RCPCH Annual Report 2008 by Royal College of Paediatrics and Child Health

Royal College of Paediatrics and Child Health

From the College’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

Policy and standards

Training and assessment

Education

Research

Health services

International work & Devolved Nations

Chief Executive’s report

Structure of the College

Officers and Trustees

Treasurer’s report

Accounts

Fund-raising

Bequests

Form of Codicil

Since my last Annual Report the College has achieved many things – not least moving into new premises.This is not just a practical process but also a rite of passage along our growth from a young offspring of the Royal College of Physicians to a grown up Royal College of our own. Like any nearly grown up adolescent we have been though periods of uncertainty, crises of identity and daunting decisions to make on our own. I think we have moved relatively smoothly through adolescence towards young adulthood. We have kept some of the good things about adolescence – challenging the status quo, not conforming to the image expected of us and providing creative innovations that will some day be regarded as the norm. The building has been all we hoped it would be – modern, transparent outward looking and flexible. We cannot let the rooms out fast enough to those who want to hold meetings there and we have been able to host launches of our work, art exhibitions, dinners, meetings with breakout rooms and conferences with equal aplomb. Most of all it has symbolised what we have achieved over the last year. We have produced several training courses that can be delivered in the workplace and online. The adolescent project – an e-learning platform of over 70 modules – has received praise from the DH who funded it and more importantly from those who use it. As a result, the DH has commissioned a second learning project on child health promotion. Both of these will contribute to the health of children and young people. Safeguarding has – sadly – remained a challenge. I have been reluctant to fight this battle in the media. I prefer to take action by developing training courses, talking to the GMC, MPs and select committees, government ministers and lay groups. I believe our voice is the more influential for it.

Our education and training programmes have been widely acclaimed as being exemplars for others.We have been challenged, as has everyone, by the run up to the WTD and the lack of locums to fill the gaps in the rotas and we are taking action to help services be prepared for August 2009. Our international work was presented to the Princess Royal in a symposium when she opened the new building. The coherent strategy behind the work and yet the individual initiative in areas in Africa, India and the Middle East were most impressive. They particularly highlighted the contribution of the funding from the David Baum International Foundation and I know David would have been so proud to see the results of the initiatives he started. The Research Division has taken on many important projects, which meant that the Department of Health has commissioned others. In the past 3 years the College has, overall, received several million pounds in grants from various bodies commissioning work from us. Finally, I believe our College is viewed with respect by other Colleges, the DH, DCSF and other key organisations, as leading in many ways, but also collaborative and constructive, forward thinking and innovative. Challenging times are ahead but we believe we have contributed to childrenâ&#x20AC;&#x2122;s health through the work of our paedatricians and our colleagues and we will continue to do so.

Dr Patricia Hamilton President

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. Our Policy Conference this year was on the issue of first contact care (GPs, paramedics, emergency departments). The most important conclusions were that there should be a single point of access for parents and children, an integrated pathway of care (and team) was needed around the child, the training and competences of any individual on the pathway was paramount and services should be delivered as close to home as possible when it is safe to do so. There is also a need to focus on governance and quality assurance. We will continue to take this work forward with a particular emphasis on further collaboration with the RCGP. One of the tasks I have been involved in this year has been to review certain aspects of the College and its committee structure and this work is continuing. We have made some progress as Council has reviewed its own terms of reference and those of Executive Committee, to whom it delegates the task of ensuring that the objectives agreed in the annual work plan are achieved. 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. We will also look at their size and composition with the aim of making a significant reduction in costs and the College’s carbon footprint and to this end we will also be encouraging more use of videoconferencing. In future, there will be a greater emphasis on setting up short life working parties rather than establishing more committees. We have however set up two important new committees during the course of the year. The Elections and Appointments Scrutiny Committee has been set up to review all College appointments and report to Council to ensure total transparency is maintained. The committee will also be reviewing the rules and process for all appointments and ensuring that comprehensive job descriptions are produced for elected posts and job specifications for those appointed by interview. The new Policy Committee will be responsible for management and coordination of the College’s policy work and we also plan to develop more position

statements for our members. It will also advise on the overall priorities for policy work across the College and make recommendations to Council. In addition, the College has a permanent Advocacy Committee to review issues of children’s rights and specifically issues of access to health and healthcare to improve children’s health in this country and overseas. During the year the committee held a training day on the United Nations Convention on the Rights of the Child for paediatricians, health professionals and lay people which gave an opportunity for them to learn about children’s rights issues. The Committee was also involved in the Children are Unbeatable campaign and in work to prevent dental x-rays being used to ascertain the age of asylum-seeking children and this method will not now be used by the Home Office. The Patients’ and Carers’ Advisory Group continues to play an important role in providing lay advice to College committees and promotes the views and experience of children, parents and carers. This year the group held a seminar on

Dr David Vickers Registrar

child protection for all lay members which gave them an opportunity to learn about child support issues and to meet and share their experience of being involved in College work. The group also helped to review documents from a lay perspective and contributed to a number of key meetings at the College, including the RCPCH Spring Meeting. Mrs Sally Sweeney Carroll, who has chaired the group for the past three years, will shortly be stepping down. We will miss her wise guidance and we thank her for an enormous contribution in this area of work. The College is committed to ensuring children and young people and their perspectives significantly influence the work of the organisation and this participation must become embedded in the way that we think about our work. Our first Children and Young People’s Participation Manager, Sophie Auckland, departed during the year and we thank her for the progress made in pioneering the children and young people’s participation projects within the College. One of these was the work done in developing the RCPCH Youth Advisory Panel and they presented an inspiring workshop at the Spring Meeting 2008 on ‘Mental Health & Young People.’ Members of the Youth Advisory Panel also supported the College in developing a ‘Careers in Paediatrics’ booklet which was launched during the year. Also at the Spring Meeting the Young People’s Health Special Interest Group was launched, which will consider the particular issues faced by adolescents in relation to health services. We have now appointed Bharti Mepani, who joins us from Save the Children, to take our participation work forward. During the year the College responded to a wide range of consultation documents. These included: n Our NHS, Our Future (The Darzi Review) n Child and Adolescent Mental Health Services Review n Improving Health,Supporting Justice (DH) n Murder, Manslaughter and Infanticide – proposals for reform of the law n And a number of documents in relation to strengthening children’s trusts from the Department for Children, Schools and Families.

Another important issue we addressed during the year was to improve the induction we provide to members of Council, who as trustees of the College have a wide range of responsibilities. We ran two very successful induction events during the year and these will be mandatory for trustees in future. We are also considering how we can improve the service provided to Regional Committees and the communication provided to you the members. We have also begun to consider how our regional

councillors and regional advisers can work better together in future. We are fortunate in benefitting from strong regional representation currently existing in our Council and regional advisers but we must ensure that we make the best use of their precious time. Finally I must record my thanks to my predecessor Dr Hilary Cass, who made a huge contribution during her time in post, and Dr Eddie Estlin, Assistant to the Registrar, for his support in particular on child participation work.

