psychiatrists, Mike Shooter. We have also had our usual two meetings of the Welsh Paediatric Society; the first hosted by paediatricians in Wrexham and held jointly with our colleagues from Ireland; the second in Merthyr Tydfil, the first time to my knowledge that the meeting has been held in a football club.

Framework. In the afternoon Neil Gibson led the debate on Postgraduate Training for Paediatricians in Scotland, and Graeme Muir addressed the audience on Examinations in Scotland and How to be an Examiner. St Andrew’s Day Symposium This joint event with our College, SPS, RCPSG and RCPE was a very successful day, with 178 attendees, held in the Royal College of Physicians, Edinburgh on 23rd November 2005. There were high quality presentations. Professor Neil McIntosh, Vice President of Science and Research of RCPCH, gave the RCPCH address “What Have the Romans Ever Done for Us? Your College Research Division” and presented the prizes, and Dr Robert Tasker of Addenbrookes Hospital, University of Cambridge gave the Charles McNeil Lecture entitled ‘Sea-horse, Egyptian God,

Kennedy Report, the Child Protection Companion and the BNF for Children. Plans are in preparation for a new children’s hospital in Belfast. It is hoped that the Northern Ireland Assembly will recommence in 2006. A review of paediatric hospital services, particularly for Dublin tertiary specialties, is being conducted in January 2006. Joe McMenamin is the current Dean of Paediatrics RCPI. The Ireland

Finally, for anyone who wishes to contact their regional representative on the Welsh committee, they are Brendan Harrington and Val Klimach (North Wales), Tom Williams and Alison Kemp (South & East Wales) and Gareth Morgan and Dewi Evans (Mid and West Wales).

Dr Gwyneth Owen Officer for Wales

Spaceman in a Rocket and the Decades of the Brain’. Next year SACCH will become a co-sponsor of this event, thus integrating almost all Scotland’s paediatricians at this meeting. Consultations We have this year assisted with 10 consultations from the Scottish Executive. This is an important part of our remit and the Scottish Executive is now taking advantage of the Scottish Office of RCPCH.

Dr Adrian Margerison Officer for Scotland

Committee owes a great thanks to Moira Stewart who will step down as Secretary this year.

Professor Denis Gill Officer for Ireland

Running the College

The College belongs to its members and is ultimately answerable to them for all that it does.

Mr Len Tyler College Secretary

The College continues to grow rapidly, for which (on the whole) we should be grateful. More people wish to be members, which gives us more resources - people and cash - which allows us to do more work on behalf of children and on behalf of the profession. This work is illustrated in the preceding chapters of this Annual Report. How we organise ourselves to do that work has been a continuing preoccupation for us during the year. One self-evident truth is that it is becoming more and more difficult to persuade employers to release paediatricians to carry out essential work for the College, acting as officers, regional advisers, Councillors, examiners, tutors and committee members. As the time of our members becomes a more and more valuable commodity we must use it more and more efficiently. In part this means streamlining our processes, and in part it means the delegation of tasks not requiring clinical expertise to paid managers and administrators. We have looked at both issues during the year. We have slimmed down Executive Committee and we have tried to make Council meetings more focussed, so that Councillors can concentrate on issues of strategy and governance and more easily hold the executive to account over its achievements against agreed targets. The process of delegation will be gradual, and we must ensure that we are careful which functions are delegated and that we do not lose sight of the fact that the College belongs to its members and is ultimately answerable to them for all that it does. One group of members to whom we continue to be very grateful is the Press Panel, to whom we again referred many media queries during the year. We had a number of difficult high profile cases, where paediatricians were appearing before the GMC. There is always a difficult call to be made in these cases. Should we, in our press releases, reflect the concern (and sometimes anger) of our members at the outcome of certain hearings and thus risk appearing to be primarily concerned with

the welfare of doctors rather than children? Or should we try to avoid commenting on individual cases, thus missing the chance to speak out for both the profession and children? We intend, in 2006, to be more proactive in our work with the media – both in commenting on “bad news” and promoting good news. Growth in our activities meant that we had to take on additional office space during the year, and Research Division moved to Great Portland Street, where it is co-located with the National Collaborating Centre. Other promising options for expansion having fallen through, we have spent some time looking for sites where we could bring the College together again in a single building somewhere in central London. We are not the only medical Royal College trying to do this at present and, as other Colleges have found, suitable buildings are very few and far between. We hope that, whatever solution we come up with, the College will be more accessible to members than it has been in the past. We do not plan to turn the College into a club with leather armchairs, but a room where members can come and read the journals over a cup of coffee when they are in London would be nice, and we hope to provide facilities at least at this level. We plan to consult members over what else they would like to see in a new building. Finally, though we look towards the future, we are conscious and proud of our past. Bernard Valman and Susan Scott continue to ensure that the College’s history is documented and in particular that we have records of the achievements of our members in the form of a CV kept on file here at the College. You will all be invited to submit one in due course. Could I appeal to all of you who have already been asked to do so to let Susan have a CV as soon as you can? My thanks as ever to all of the College officers, staff and committee members for their help over the past year.