A year of new beginnings So much has happened during the 2007/8 training year that the Training and Assessment Department can truly call it a year of new beginnings. In fact, the merger of the Training and Examination Departments of the College to create the new Training and Assessment Department was the first act of the new year. We began the year by enrolling our trainees for the first time, which involved amending the database, tracing the existing trainees and encouraging new ones to register. This is really important as for the first time we know who our trainees are and how to contact them. This will enable us to ensure trainees are kept up to date with training developments. The first set of run-through trainees began their training using the new curriculum and assessment strategy. Not only were examinations required, but now workplace assessment was introduced. The process of preparing the Assessment Strategy identified areas where we might not be adequately assessing trainees in Level 3 of their training. These include skills which are expected of consultants in their daily practice. In order to investigate this further, we are piloting the development of a new assessment exercise to see if it can enhance our assessment portfolio. In line with when it will be taken in run through training it will be known as ST7 assessment. The aim is not to provide an exit examination, it is purely an exercise to try to detect those few trainees whose competence to progress to consultant practice might not have been questioned and to enable remedial action to occur before they leave specialty training. Part of the new assessment system involves a new supervision regime with a

more formalised system of supervision meetings â&#x20AC;&#x201C; inductions, review reports and trainersâ&#x20AC;&#x2122;reports. RITAs are replaced by Annual Review of Competence Progression (ARCPs). Already busy trainers and trainees are now meeting the challenges of becoming familiar with the assessment tools and supervision process and ensuring that the assessment strategy is being delivered. We started to pilot a new paediatric e-Portfolio with trainees and trainers in the Yorkshire region who were joined later by trainees and trainers in Northern Ireland and Oxford. Training was arranged for new e-Portfolio champions in each region so that local support would be available for trainers and trainees. Now the e-Portfolio is available for all specialty trainees across the UK. Two new sub-specialties were approved â&#x20AC;&#x201C; Inherited Metabolic Medicine and Palliative Care Medicine. A working group was set up to look into the possibility of establishing Child Public Health as another new sub-specialty and rapid progress is being made. Others began to look into the possibility of modular training for those with a special interest. We were sad to say goodbye to our lead dean Professor Bill Burr who has been very supportive over the last couple of years. We are however, delighted to welcome Wendy Reid as our new lead dean who not only has enthusiastically taken over running

the National Grid but has also made huge contributions to our national recruitment process. The RCPCH has led and co-ordinated national recruitment in paediatrics for England and Wales for 2008. The process included a common application form, common shortlisting scoring system, and a common interview selection and scoring process. Applicants were eligible to be interviewed in the first two deaneries of their choice and those ranked but unplaced were entered into a clearing system allowing them to be considered for other vacant programmes. 99% of run-through posts were filled and 84% of applicants were placed in their first or second choice deanery. We have further refined this process for the 2009 recruitment process. In addition we ran selection into specialty training, National Grid, now in its eighth year. The MRCPCH has had a longstanding high international reputation. It serves its purpose well and candidates, patients and examiners regularly give us good feedback. During this reporting year we have started the process of informing the world of our experience with examinations. We were responsible for seven presentations at various national and international medical education conferences. The excellent and interested reception that all our presentations received reinforces our belief in the quality

Dr Mary McGraw Vice President, Training and Assessment

of our examinations. Our ability to be able to provide such high quality presentations is testament to the excellent analysis and review work carried out by our Psychometric team in the Department. We aim to continue to develop and improve all aspects of College assessment through rigorous quality assurance and analysis. In order to continue to maintain the excellence of the MRCPCH a programme of examiner training has been instituted. One-day induction sessions to familiarise new examiners with the detail of what is required of them upon appointment are now obligatory. Attendance at a two-day refresher training course, at least once every five years, is also now a compulsory requirement of being an examiner. The other significant event that merits reporting is the development of Egypt as an examination partner for the MRCPCH. Following visits to establish local suitability to become a centre for the MRCPCH Clinical, a team from the College made two trips to Cairo to provide training for new examiners and candidates. The second

visit involved a full pilot of the MRCPCH examination and was very successful indeed. This venture is not only important in helping to provide a benchmark for standards of clinical practice in Egypt but it has also given the College a mechanism through which to work with local colleagues to collaborate on a range of education and training projects in the coming year. Ensuring that the training and assessment being delivered is of high quality is crucial. We have enhanced the feedback from trainees on training by ensuring appropriate specialty questions are included in the PMETB trainee questionnaire. We are also grateful to our CSACs for helping set some guidance for deaneries on indicators of the quality of training across all specialties in paediatrics which should be used by deaneries in 2009. We are aware that changes in immigration regulations in recent years have reduced the number of overseas doctors being able to have the opportunity to train in the UK. We are, therefore, delighted that the Department of Health re-launch of the

Medical Training Initiative will allow us to offer 2-year training programmes either at a junior or senior level to doctors from overseas. We are working in partnership with deaneries to provide programmes and overseas partners to identify doctors who will benefit from this training. We are hopeful that an increasing number of overseas doctors will be entering these programmes. We recognise that all this is going on against the background of departments struggling to deliver the service with gaps in rotas and difficulty in recruiting to short term vacancies. We are enormously grateful not only for the hard work of all the members of the Training and Assessment Department led by Christine Cooper and Graeme Muir and the officers, Dr Ian Doughty (Training), Dr Colin Campbell, now replaced by Dr Andrew Long (Assessment) and Dr Simon Newell (Examinations), but also all those Regional Advisers, College Tutors and Heads of Schools who are working so hard to implement the provision of high quality training and assessment at a local level.

It has been a year of considerable change for the College’s Education Department. We said goodbye to Dr Chris Verity, who demitted office as Vice President for Education and Chair of the Academic Board. During his 5 years in office, he had led the development of existing education activities and an expansion in the number and size of projects in the Department’s portfolio. We welcomed Dr Alistair Thomson, who took over these responsibilities in April 2008. The Education team at the College is led by Rosalind Topping, Head of Education. The team’s purpose is to develop and provide high-quality and robust educational materials for doctors working at all levels in the field of paediatrics and child health. This includes conferences and one-day courses, Continuing Professional Development (CPD), and increasingly, e-learning initiatives. The guiding principles for this work continue to be that the educational resources produced by the College should not duplicate any found elsewhere and that they should address generic topics which are essential to all paediatricians. Plans were laid down during the year for the development of new projects. The Department has taken responsibilty for the planning and eventual imlementation of revalidation for paediatricians, which is a major addition to the Department’s remit this year. The College’s flagship educational event continues to be the Spring Meeting, which has taken place for many years at the University of York. It comprises plenary sessions, specialty group meetings, the College’s Annual General Meeting, as well as a range of social functions. The cost is kept as low as possible in order to maximise the number of people who are able to attend. Attendance can be anything up to

2,000 across the four days of the meeting. This year, the Spring Meeting focussed especially on presenting a programme that met the CPD needs of those attending. Highlights of the 2005 to 2008 meetings are on the website. The Academic Board hosted a follow-up session in October 2007 to seek a wide range of views on future improvements to the meeting. As a result of those discussions,the following points will be put in place from 2009: n The College’s Spring Meeting aims for content of the highest quality, with a rejuvenated programme. n The meeting will open with a ‘3 x 5 hot topics’CPD session on Monday afternoon. n By popular demand, the plenary sessions will move to mornings on Tuesday, Wednesday and Thursday. n There will be more joint specialty groups sessions, more posters and a clearly signposted CPD pathway through the week. n The Annual Dinner is on Wednesday evening, with black-tie optional, to encourage as many Fellows, Members and guests as possible to attend. Continuing Professional Development The Government’s plans for revalidation/ recertification of doctors emphasise the

central role CPD will have. The College’s CPD scheme has now been running for a decade, providing a framework for members to demonstrate that their practice is up to date. Members are required to obtain an average of 50 CPD credits each year (i.e. 250 across each five-year period). The CPD is to be one of five elements for the recertification of specialists. Consequently, the guidelines and logistic support for the scheme have been closely monitored by the College so that both may as far as possible conform to those across all the colleges and provide smooth transition towards revalidation, once requirements for this major initiative become clear. Plans are in place for enhancement of the software for participants in the scheme to register and manage their CPD. Priority is being given to work on training-the-trainers courses for career-grade paediatricians. This work is led by Dr Ian Spillman, Senior College Tutor, and future developments will be announced on the College website. Revalidation In preparation for the introduction of revalidation and recertification, the College has established a Revalidation and Recertification Development Committee to act as an overarching group to look at

Dr Alistair Thomson Vice President, Education

generic areas of work and ensure the project fulfils its aims and objectives. The Development Committee has planned to consult Fellows and Members at all relevant stages of the project via both an e-survey and targeted focus groups. The College is to receive external funding for some aspects of this project.The Academy of Medical Royal Colleges invited bids for College-based Recertification tools. A bid by the College to review the use and acceptability of SHEFFPAT for consultant assessment under the Revalidation process was planned during the year. The bid was subsequently submitted and accepted. Education Projects There has been a major expansion in the College’s portfolio of education resources, which are a range of courses aimed at improving standards in core areas of paediatric expertise. Some of the most important are: n Adolescent Health Project The RCPCH, with the Royal College of General Practitioners, the Royal College of Nursing, other Royal Colleges and e-Learning for Healthcare have collaborated with other health professionals to produce interdisciplinary training materials to enable all doctors and nurses to achieve the necessary skills to help their young patients make the necessary changes to lead healthier and more active lives. The project was launched by the Secretary of State for Health,The Rt Hon Alan Johnson in July 2008. This project is notable not only for the importance of its subject matter, but also the speed at which both the development work took place. Access to the launched materials has been made available to a wide range of health professionals. n HENRY (Healthy Eating Nutrition for the Really Young) The College is proud to be hosting this exciting project, funded by the DH and DCSF, and run by an enthusiastic and dedicated team based in Oxford and Leeds.HENRY aims to tackle childhood obesity by training community and health practitioners to work more effectively with parents and young families.It was awarded the Association for the Study of Obesity Best Practice Award 2008. n Court Skills in Child Protection This programme was developed in the light of many paediatricians’concerns about giving expert witness evidence, especially in child

protection cases. It provides a grounding in family and civil law in England and Wales, and also covers skills in report-writing and evidence-giving. A corresponding programme is being developed for Scotland. In addition to the two-day course run annually in London, there are plans for it to run in the regions, with a view to strengthening collaboration between paediatricians and their legal colleagues locally. n Diploma in Paediatric Nutrition This project, which is a joint venture between the College and the University of Southampton, has been running for several years. It aims to give paediatricians an understanding of what nutrition is and how it impacts on their work, especially in the context of growth and development. The College is seeking an agreement with the University of Southampton for the external validation of the course. n Paediatricians as Educators Paediatricians are increasingly being called upon to work as educators, but many feel that they have not been trained in the necessary skills; this course aims to address that gap.It is aimed especially at paediatricians whose jobs have educational components, and its goal is to enhance skills in communication and working with those being trained. n Child Protection In conjunction with the NSPCC and the ALSG, and under the leadership of Dr Neela Shabde, the College has developed

a comprehensive programme to educate trainee paediatricians in this sensitive area. The course currently comprises a comprehensive Child Protection Reader, an accompanying DVD, and regular one-day training programmes advertised on the College website. There are plans to develop a course in child protection for career grade paediatricians. n Child in Mind This project aims to give a comprehensive grounding in child mental health, and is currently aimed at trainee paediatricians. The course material has been developed over the last few years by Dr Quentin Spender and Dr Avril Washington, and the College is now working to ensure that the course is rolled out as fully as possible to those who need it. At present, this includes College-run ‘Training the trainers’ workshops, backed up by a website that gives trainees access to course materials. Details of all these courses can be obtained from www.rcpch.ac.uk/Education/EducationCourses-and-Programmes. In all of these projects, the College is continuing to look at additional means of delivery, especially e-learning, and is aiming to make many of these courses available via web-based platforms in the future. Further education projects take place as part of the College’s International programme and details can be found on page 16 of this report.

The Research Department, which is overseen by the Vice President for Research, Terence Stephenson, has had an extremely busy year with a significant number of new projects commissioned. Work on these externally funded projects has been balanced alongside the ongoing work promoting the implementation of evidence-based guidance, workforce planning and the BPSU activities. In March the Department was funded by the DH to undertake a project to produce new growth charts for the UK incorporating the new data from WHO on breastfed infants. The project, which has been led by Professor Charlotte Wright, will result in new A4 and Personal Child Health Record charts for 0-4 year olds and a new chart for low birthweight infants as well as web-based training materials. The project has been completed in a remarkably short time thanks to the hard work of an extremely dedicated team of child growth experts and the new charts will be launched in May 2009. Another new project in the reporting year explored the feasibility of using care bundles to bring about improvements in neonatal care. The Safer Practice in Neonatal Care Project which was funded by the NPSA and led by Professor Neena Modi, developed and piloted care bundles in relation to

prevention of bloodstream infections and improving the safety of gentamicin prescribing. In third area, neonatal transport, a national survey of transport services was undertaken to identify potential safety issues. The project is due to be finished in April 2009. Clinical Guidelines and Audit The RCPCH Guidelines programme is conducted by the Collegeâ&#x20AC;&#x2122;s Clinical Effectiveness (CE) Team and is overseen by the Quality of Practice Committee (QPC). During the year, the number of members getting involved in the guideline development process increased with a response rate to consultations of 80%. Over 20 guidelines were endorsed and the key messages disseminated.The full list can be viewed at: www.rcpch.ac.uk/endorsedguidelines In January 2008, the National Neonatal Audit Project received two futher years funding from the HealthCare Commission.

The number of English units submitting data has continued to rise. Units in Wales and Scotland have been invited to join the audit and there have now been three quarterly reports to feed back the results to participating units. An Annual Report including analysis of the complete 2008 data will be published in May 09. Further information can be obtained from www.rcpch.ac.uk/nnap. Also this year the team was funded by DH to carry out an audit of urgent care services for children in England using the NICE feverish illness guideline as a framework to gain an in-depth understanding of the care pathway and timelines involved. The study is being carried out in 4 sites and includes all services providing urgent care such as A&E, NHS Direct and the ambulance service. A research element has been added to explore parents experiences and understand why they

Professor Terence Stephenson Vice President, Science and Research

use particular services and what can be improved.The findings will be available in Autumn 2009. In April 2008, the QPC and the Clinical Effectiveness team held its second Clinical Guideline workshop at the RCPCH Spring Meeting.The workshop provided information on how to develop an evidence-based guideline to College standards and the process of College endorsement. In addition, the event provided an opportunity to discuss issues surrounding guideline development using worked examples with experts in the field. In May 2008, the UK Guideline on Screening and Treatment of Retinopathy of Prematurity (ROP), a collaboration between the RCPCH, Royal College of Opthalmologists, British Association of Perinatal Medicine, and the premature baby charity Bliss was published. The guideline which is available on the RCPCH website, has been well received and has accompanying parents leaflets. Child Protection Research During the year the project to explore parents’ experiences when non-accidental injury (NAI) is suspected was completed. As part of this small qualitative project, which was jointly funded by the DCSF and the DH, 12 families who had been in the situation where professionals had initially suspected NAI in their child were interviewed about how concerns were communicated to them.The study has identified a number of key principles for paediatricians in relation to communicating with families in this sensitive situation which will inform child protection training. The research findings will be available from the RCPCH website in spring 2009. The review of the evidence-base for the physical signs of child sexual abuse was finished during the reporting year.The resulting publication was successfully launched in April to an audience of press and professionals, and Baroness Butler-Sloss was among the speakers. As well as the evidence review the publication outlines good practice in relation to the assessment, examination and STI testing in children where sexual abuse is suspected and has been very well received by child protection professionals, general paediatricians and members of the legal profession.

Workforce 07/08 The direction of the Workforce team’s work in 2007/8 was heavily influenced by the introduction of the MMC training scheme in 2007, the forthcoming implementation of the Working Time Directive WTD in 2009 and the consequent need to look at new models of consultant working. The team’s activity throughout the year included: n The College’s biennial workforce census which found that the growth in the paediatric workforce continued to slow. Publication of the full report is due in early 2009. n A joint study with the Royal College of Obstetricians and Gynaecologists, funded by National Workforce projects, was completed and published in July 2008. This considered the level of WTD compliance in England and following visits to a number of trusts, provided a detailed set of criteria to assess solutions produced by an expert panel. n Workforce and service data was modelled as part of the Modelling for the Future Project in order to produce more effective and evidence-based forecasts for future workforce demand. n Work began on a survey of first year trainees.This study aims to improve workforce planning by understanding trainee career intentions, improve career advice to prospective trainees and influence the development of training programmes. It is hoped that this cohort of trainees will be followed throughout their training. British Paediatric Surveillance Unit The year saw the commencement of one new study, Intussusception (IS) in children less than 12 months of age. However during the year there were several more in preparation and these have now come on to the cards (anaphylaxis following immunisation; conversion disorder; sudden unexpected postnatal collapse and toxic shock syndrome). Details of all the current studies can be found on the British Paediatric Surveillance Unit (BPSU) website www.bpsu.inopsu.com . The highlight of the year was hearing in July 2008 that funding for the BPSU has been secured until 2012.This followed a significant amount of work preparing the

application to the Department of Health. During the year the unit also undertook a formal evaluation of its activities which supported the application to the DH and showed that the unit meets all the CDC Atlanta requirements for effective surveillance. Part of the evaluation involved a survey of paediatricians which established that the orange card continues to be a valuable epidemiological and educational resource with 45% of paediatricians stating that results had changed their practice. The BPSU staff continue to administer the work of the International Network of Paediatric Surveillance Units; supporting the networks conference recently held in Germany. At home the BPSU methodology continues to be used by other specialties; paediatric surgeons have been involved in the IS survey and autumn saw the launch of the Child and Adolescent Psychiatric Surveillance System. The BPSU work is overseen by an Executive Committee chaired by Professor Allan Colver. In 2009 Allan is stepping down from the committee after 7 years of service. Our thanks go to Allan for maintaining the high standards of the BPSU and helping to secure its financial future.