Financial Reserves

Membership Numbers

£7.0m £6.5m £6.0m £5.5m £5.0m £4.5m £4.0m £3.5m £3.0m £2.5m £2.0m £1.5m £1.0m £0.5m 0

10,000 9,000 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 2002-3 Target

2003-4

2004-5

2005-6

2006-7

2002-3

Actual

Target

Percentage of members who are fellows

2003-4

2004-5

2005-6

2006-7

2005-6

2006-7

Actual

No. of doctors sitting College examination

50%

12,000

45%

11,000 10,000

40%

9,000 35%

8,000

30%

7,000

25%

6,000

20%

5,000

15%

4,000 3,000

10%

2,000

1,000

0 2002-3 Target

2003-4

2004-5

2005-6

2006-7

Actual

2002-3 Target

Staff Turnover

2003-4

2004-5

Actual

Proportion of ethnic minority members on College committees

excluding retirements at or after the normal age and the completion of short-term contracts

20%

25%

18% 16%

20%

14% 12%

15%

10% 8%

10%

6% 4%

2% 0

0 2002-3 Target

2003-4

2004-5

Actual

2005-6

2006-7

2002-3 Target

2003-4

2004-5

2005-6

2006-7

Actual

Fund-raising

We are very grateful

The last 12 months has been a busy time for the Fund-raising Section in the College.

to all those who have

After much planning and consultation, the brochure Striving for a Healthier Future for Children was published and distributed to our members in late 2005, highlighting the importance of donations to the College to allow us to fulfill our ambitions in improving the health of children in the UK and beyond.

made donations to the College to help us achieve our aims.

As a result, we received over £6,500 in oneoff donations within a few weeks, and a lot of interest has been shown from members in exploring additional ways of supporting the College financially, including making legacies in favour of the College.

including members of the Baum family. An excess over direct costs of £27,000 was raised. This represents a generous addition to a healthy Foundation, which is now funding a growing number of educational projects in developing countries in Africa and Asia as well as in Gaza and the West bank.

A gift in your Will

We are very grateful to all those who have made donations to the College to help us achieve our aims. This will help us to invest more in research, education and training.

The College is a charity and a gift in your Will can help reduce your inheritance tax burden. We have a standard codicil form (an appendix to your Will) that we can send you to send to your professional adviser. And if you have not yet written a Will and need a solicitor we can help with that too. Please fill out the response form on page 37 accordingly if you would appreciate such assistance.

Once again, I would like to thank Mike Poole and the staff of the Finance and Membership Department, especially Elaine Johnston, for their invaluable support and advice in raising funds for the College.

Alternatively, guidance on making a legacy in favour of the College is given on the College website, which along with all the information on fund-raising, appears within the “Membership” menu option.

Dr Ben Ko Assistant to the Honorary Treasurer

David Baum International Foundation Active fund-raising for the Foundation continued over the last 12 months. The most notable event was the “Palace to Palace” walk, which took place in Scotland. David Gerrard who organized the walk said “I organized a ‘Palace to Palace’ walk to mirror that fateful ‘Palace to Palace’ cycle ride in memory of David Baum on which he tragically died in September 1999 and to assist in raising funds for the DBIF.” His efforts have been rewarded by warm support and participation from friends, family and colleagues of the College,

Other ways of making a donation include: • Regular donations by direct debit • Single donations by cheque or credit card • Gifts of shares • Gifts of dividend income • Support by payroll giving through your workplace • Taking part in a sponsored event If you would like to help us by making one-off donations then please use the response form on page 37 as it includes a gift aid declaration which can increase the value of your donation by over 28%. The response form can also be used to help us to provide you with further information on how to further support the College.