The Health Services Department influences policy and supports paediatricians to improve the quality of health services for children. The Modelling the Future project, which started in 2006, aims to develop a practical vision for the future of children’s health services in the UK.The first report, published in September 2007, outlined the current issues facing children’s services and consulted paediatricians on new models of service delivery.The second report, published in August 2008, focuses on workforce and reconfiguration and in particular, explores how to achieve the right balance between numbers of doctors in training, and the numbers of trained doctors.The report consulted paediatricians on possible solutions including reconfiguration to reduce overnight rotas, the use of alternative staff groups, and new approaches to the role of the consultant paediatrician. The final report is expected in spring 2009, and will combine the two previous reports with consultation responses, to create a framework for the local planning, delivery, evaluation, and improvement of children’s health services, that is in keeping with the aspirations of the NHS Review and the Child Health Strategy. Over the year, the Health Services Department has also produced a number of short briefings to assist paediatricians in interpreting the implications of national policy on their daily work.These include: a succinct summary of the workforce issues

facing children’s services; a briefing on the implications for children and young people’s services of the Comprehensive Spending Review, Public Service Agreements, and Operating Framework for 08/09; and advice for paediatricians who work in Trusts with targets on new to follow-up ratios. To complement Modelling the Future, the Paediatricians in Medical Management (PiMM) Committee sought to support paediatricians in planning and implementing service change through the development of a framework of essential safety and quality standards for any reconfiguration. Supporting Paediatric Reconfiguration – A Framework for Standards, focuses particularly on general acute paediatric services, but also considers the interface with specialist, community and primary care.The report outlines: clinical competencies required, and the minimum workload to ensure that they are maintained; essential services; the appropriate environment of care; and essential protocols.The report also explores potential barriers and unintended consequences of reconfiguration and considers how these can be overcome. The PiMM Committee has also equipped paediatricians with the skills and competencies to tackle the challenges of service development and management through their clinical leadership courses.

A successful course was run in November 2007, including presentations on reconfiguration standards, working time solutions, and the development of urgent care pathways.This course received very positive feedback, and others are being run in 2009. Meanwhile,the Intercollegiate Committee for Services for Children in Emergency Departments has been working to support service development in emergency care. The Role of the Consultant Paediatrician with Subspecialty Training in Paediatric Emergency Medicine (PEM) describes how the interfaces between emergency paediatric care, short stay inpatient care, outreach community care, child protection, and paediatric critical care can be improved through utilising the skills of consultants with subspecialty training in PEM. Prior to the mandatory introduction of Child Death Review Processes for Local Safeguarding Boards in England in April 2008, the Health Services Department also published guidance on how paediatricians can best contribute to the process.The guidance considers the competencies required by health professionals in rapid response teams, gives examples of how the teams work, and makes recommendations for implementation. Great progress has been made this

Dr Simon Lenton Vice President, Health Services

year by the Young Person’s Health Special Interest Group (YPHSIG) in raising awareness of young persons’ health, and supporting paediatricians with work in this field. In 2008, the YPHSIG was launched at the College Spring Meeting, after a grant was received from the Department of Health.The YPHSIG has developed an excellent website (www.yphsig.org.uk); produced good-practice guidelines on participation and transition; and delivered its First Annual Residential Conference on Improving Practice in Young People’s Health, in October 2008. Regular monthly e-bulletins are sent to the growing membership, and further activities are being planned for the coming years. Child Protection The College has continued its work to support paediatricians in the challenging field of Child Protection, led by the Child Protection Officer, Dr Rosalyn Proops. Through its work on Child Protection, the College has developed strong links with the Child Protection Special Interest Group, the Royal College of Nursing, the NSPCC,

the Royal College of General Practitioners, as well as government departments. Over the past year, the College has produced a number of publications to guide paediatricians in dealing with suspected cases of child protection. Standards for Radiological Investigations of Suspected Non-accidental Injury, a joint publication with the Royal College of Radiologists, was launched at the 2008 Spring Meeting. Members of the Child Protection Standing Committee also worked with the Research Department on The Physical Signs of Child Sexual Abuse, an evidence-based review and handbook to aid clinical decision-making. This was published in March 2008 and disseminated via a series of road-shows across England, jointly delivered with the Child Protection Special Interest Group. Further work is in progress to ensure the guidelines are regularly updated in the light of new evidence. The College also set up a working group to produce updated guidance on Fabricated or Induced Illness by Carers (FII). The document, which is due to be published in

spring 2009, will provide practical guidance for paediatricians and other professionals with the aim of improving competence and confidence, and encouraging earlier recognition and optimal response when faced with a child with suspected FII. In 2008, the College ran its second Court Skills in Child Protection Course, which included presentations from experts in the legal and health fields on a range of issues in child protection and forensic medicine, as well as the opportunity to participate in a mock court exercise led by senior barristers. The course received very positive feedback, and the College has now committed to running it on an annual basis. The Child Protection Standing Committee has continued its work with the College Education Department to develop Child Protection in Practice, a level 2 safeguarding course, with roll-out expected in Spring 2009.The Child Protection Officer has also worked closely with the Media Affairs Department to educate and build awareness of child protection, and to promote the positive work of paediatricians in this area.

International

Wales

In the past year, the College has continued to develop its strategy for international work and commitment to child health throughout the world.The MRCPCH examination is now run in 22 locations overseas. International activity is overseen by Dr Stephen Green, International Officer, and the overseas Directors, Dr Steve Allen (Africa), Dr Ezzedin Gouta (Middle East), and Dr Mike Webb (India).

The Welsh Office continued to develop a consultative relationship with the Welsh Assembly Government with communication and regular meetings between the Officer for Wales and the Ministers Offices. In January 2008 Dr Gwyneth Owen (Officer for Wales), Dr Justin Warner (Hon Secretary), and Dr.Tom Williams (South & East Wales Regional Representative) met the Health Minister for Children, Education and Lifelong Learning Skills.The purpose was to discuss the CYPSSP, paediatricians in child protection, the provision of services for children with disabilities, issues in Child Health and raising the profile of children’s issues in Wales. Dr Iolo Doull and Dr Val Klimach (North Wales Representative) also met with the Deputy Minister for Social Services in June 2008 to discuss services for children with disabilities.

Palestine The piloting of the Palestine Child Health Diploma was completed and participants were presented with certificates by the President at a ceremony in Ramallah in October 2007. An examination has been introduced at the end of the course which leads successful candidates to receive a Palestine Child Health Diploma.The full project is now being run in two centres – Ramallah and East Jerusalem. Jordan Courses in ‘Teaching paediatrics and child health’ and ‘Paediatric life support’ were delivered in Amman, Jordan in November 2007 to paediatricians from Iraq, Jordan, West Bank, Syria and the Yemen. These courses were run in collaboration with the Jordanian Pediatric Society (JPS) and discussions were also held about the next courses in Erbil, Kurdistan, Northern Iraq. India The Indian Academy of Paediatrics is keen to extend the DBIF sponsored ‘Evidence-based medicine’ course regionally within India. Further plans to develop a RCPCH child protection course, as well as the MRCPCH examination in India, are also under discussion. Africa The College is helping to evaluate medical education courses in Ibadan, Nigeria and has negotiated with the Paediatric Association of Tanzania about providing exams ‘off the shelf’. David Baum International Foundation The David Baum International Foundation (DBIF) Symposium was held in December 2007 with presentations on all of the projects funded by the DBIF. The Trustees Advisory Group started discussions on a potential change of focus for the DBIF in the following ways: n Continue to support current projects to completion instead of taking on any new ones n Concentrate remaining resources on one large international initiative, the objectives of which, would be in line with the College’s international strategy n To look at funding a prize for international child health.

The following events during this reporting year were well attended and well received: n In November 2007 the joint WRCPCH & WPS Autumn Meeting in Llanelli was hosted by Dr Gwyneth Owen and followed by Dr Mair Parry hosting the Spring event in Deganwy, North Wales in May 2008. n In March 2008 the WRCPCH St. David’s Day Conference was held in Aberystwyth. There have been a number of committee and staff changes during 2008. In May, Dr Iolo Doull became the new Officer for Wales taking over from Dr Gwyneth Owen. Our thanks go to Dr Owen for her contributions during her time in post and to Dr Doull for his continuing work. Other Committee Appointments in 2008: North Wales Regional Representative: Dr. Markus Hesseling Mid & West Wales Representative: Dr. Velupillai Vipulendranm South & East Wales Representative: Dr. Ian Bowler Elected to RCPCH Council: Dr. Justin Warner Regional Advisor: Dr Peter Dale Staff Appointments in 2008: Welsh Office Manager: Rebecca Robson Administrative Assistant: Amanda Llewellyn-Pace The Wales Office plans to contribute to the consultative process in 2009 on the proposed restructure of the NHS in Wales, including voicing concerns about potential manning shortfalls in Paediatrics in Wales following the implementation of European working time legislation.

Scotland

Ireland

The Scotland Office has been working with the Scottish Government on the National Delivery Plan for specialist children’s services that has attracted £32 million of additional funding over a 3-year period to support and develop improvements to specialist services. Meetings have also been held between the Officer for Scotland and the SG minister responsible for child health and the CMO. Committee work has included the production of a document on managed clinical networks for child protection, by the Child Protection Sub Committee, that has been favourably received by the SG. Office staff continue to support and encourage the paediatric lecture series with lectures being delivered via a videoconferencing network to up to 12 hospital sites throughout Scotland.

The Ireland Committee has continued to have an important role over the past year as there have been a number of changes within paediatrics and child health in the Province and the Republic. It was announced earlier in the year that a national service framework for children’s health and wellbeing will be developed in Northern Ireland. The Ireland Committee wrote to the CMO to thank him for his support and we are pleased that Barbara Bell, the College’s regional representative in Northern Ireland, has been appointed as Lead Clinician for the proposed framework. Barbara Bell will be liaising with paediatricians across the Province to make sure that their priorities for services for children are taken into account. The College has been involved in the O’Hara Inquiry into deaths in children from hypernatraemia which is ongoing. The Inquiry has been very detailed, requiring time commitment and may well be the precedent for inquiries in the future. Guidelines on Paediatric Parenteral Fluid Therapy have been produced by the Department of Health, Social Services and Public Safety (Northern Ireland) and are already in place and we will need to wait to hear the outcome of the Inquiry before we know whether further steps need to be taken. During the year a symposium was held in Belfast to disseminate the results from the CEMACH Pilot Inquiry into Child Deaths. Northern Ireland was one of the pilot sites for the Inquiry and it was an opportunity for professionals in Northern Ireland to hear first hand some of the outcomes. The Ireland Committee held an extraordinary meeting in Dublin in June to fully inform members of the Committee of the current requirements for entry into Specialty Training Programmes in the UK. In the past, MRCPI was recognised as an entry criterion for specialist training in the UK but this equivalence has disappeared under the introduction of the current training programme. Mary McGraw, Vice President, Training and Assessment and Graeme Muir, Head of Assessment, explained the current situation in more detail so that this information can be passed on to trainees who might wish to undertake part of their paediatric training in the UK. The Ireland Committee has continued to facilitate exchange of information in these areas and to provide help and support.

A number of successful events have been held: n The St Andrew’s Day Symposium was held in November 2007, where HRH Princess Royal gave the RCPCH address.The symposium was a joint meeting between RCPCH Scotland, the Scottish Paediatric Society, the Royal College of Physicians of Edinburgh, the Scottish Association for Community Child Health and the Royal Collage of Physicians & Surgeons of Glasgow. It was attended by approx 200 paediatricians and acted as a platform for trainees to present research papers. HRH Princess Royal and Dr Patricia Hamilton presented prizes to the winners. n Also in November 2007, the RCPCH Admission Ceremony took place in Edinburgh for the first time, along with the Presidents Summer Lunch in July 2008. n In May 2008 the Policy Conference was held on the theme of “influencing policy”. Chaired by Dr Jim Beattie, the conference discussed the SG review of nursing in the community and clinical outcome indicators and Dr Harry Burns, Chief Medical Officer gave an excellent presentation on the biology of poverty in the early years. The Officer for Scotland, Dr Adrian Margerison retired in April 2008 and was replaced by Dr Jim Beattie. Our thanks go to Dr Margerison for his contributions during his 3-year term in office and to Dr Beattie for his continuing work.

As I reported last year, early 2008 saw us on the brink of moving into the new Headquarters building. We had already bought 5 Theobalds Road, and were squatting, rent free, in our old building in Hallam Street while we waited for Maris to complete the fit-out of our new accommodation. With hindsight, it is sobering to think how many things could have gone wrong in the run-up to Easter and surprising that the project board got much sleep during February and March. Building projects have been known to hit snags and over-run, and Good Friday was inked, not merely pencilled, in as the date by which we had to be out of the old offices. If we exceeded our small margin of error, we were on the street. It was with a sense of relief that we took over the completed building with a week or so to spare. Even then, staff went home on Maundy Thursday with a promise that we were still not sure we could fulfil – that, over the Easter break, all of their crates and furniture would have been moved and that IT, phones and other services would be up and running for them by Tuesday morning. But that’s what happened. We were able to report to the AGM a couple of weeks later that the project had been completed on time and to Council, in July, that it had been completed at the cost we had originally predicted. You may remember that Heathrow’s Terminal 5 opened at about the same time but with less success. We were a bit smug about that. Though I mentioned many of them last year I would like to thank again Council, the project board, AYH (our project managers), Maris (the fit-out company), Debbie Sayers and her facilities team, Olly Rice and his IT team, and the many others who contributed to the success of the project. We have now settled into the new

building, which pretty much everyone – officers, staff, committee members and College members and fellows who have visited – agrees is a vast improvement over what we had before. We were able to take advantage of the improved meeting facilities almost immediately, with the launch at the College of the new edition of The Physical Signs of Child Sexual Abuse. Later during the year we were also able to run other major events in-house including a seminar on climate change and a joint launch, with The Lancet, of their child protection series. Though one of the main advantages of the new building is its well-equipped committee rooms, we are in fact reviewing our committees and looking for economies. Both for reasons of cost and carbon footprint, we do not want our committees to be larger or more numerous or to meet more often than necessary. The excellent new videoconferencing facilities should reduce the need for travel – and internal flights in particular. David Vickers is leading this review. Rollo Clifford, with the help of Yasir Musawar, is championing a more general drive to reduce the College’s carbon footprint, including recycling and our consumption of energy in running the building. (Do not fear however that our new committee rooms will be unused – they are already much in demand for external bookings). While on the subject of committees we have reported back in previous years on various performance measures. Most of now covered elsewhere in the report, but it

is worth noting that the percentages of committee members from ethnic minorities composition of committees (a statistic on which we have reported regularly) remains steady at about 17%. There has however been a significant increase in the number of members of Council from ethnic minorities. Our media work continues to grow. The Baby P case was, unfortunately, one of the bigger stories of the year and we needed to respond to requests for related information – primarily general ones about child protection. We also continued, through our media work, to get out important messages about MMR, obesity and adolescent health. There are now regular reports in the College Newsletter about media affairs to keep members updated on what the key issues are. On behalf of the media team I must, as in previous years, thank the members of the press panel for their invaluable work in fielding technical enquiries from journalists. The year also saw greater contact with Government ministers and with MPs, MSPs and members of the Welsh Assembly. We were able to brief MPs particularly on child protection issues. Dr Rosalyn Proops gave evidence to the parliamentary committee for children, schools and families as part of their enquiry into looked-after children. Towards the end of 2008, she also briefed a group of MPs more generally on safeguarding issues. In conclusion I should like to thank the President, officers and staff of the College for their support during one of the busiest years on record.