Further information Please visit our website at www.rcpch.ac.uk (on the website the fund-raising section can be found under the “membership” button). Alternatively please contact Elaine Johnston at: The Royal College of Paediatrics and Child Health, 50 Hallam Street, London, W1W 6DE. Email: elaine.johnston@rcpch.ac.uk Telephone: 020 7307 5622.

Major Donations, Grants and Gifts We would especially like to thank the following who have supported our activities in 2005 through major donations, grants, gifts and gifts in kind (including consultancy services and advice): Children’s Research Fund Charles Crowther (David Baum International Foundation) Department of Health G M Morrison Charitable Trust GlaxoSmithKline PLC Health Protection Agency Institute of Child Health Johnson & Johnson Pediatric Institute Medical Aid for Palestinians (MAP) (David Baum International Foundation) Medical Protection Society

To quote from the brochure Striving for a Healthier Future for Children:

“A great many lives are saved each year by the work of paediatricians. Many more lives are extended, and much pain is alleviated, resulting in a dramatic improvement in the quality of childrens’ lives. The College is determined to increase its resources so that future generations of children, throughout the world, and their parents and the public, can be provided with the best

NSPCC Wales Office of Research and Development for Health and Social Care (WORD) Well Child West Midlands Specialised Services Agency Plus a big thank-you to our members who kindly donated to the College in response to our fund-raising brochure, ‘Striving for a healthier future for children’. Your kind donation will help us expand our work for the benefit of children everywhere.

information, the best education and the best preventions and treatments.”

Structure of the College

Heads of Department College Secretary: Committees: Education: Education Adviser: Examinations:

Len Tyler David Ennis Rosalind Topping Kim Brown Graeme Muir

Finance and Membership: Mike Poole HR IT and Information:

Laura Vincent Mary Butler

Research:

Linda Haines

Training:

Alix Clark

2004/2005 College Boards and Committees The governing body of the College is its Council, which consists of the Trustees of the College. Trustees are elected by members and fellows of the College and comprise honorary officers, representatives from each of the College regions in the UK and the Republic of Ireland, paediatricians in the training grades, associate specialists, honorary and senior fellows and specialty paediatrics. The Collegeâ&#x20AC;&#x2122;s primary functions are co-ordinated by a number of boards and committees, which are in turn supported by sub-committees and working parties, which report their activities to Council. The officers of the College meet formally and informally with representatives from other Royal Colleges, and with government and external organisations allied to child health. The College also participates fully in consultation exercises and wider discussions on paediatric health care issues at national level. Regional representatives, regional advisers, paediatric tutors and specialty advisers work on behalf of the membership across the UK and Republic of Ireland. Regional committees have been established to improve communication at all levels. The Collegeâ&#x20AC;&#x2122;s national network is managed through its Scottish, Welsh and Irish committees. These provide a powerful voice for fellows and members, and also ensure effective communication with the four UK Departments of Health. The College is in regular touch with its members through the monthly publication of its scientific, peer-reviewed journal, Archives of Disease in Childhood, and quarterly newsletter which contains general news and information.

Executive Committee Reviewing College activities, offering strategic direction to College activities and advice to Council Chair: President, Professor Sir Alan Craft Finance Committee Responsible for ensuring the proper management of the finances of the College Chair: Honorary Treasurer, Dr Alun Elias-Jones Specialty Board Coordinating the work of College specialties Chair: Vice President, Dr Patricia Hamilton Training Board Setting, delivery and maintaining the standards of paediatric training and examinations throughout the UK and Republic of Ireland Chair: Vice President, Dr Patricia Hamilton Research Division Executive Committee Reviewing research activity and offering strategic direction in the areas of research, surveillance and data collection Chair: Vice President, Professor Neil McIntosh Health Services Committee Provision of child health services and service configuration Chair: Vice President, Dr Simon Lenton International Board Coordinating the international activities of the College Chair: David Baum Fellow, Dr Peter Sullivan Academic Board Managing conferences, scientific meetings and CPD Chair: Vice President, Dr Chris Verity Secretary: Dr Alistair Thomson Examinations Committee Setting and conducting the MRCPCH and DCH examinations Chair: Officer for Examinations, Dr Tom Lissauer Publications Board Strategic management of College publications Chair: Honorary Editor, Dr Mark Everard

Patron: Her Royal Highness The Princess Royal Trustees 2004-2005: The Officers of the College and members of Council are as follows: Officers of the College