Len Tyler Chief Executive Officer

Senior management team Chief Executive Officer Len Tyler Director of Internal Services Mike Poole Director of Operations Jacqueline Fitzgerald Director of Policy and Standards David Ennis Head of Human Resources Michelle Macadam Governance The College has a formal constitution, which sets out its powers and the ways in which it may operate. Changes to the Charter and Bye-Laws must have the approval of the Privy Council and Charity Commissioners, as well as the College’s own Annual General Meeting. The AGM has the power to agree changes to regulations, which cover matters of detail such as membership criteria and the arrangements for running examinations. The composition of Council is determined by the Bye-Laws; however, the College’s committee structure is not prescribed and is regulated by Council itself. 2008 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 College’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 College’s national network is managed through its Scottish, Welsh and Irish committees. The College also has offices in Edinburgh and Cardiff. Together this provides a powerful voice for fellows and members, and also ensures 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, the quarterly newsletter which contains general news and information and through regular presidential e-bulletins sent to those members who have elected to be contacted by this method. Executive Committee Reviewing College activities, offering strategic direction to College activities and advice to Council Chair: President, Dr Patricia Hamilton Financial Governance and Audit Committee Responsible for ensuring the proper management of the finances of the College Chair: Honorary Treasurer, Dr Sue Hobbins Specialty Forum Coordinating the work of College specialties Chair: Vice President, Dr Simon Lenton Training Committee Setting, delivery and maintaining the standards of paediatric training and examinations throughout the UK and Republic of Ireland Chair: Vice President, Dr Mary McGraw Research Division Executive Committee Reviewing research activity and offering strategic direction in the areas of research, surveillance and data collection Chair: Vice President, Professor Terence Stephenson 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 Steve Greene

Academic Board Managing conferences, scientific meetings and CPD Chair: Vice President, Dr Alistair Thomson Examinations Committee Setting and conducting the MRCPCH and DCH examinations Chair: Officer for Examinations, Dr Simon Newell Publications & Communications Committee Strategic management of College publications Chair: Registrar, Dr David Vickers College Specialist Advisory Committees Represent the major paediatric specialties and advise the College primarily on training issues Standing Committees Additional to this central committee structure there are standing committees which report to the Executive Committee and Council. These committees offer expert advice to the College and assist with the development and execution of College policy. These include: n Advocacy Committee n Child Protection Committee n Ethics Advisory Committee n Immunisation and Infectious Disease Committee n Medicines Committee (jointly with the Neonatal and Paediatric Pharmacists) n Nutrition Committee n Policy Committee n Staff & Associate Specialist Group Committee n Trainees Working Parties and Publications The College (and previously the BPA) has a long standing and successful record in convening working groups with clear terms of reference specifically to focus on finite problems with a view to producing written reports. Some of the larger working parties are intercollegiate with the membership coming from a wide range of medical disciplines, nurses/midwives and charities related to children’s welfare. The College publishes reports on clinical paediatric services, workforce, training, assessment, audit and research.

Patron: Her Royal Highness The Princess Royal Trustees 2007-2008: The Officers of the College and members of Council are as follows: Officers of the College

Dr Ramesh Mehta

Eastern

President Dr Patricia Hamilton

Dr Nisar Mir

Mersey

Dr Venkat Ramesh

Northern

Vice Presidents Dr Simon Lenton (Health Services) Dr Mary McGraw (Training & Assessment) Professor Terence Stephenson (Science & Research) Dr Alistair Thomson (Education)

Dr Russell Viner

North East Thames

Honorary Treasurer Dr Sue Hobbins Registrar Dr David Vickers Scotland Dr Jim Beattie

Dr Ruby Schwartz

North West Thames

Dr Javed Iqbal

North Western

Dr Nicholas Mann

Oxford

Dr John Trounce

South East Thames

Dr Ruth Charlton

South West Thames

Dr Michael Webb

South Western

Dr Peter Macfarlane

Trent

Dr Robert Scott-Jupp

Wessex

Dr Steve Bennett Britton

West Midlands

Wales Dr Iolo Doull

Dr Adrian Minford

Yorkshire

Dr Justin Warner

Wales

Ireland Dr Moira Stewart

Dr Donald Macgregor

N, NE, E Scotland

Dr Sepideh Taheri

South Eastern Scotland

Examinations Dr Simon Newell

Dr Katherine Mckay

Western Scotland

Dr Barbara Bell

Northern Ireland

David Baum Fellow (International Affairs) Dr Steve Greene

Vacant

Republic of Ireland

Assessment Vacant Child Protection Dr Rosalyn Proops Policy Dr Geoff Lawson

Dr Paul Dimitri and Dr Mo Gnanalingham

Trainees

Vacant

Associate Member

Professor Richard Olver

Association of Clinical Professors of Paediatrics

Dr Keith Dodd

Senior Members

Dr Jeremy Kirk

Paediatric Specialities

Details correct as of 31 August 2008.

Training Dr Ian Doughty Continuing Professional Development Dr Rollo Clifford Workforce Planning Dr David Shortland

This report aims to explain the figures for the College’s financial year to 31 August 2008, summarised on pages 24 to 26. Since my annual report of 2008, banks worldwide have demonstrated increasing instability and the UK’s economy is officially in recession.The College has experienced major financial changes following the sale of 50 Hallam Street and the purchase and move to 5-11 Theobalds Road. This move in early 2008 would not now be possible in the current economic climate due to investments being considerably reduced, property values falling and mortgage availability seriously limited. The move has achieved the desired objective of protecting the College from the uncertain future effects of the property rental market and is delivering the benefits of efficient working together with capacity and vision for growth. The College expects to have sufficient cash balances for the foreseeable future with relatively small risks to core income streams and opportunities to income generate whilst benefiting from owning new premises. Income and costs are finely balanced and there is continual financial evaluation to mitigate potential adverse effects (Figure 1). Reporting year 2007-2008 The move to new premises has had an effect on the College’s balance sheet, page 25.

Although the total net assets and funds of the College have marginally increased from £17.90million to £17.95million, the mix of assets, liabilities and different fund types has changed substantially. The College has fixed assets of £19.5million almost entirely made up of the freehold property Theobalds Road that compares to £7.5million the year before, of which £7.3million was in respect of 50 Hallam Street. The property purchase is the reason for the £7million overall reduction in total investments and cash from £11million to £4million. A £4million mortgage loan was required for the purchase and forms most of the £4.3million total for “Creditors… due after more than one year”. The corresponding effect of the property purchase on funds has been to increase designated funds (unrestricted funds earmarked for particular activities) from £8.6million to £16.3million and to almost exhaust General Funds.The transfer of £7.9million from general funds to the fixed assets fund still leaves the College with general funds of £400,000. Restricted funds, (external funding received to be used for specific purposes), have not been affected by the move and

stand at £1.21million compared with £1.07million in 2007. The Statement of Financial Activities on page 24 gives the summary of income and expenditure.The College, because of its constitution undertakes a variety of activities, which are described within the other reports in this document and explains the variance of income and expenditure from year-to-year (Figures 2 and 3). The overall “bottom line” is a small net increase in funds of £52,000,which results in: n £143,000 increase in restricted funds (funds received and used for a specific purpose) n £232,000 decrease in designated funds (unrestricted funds used for particular activities) n £141,000 increase in general funds (available for general purposes) The increase in general funds from operating activities is a significant achievement given it is after the inclusion of the one-off costs of £208,500 associated with the move (mainly cost of disposal of the leased property 56 Hallam Street plus removal costs). Figure 2: Income 2007-8 Total = £8.85 million

Figure 1: Trends, 1996 to 2008

Figure 3: Expenditure 2007-8 Total = £8.83 million

Purchase of 5 Theobalds Road

£10

Members Subscriptions 32%

£9

Assessment 24%

£8 Spring Meeting 6%

£7 Education 11%

Millions

£6 £5

Purchase of 50 Hallam Street

Assessment 29%

Research 11%

£3 Spring Meeting 5% Education 4% Training 2% Research 8%

£2 £1 £0 £1

1997

1998

1999

2000

2001

Income

2002

2003

Expenditure

2004

2005 Surplus

2006

2007

2008

General Funds

Voluntary 2% Investment 6%

One-off costs of move 2%

Professional & Standards 35%

Publications 10% Other 4%

Training 10%

£4

Other 1%

Dr Sue Hobbins Honorary Treasurer

Other headlines and achievements include: n Total incoming resources of £8.85m - 1.8% increase. n Total resources expended (excluding one-off costs of the move) of £8.62m 4.3% increase. n Membership subscription income of just under £2.8m, (9.7% increase) reflecting the growth in total membership by 14.6% from 9,404 to 10,774 members and membership subscription rates increased by 4% on 1 January 2008 n Significant growth in the College’s Junior membership from 164 to 1,132 as paediatric trainees in the UK have to enrol with the College for monitoring of training and assessment tools access. n Assessment income from examinations of £2.3m, a reduction of £206,000 or 8.3%. For a second consecutive year candidate numbers have fallen and reflects the end of permit-free training. This is being monitored by the College and is conscious of the increasing costs associated with the examination. n Gains on disposal of the remaining investments in September 2007 of £9,195. n Following disposal of all investments and until completion of the purchase of new premises on 15 January 2008, the College held significantly higher levels of deposits with the College’s investment managers and bankers.The average return on these investments was 5.75% (2007 - 5.28%). The Bank of England base rate for the year averaged 5.34% (2007 - 5.23%). n Successful publication July 2008 of the 4th edition of the British National Formulary for Children (BNF-C) resulted in net Publications income of £197,000 (2007 - £213,000). n Publications income includes £474,000 (2007 - £471,000) because of the surplus due to the College from the joint venture to publish Archives of Disease in Childhood (ADC). n For a second year attracted increased grant funding of £1,105,000 (2007 - £969,000). n Despite higher attendance at 2008 Spring Meeting, income was £9,000 lower due to greater availability and discount take-up. n The external Auditors gave the College a “clean bill of health” The increase in total expenditure reflects a significant expansion of College work, particularly Assessment, Education and Other

Professional Activities.There has been increased expenditure to support activities for examination development and improve its quality and robustness. Meeting the requirements of PMETB for training,assessment and examinations have an impact on costs and is expected to continue. The Everley Jones fund continues to fund Education, Training and Research initiatives unable to attract external funding.The balance at 31 August 2008 is £425,000 with £85,000 committed to underwrite such activities. The increase in expenditure has been kept to a minimum by carefully monitoring and controlling costs.“Budget Scrutiny Day” allows Financial Governance and Audit Committee members and senior management to review with budget holders draft budgets. Expectations for 2008-2009 The General Fund allows the College to respond appropriately to most eventualities. At 31 August 2008 it was £400,000 after being used to fund the property purchase.The task of rebuilding the general fund begins again in earnest focussing on operating costs and new income generation and developing a proactive approach to fund-raising.There is adequate cash for the foreseeable future but though the economy is tight the College remains in a positive position (due to the value of 5 Theobalds Road) to increase its borrowing should some unforeseen event make it necessary.Achieving sustainability for current education initiatives is important.There is a continued drive for improved efficiencies internally with better systems integration, a Records management project, updating the College intranet, delivering improved services via the College’s website to name a few. There is now scope to expand on work that includes revalidation, additional research projects and bringing new assessment services in-house. Further information Transparency particularly with finances is essential and encouraged by the College. Full financial statements are available on the College website.

Accompanying statement to the accounts Independent Auditors’ statement to the Trustees of the Royal College of Paediatrics and Child Health We have examined the summarised financial statements of the Royal College of Paediatrics and Child Health. Respective responsibilities of trustees and auditors The trustees are responsible for preparing the summarised financial statements in accordance with the recommendations of the charities’ Statement of Recommended Practice. Our responsibility is to report to you our opinion on the consistency of the summarised financial statements and Trustees’ Annual Report. We also read the other information contained in the Annual Report and consider the implications for our report if we become aware of any apparent misstatements or material inconsistencies with the summarised financial statements. Basis of opinion We conducted our work in accordance with Bulletin 1999/6 “The auditors’ statement on the summary financial statements” issued by the Auditing Practices Board for use in the United Kingdom. Opinion In our opinion the summarised financial statements are consistent with the full financial statements and the Trustees Annual Report of Royal College of Paediatrics and Child Health for the year ended 31August 2008. Kingston Smith LLP Chartered Accountants and Registered Auditors 25 February 2009

If you have any queries about the finances, please do contact me (sue.hobbins@bromleyhospitals.nhs.uk) or Mike Poole (mike.poole@rcpch.ac.uk), Director of Internal Services at the College.

Summarised Financial Statements for the Year Ended 31 August 2008 Consolidated income & expenditure Consolidated Statement of Financial Activities for the Year Ended 31 August 2008 Unrestricted Funds £

Restricted Endowment Funds Funds £ £

2008 Total £

2007 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 Publications Other income

2,833 162,741 390,525

119,654 23,145

122,487 162,741 413,670

164,320 160,760 537,544

2,280,748 333,956 64,094 76,309 284,881 2,785,938 903,769 307,963

420,767 172,185 522,663 -

2,280,748 333,956 484,861 248,494 807,544 2,785,938 903,769 307,963

2,486,720 343,077 380,234 212,055 660,092 2,539,890 891,541 316,633

Total Incoming Resources (see note 3)

7,593,757

1,258,414

8,852,171

8,692,866

RESOURCES EXPENDED Costs of Generating Funds Costs of generating voluntary income Fundraising Trading: Costs of goods sold & other costs Charitable Activities Examinations Spring Meeting Education Training Research Other professional activities & standards Governance Costs Other Resources Expended

54,917 48,791

34,791 44,738

2,128,790 449,330 498,628 687,959 585,810 2,924,659 44,063 208,506

491,727 181,415 393,465 132,049 -

2,128,790 449,330 990,355 869,374 979,275 3,056,708 44,063 208,506

1,980,282 451,783 851,224 883,178 1,088,266 2,885,185 44,419 -

Total Resources Expended (see note 1)

7,631,453

1,198,656

8,830,109

8,263,866

(37,696) (83,042)

59,758 83,042

22,062 (0)

429,000 -

(120,738) 20,712 9,195

142,800 -

22,062 20,712 9,195

429,000 5,144,106 180,604

Net Movement in Funds Fund balances brought forward

(90,831) 16,819,284

142,800 1,067,541

14,855

51,969 17,901,680

5,753,710 12,147,970

Total Funds Carried Forward

16,728,453

1,210,341

14,855

17,953,649

17,901,680

Net Incoming Resources before interest in Associate and Transfers Transfer between funds Net Incoming Resources before other Recognised Gains and Losses Gains on revaluation of fixed assets Gains and losses on investment assets

All incoming resources and resources expended derive from continuing activities. There were no recognised gains and losses for the year other than those included in the Statement of Financial Activities. The notes on page 26 form part of these financial statements.