Dr Ramesh Mehta

East Anglia

President Professor Sir Alan Craft

Dr Sian Snelling

Mersey

Dr Geoffrey Lawson

Northern

Dr Ben Ko

North East Thames

Dr Ruby Schwartz

North West Thames

Dr Ian Swann

Oxford

Dr Andrew Evans

South East Thames

Dr Ruth Charlton

South West Thames

Dr Jane Tizard

South Western

Dr Peter Macfarlane

Trent

Vice Presidents Dr Simon Lenton (Health Services) Dr Patricia Hamilton (Training & Assessment) Professor Neil McIntosh (Science & Research) Dr Chris Verity (Education) Honorary Treasurer Dr Alun Elias-Jones

Dr Edward Wozniak

Wessex

Dr Steve Bennett Britton

West Midlands

Registrar Dr Sheila Shribman

Dr David Beverley

Yorkshire

Dr Iolo Doull

Wales

Scotland Dr Adrian Margerison

Dr Stephen Greene

N, NE, E Scotland

Dr Sepideh Taheri

South Eastern Scotland

Wales Dr Gwyneth Owen

Dr Jack Beattie

Western Scotland

Dr Moira Stewart

Northern Ireland

Ireland Professor Denis Gill

Dr John Cosgrove

Republic of Ireland

Dr Martha Wyles and Paul Dimitri

Trainees

Dr Greg Dilliway and Natalie Lyth

Associate Members

Prof. Richard Olver

Association of Clinical

Dr Margaret Mearns

Senior Members

Dr Richard Newton and Dr Helen Venning

Paediatric Specialities

Examinations Dr Tom Lissauer David Baum Fellow (International Affairs) Dr Peter B Sullivan Donald Court Fellow Dr Claire Smith

Professors of Paediatrics

Details correct as of 31 August 2005.

Higher Specialist Training Dr Mary McGraw Continuing Professional Development Dr Alistair Thomson Workforce Planning Dr Sue Hobbins Honorary Editor Dr Mark Everard

Treasurer’s Report

The College has invested heavily in developments in Training and Education, competency assessment, and the Child in Mind project.

Dr Alun Elias-Jones Honorary Treasurer

This financial period (2004-2005) has yielded a further substantial surplus for the College of £1,634,553 (split £1,402k/£232k between unrestricted and restricted funds). This surplus has been generated by a 13.7% rise in incoming resources to £7,834,470 plus a substantial gain on investments of £592,468. This has been offset by a 16.1% increase in expenditure to £6,694,336 and a turn around in the College’s share of the RCPCH Publications result from a £14,716 surplus to a £98,049 deficit as a result of developing the British National Formulary for Children (BNFC). Income from exams rose by 10.1% to £2,512,767 (2004- £2,283,183) reflecting the increased number of candidates in the UK and overseas. However, the total expenditure on education, training and exams has also risen from £2,680,103 in 2004 to £3,093,759 in 2005, with the introduction of the new modular examination system and first diet of the new format clinical exam in October 2004. Membership income rose mainly as a result of a significant increase in total College membership from 7,968 to 8,479 (and 8,688 by end December 2005).

Within “Other income”, income from information and publications totals £293,009, a fall from 2004 (£347,021) and is mainly generated by income from Archives of Disease in Childhood. This income stream is under threat from developments in electronic publishing. We are working closely with our partner, BMJ Publishing, to minimise this threat and having launched the additional Education and Practice Journal in June 2004 together with Archives to aid CPD and maintain our competitiveness; the year ending December 2005 has seen an increase in the net profit to a forecast £498,859 shared between RCPCH and BMJ Publishing with a further budgeted rise in net profit to £556,000 for 2006 In September 2003, the second editions of Medicines for Children and Pocket Medicines for Children were published, and both books sold well and generating good sales shared with our partners, the Neonatal and Paediatric Pharmacists Group. This surplus was largely used to finance our share of the development costs of the BNFC, published in September 2005 delivered free to all doctors and pharmacists in England through a Department of Health contract, and with substantial orders for doctors and other prescribers in Wales,Scotland and Northern Ireland. A freely available website has also been developed along with a CD rom. A palm top version is planned with the second edition to be published in July 2006.There has been considerable interest in the BNFC in Europe and elsewhere with the possibility of translation or adoption of the book in several countries. Despite continuing uncertainties over the impact of the Postgraduate Medical Education Training Board, the College has invested heavily in developments in Training and Education, competency assessment, and the Child in Mind project, including a number of new key posts.

The College continues to consider its accommodation needs with a rise in College staff from 24 FTE in 1997 to 75 FTE as recorded in the accounts for the year ended 31 August 2005 and over 100 people on the payroll as we entered 2006. With this in mind we have continued to follow a prudent approach to the investment of the retained surplus, with much of it likely to be required for a new building to house our evolving College which is currently split between 3 sites in London with additional offices in Cardiff and Edinburgh. The College has continued with the same investment manager Lazard Asset Management appointed in October 2001. Funds administered by Lazard achieved a return including gains of 19.5% (2004 5.3%) for the year. Meanwhile cash funds invested as deposits with the Collegeâ&#x20AC;&#x2122;s bankers have yielded 4.6% (2004 3.9%). The corresponding Bank of England base rate averaged 4.7% (2004 4.0%).

Accompanying Statement by the Council of the Royal College of Paediatric and Child Health These summarised financial statements on pages 32 to 35 have been derived from the full statutory Council report and financial statements for the year ended 31 August 2005 which have been audited by Sargent & Co who gave an unqualified audit opinion on 22 February 2006. The auditors have confirmed to Council that the summarised financial statements are consistent with the full financial statements for the year ended 31 August 2005. The full statutory Council report and financial statements were approved by Council on 22 February 2006 and signed on their behalf by Professor Sir Alan Craft and Dr Alun Elias-Jones. They will be submitted to the Charity Commission by 30 June 2006. These summarised financial statements may not contain sufficient information to allow for a full understanding of the financial affairs of the College. The full statutory Council report and financial statements can be obtained from: The Secretary, Royal College of Paediatrics and Child Health, 50 Hallam Street, London, W1W 6DE On behalf of Council, 22 February 2006 Dr Alun Elias-Jones 31

Accounts Summarised Financial Statements

Consolidated Statement of Financial Activities for the Year Ended 31 August 2005 Unrestricted Funds £

Restricted Funds £

Endowment Funds £

2005 Total £

2004 Total £

Incoming Resources Incoming Resources from Generated Funds Voluntary income Activities for generating funds Investment income Incoming Resources from Charitable Activities Examinations Spring Meeting Education Training Research Members subscriptions Other income

7,067 166,511 353,716

187,455 24,693

194,522 166,511 378,409

101,649 138,508 264,036

2,512,767 507,446 90,266 64,139 2,183,063 582,131

16,495 283,351 360,503 494,867 -

2,512,767 523,941 373,617 424,642 494,867 2,183,063 582,131

2,283,183 474,403 322,165 437,523 215,818 2,073,908 576,461

TOTAL INCOMING RESOURCES (see note 3)

6,467,106

1,367,364

7,834,470

6,887,654

38,982 27,807

30,623 29,201

17,625 393,634 665,606 412,108 71,049 -

1,705,443 537,173 633,412 754,904 855,440 2,097,318 43,857

1,442,302 509,984 660,376 577,425 726,511 1,749,796 41,449

Resources Expended Cost of Generating Funds Costs of generating voluntary income 38,982 Fundraising Trading: Cost of goods sold and other costs 27,807 Charitable activities Examinations 1,705,443 Spring Meeting 519,548 Education 239,778 Training 89,298 Research 443,332 Other professional activities & standards 2,026,269 Governance costs 43,857 TOTAL RESOURCES EXPENDED (see note 1)

5,134,314

1,560,022

6,694,336

5,767,667

Net Incoming / (Outgoing) Resources Before Interest in Associate and Transfers Interest in result of Associated Undertaking Transfer between Funds

1,332,792 (98,049) (424,873)

(192,658) 424,873

1,140,134 (98,049) -

1,119,987 14,716 -

809,870 592,468

232,215 -

1,042,085 592,468

1,134,703 57,224

1,402,338 8,133,554

232,215 1,154,213

14,855

1,634,553 9,302,622

1,191,927 8,110,695

£9,535,892

£1,386,428

£14,855

£10,937,175

£9,302,622

Net Incoming Resources Before Other Recognised Gains and Losses Gains and losses on investment assets Net Movement in Funds Fund balances brought forward TOTAL FUNDS CARRIED FORWARD

There were no recognised gains and losses for the period other than those included in the Statement of Financial Activities.

Consolidated Balance Sheet as at 31 August 2005 Group 2005 £

Group 2004 £

Fixed Assets Tangible Assets

2,361,645

2,342,526

Investments

4,732,580

3,703,470

7,094,225

6,045,996

1,147 734,303 5,256,766

1,665 493,457 4,000,000 243,707

5,992,216 (2,148,266)

4,738,829 (1,481,203)

3,843,950

3,257,626

10,938,175

9,303,622

(1,000)

£10,937,175

£9,302,622

Current Assets Stock of Publications and Merchandise Debtors Investments Cash at bank and in hand Creditors: Amounts Falling Due Within One Year NET CURRENT ASSETS Total Assets Less Current Liabilities Creditors: Amounts Falling Due After More Than One Year NET ASSETS Represented by: Unrestricted Funds: Designated Funds Charitable Trading Subsidiary Fund Charitable Trading Associate Fund General Funds

3,833,441 4 (98,049) 5,800,496

3,921,675 4 4,211,875

Total Unrestricted Funds

9,535,892

8,133,554

Restricted Funds Permanent Endowments

1,386,428 14,855

1,154,213 14,855

£10,937,175

£9,302,622

TOTAL FUNDS OF THE COLLEGE (see note 2)

Accounts Notes to the Summarised Financial Statements for the Year Ended 31 August 2005 1. TOTAL RESOURCES EXPENDED Other Direct Costs £

Other Allocated Costs £

12,208

18,838

7,936

38,982

30,623

27,807

29,201

567,100

853,138

285,205

1,705,443

1,442,302

73,208

437,341

26,624

537,173

509,984

Education

127,637

456,344

49,431

633,412

660,376

Training

369,452

237,173

148,279

754,904

577,425

Staff Costs £ Costs of generating voluntary income Fundraising trading: cost of goods sold and other costs Examinations Spring Meeting

2005 Total £

2004 Total £

Research

484,810

192,333

178,297

855,440

726,511

Other professional activities and standards

772,594

1,013,200

311,524

2,097,318

1,749,796

Governance costs TOTAL RESOURCES EXPENDED

43,857

41,449

2,407,009

3,280,031

1,007,296

6,694,336

5,767,667

Other Allocated Costs in 2005 can be further analysed by activity as follows: Premises & Facilities £

Human Resources £

Information Technology £

Finance £

Total Other Allocated Costs £

3,873

842

2,146

1,075

7,936

120,718

26,254

106,324

31,909

285,205

12,937

2,813

7,166

3,708

26,624

Costs of generating voluntary income Fundraising trading: cost of goods sold and other costs Examinations Spring Meeting Education

23,059

5,015

12,773

8,584

49,431

Training

74,239

16,145

41,123

16,772

148,279

Research

89,603

19,487

49,633

19,574

178,297

94,109

36,301

311,524

313,274

117,923

1,007,296

Other professional activities and standards Governance costs TOTAL OTHER ALLOCATED COSTS

148,762 -

473,191

32,352 -

102,908

Costs of generating voluntary income are those incurred in seeking voluntary contributions and do not include the costs of disseminating information in support of the charitable activities. Governance costs include the costs associated with the meetings of the Council, Executive Committee and Finance Committee and those incurred in connection with the statutory external audit. All costs have been allocated on the basis of the headcount except: £58,893 of the Information Technology cost which has been directly attributed and £30,684 of the Finance cost which has been allocated on the basis of number of transactions.

2. FUNDS Unrestricted Funds The General Funds of £5,800,496 (2004 £4,211,875) represent the “free” funds of the College which are not designated for particular purposes or restricted in any way; they are essentially the College’s reserves. Such funds need to be held as reserves to permit a responsible reaction to uncertainties. During the year the College reviewed the level of reserves it requires and set the requirement at one year’s expenditure, which is currently in excess of £7million. In addition, it is estimated that a further £3million will be necessary to enable the College to acquire the type of premises it has identified as being required in the long-term. Designated funds comprise unrestricted funds that have been set aside by the trustees for particular purposes. They include the Fixed Assets Fund £2,293,790 (2004 £2,267,645) and the balance of the Everley Jones Bequest £1,038,353 (2004 - £1,196,829). Restricted Funds Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised by the College for particular purposes and comprise funds for the WellChild Fellowships, David Baum International Foundation, Education & Training, Research, Overseas Levy and Awards & Prizes. Permanent Endowments Permanent Endowments are monies which have been given to the College in trust with the restriction that they are held as capital with the income generated from them to be used for specific awards.

3. INCOME FROM COMMERCIAL COMPANIES A list of commercial companies who pay for a presence at the Spring Meeting and similar events organised by the College is available on request from the Head of Finance & Membership at the College. Any commercial companies who have made significant financial contributions to the College in the calendar year 2005 are included in the Fundraising report within this Annual Report.

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