Balance sheet Consolidated Balance Sheet as at 31 August 2008 Group 2008 ÂŁ

Group 2007 ÂŁ

19,529,485

7,437,133

2,474,920

19,529,487

9,912,053

Current Assets Stock of Publications and Merchandise Debtors Investments Cash at bank and in hand

1,070,868 4,075,967

79 1,131,464 7,996,097 493,736

Creditors: Amounts falling due within one year

5,146,835 (2,423,167)

9,621,376 (1,631,749)

Net Current Assets

2,723,668

7,989,627

Total Assets less current liabilities

22,253,155

17,901,680

Creditors: Amounts falling due after more than one year

(4,299,506)

Net Assets

17,953,649

17,901,680

Represented by: Unrestricted Funds: Designated Funds Charitable Trading Subsidiary Fund General Funds

16,331,074 4 397,375

8,657,912 4 8,161,368

Total Unrestricted Funds

16,728,453

16,819,284

1,210,341

1,067,541

Fixed Assets Tangible Assets Investments

Restricted Funds Permanent Endowments Total Funds of the College (see note 2)

14,855

17,953,649

17,901,680

Notes to financial statements 1. Total Resources Expended Staff Costs £

Other Direct Costs £

Other Allocated Costs £

2008 Total £

2007 Total £

Costs of generating voluntary income Fundraising trading: cost of goods sold & other costs Examinations Spring Meeting Education Training Research Other professional activities and standards Governance costs Other Resouces Expended

18,437 818,640 77,102 358,696 359,779 532,286 1,248,729 7,588

28,507 48,791 983,578 345,572 518,710 364,964 265,919 1,396,852 44,063 200,918

7,973 326,572 26,656 112,949 144,631 181,070 411,127 -

54,917 48,791 2,128,790 449,330 990,355 869,374 979,275 3,056,708 44,063 208,506

34,791 44,738 1,980,282 451,783 851,224 883,178 1,088,266 2,885,185 44,419 44,419

Total Resources Expended

3,421,257

4,197,874

1,210,978

8,830,109

8,263,866

Other allocated costs in 2007-2008 can be further analysed by activity as follows: Premises & Facilities £

Human Resources £

Information Technology £

Finance £

Total Other Allocated Costs £

3,936 158,130 13,158 55,755 71,393 89,381 199,869 -

521 20,935 1,742 7,382 9,452 11,833 26,461 -

1,485 65,891 4,964 21,036 26,937 33,723 81,638 -

2,031 81,616 6,792 28,776 36,849 46,133 103,159 -

7,973 326,572 26,656 112,949 144,631 181,070 411,127 -

Total Allocated costs

591,622

78,326

235,674

305,356

1,210,978

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. Costs of generating voluntary income in 2008 includes the cost of engaging fund-raising professionals to establish the feasibility of major fund-raising initiatives. Other resources expended are non-recurring costs associated with the move to 5-11 Theobalds Road from the College’s previous locations in London. Governance costs include the costs associated with the meetings of the Council, Executive Committee and Financial Governance and Audit Committee and those incurred in connection with the statutory external audit. All allocated costs have been allocated on the basis of the headcount except £22,414 of the Information Technology cost which has been directly attributed.

2. Funds Unrestricted Funds The General Funds 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. The College reviews annually the level of reserves it requires.The current requirement is £1million and has been arrived at after performing a risk analysis of unrestricted income. The College has decided to aim to achieve the reserves requirement by 31 August 2014. The purchase of 5-11 Theobald’s Road means that at 31 August 2008 most of the College’s unrestricted funds are held in the fixed asset designated fund. As a result general funds have reduced to £397,375 (2007 - £8,161,368). For the year to 31 August 2009 the College has set the annual reserves target at break-even whilst the College adapts to the effect of the move to new premises. Designated funds comprise unrestricted funds that have been set aside by the trustees for particular purposes.They include the Fixed Assets Fund £15,487,485 (2007 - £7,373,189) and the balance of the Everley Jones Bequest £424,775 (2007 - £558,962).

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, Research 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 Director of Internal Services at the College. Any commercial companies who have made significant financial contributions to the College in the calendar year 2008 are included in the Fund-raising report within the Annual Report.

Dr Ben Ko Fund-raising Lead

The College has again done well in attracting external funding for its work for the financial year ended 31 August 2008. Most of it is shown in the restricted funds column of incoming resources in the statement of financial activities. In 2007-8 it totalled £1,258,414 compared to £1,105,040 the previous year. Research, Education and Training Departments have sourced 89% of this income this year, 83% the previous year. The Department of Health has been the biggest funder. For instance, it has provided £208,000 for the HENRY initiative to help develop and deliver obesity workshops for professionals working with parents to ensure their babies and preschool children are healthy and prevent or reverse obesity. A multidisciplinary group of experts are closely involved in the design and piloting of these practical intense training workshops. The Department has also given the College £178,780 to support the work of the BPSU and £153,143 for the College’s project to pilot the introduction of the new WHO Growth Standards in the UK via integrated growth charts. The National Patient Safety Agency has granted £50,000 to the College for the Fever Audit of the Urgent & Emergency Care Pathway for Children.The College is the lead for this project as part of a consortium comprising the Royal College of General Practitioners, the College of Emergency Medicine, the University of Leicester and University of Nottingham. This type of funding cannot be considered as “statutory” or in any way guaranteed, and without attracting such funds the College would be significantly smaller and less effective. Certain areas which the College wishes to progress, such as aspects of child protection work and international education initiatives

continue to be particularly difficult to link with any external funding. Hence there is a continued need to generate additional income in order to fulfil the College’s vision and ambitions. Options for fund raising To date the College has consciously adopted a low-key approach to fund-raising. Over the last year this approach has been actively reviewed and fund-raising options are being explored with the help of professional advice. Progress will be reported in the College Newsletter. Legacy fund raising In comparison with the more established charitable organisations, the College is receiving very little in the way of legacies either from its members or others. For example, no legacies have been received in the last 2 years. Other Medical Royal Colleges have well established mechanisms encouraging their members to include them as beneficiaries in their wills. This is an area of fund-raising that the College would wish to develop and gain the benefit from. The College did receive a substantial legacy many years ago which in 2007-8 has been used to fund the following important developments: n Handbook on physical signs of Child Sexual Abuse, now published. n Welsh Systematic Review Physical Abuse - head injuries. n Finalisation of the “Child in Mind”courses. n Safe Guarding Children Programme level 2 “Child protection in practice”. n Development of “competencies” for the training curriculum.

Details of total “Other voluntary income” are as follows: Legacy income Levies collected from UK-resident members for visiting fellowships and College work overseas Donations from members to Foundation Appeal Other donations

2007-8 £

2006-7 £

81,368

77,795

2,833

4,133

David Baum International Foundation

18,286

32,357

Scottish Executive support for Training project in Malawi

20,000

165,147

20,000

British Council support for course in Jordan Grant from Department of Health to establish Adolescent Health Special Interest Group Total

30,000

£122,487

£164,320

A gift in your Will The College is a charity and a gift in a Will can help reduce the inheritance tax burden. Such gifts are often referred to as “legacies” or “bequests”. There is a standard codicil form (an appendix to a Will) that can be sent to Members and Fellows for their professional adviser to consider.The College can assist Members and Fellows who have not written a Will and need a professional adviser. Other ways of making donation include: n regular donations by direct debit. n single donations by cheque or credit card n gifts of shares n gifts of dividend income. n support by payroll giving through the workplace. n taking part in an event such as sponsored walk or even a marathon! Further information Please visit the website www.rcpch.ac.uk and select the Fundraising section from the link headed ‘About the College’ for ways in which you can contribute. Alternatively please contact Pardeep Bhakar at the College Email: pardeep.bhakar@rcpch.ac.uk Telephone: 020 7092 6016. Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH.

David Baum International Foundation Details of DBIF income are as follows: 2007-8 £ Sponsored walk – balance from June 2007 event

6,828

Fingest Barn Opera – two events in September 2007

10,500

General Donations Total

958 £18,286

List of benefactors in last year Major Donations, Grants, Gifts and Other Funding We would especially like to thank the following who have helped to further the Collegeâ&#x20AC;&#x2122;s vision towards better child health by supporting our activities in 2008 through major donations, grants, gifts and gifts in kind (including consultancy services and advice). Academy of Medical Royal Colleges Department for Educations & Skills Department of Health Healthcare Commission Health Protection Agency (re BPSU) International Atomic Energy Agency (a specialised agency of the United Nations) International Union of Nutritional Sciences Institute of Child Health (re BPSU) The National Patient Safety Agency National Reyeâ&#x20AC;&#x2122;s Syndrome Foundation NHS East Midlands Strategic Health Authority The Oak Foundation Royal College of Obstetricians & Gynaecologists The Scottish Executive Specifically as support for the David Baum International Foundation: Mr J Leaver The United Grand Lodge of England (Needlemakers Lodge)

About bequests to RCPCH Bequests to the Royal College of Paediatrics and Child Health The health and well being of children has always been the concern of paediatricians. The enormous advances made by the medical profession have cut a swathe through previously fatal diseases, and better nutrition and living conditions have produced a healthier child population. However, other dangers, social and medical, continue to threaten, and in todayâ&#x20AC;&#x2122;s market-oriented climate, money is always needed to enable us to fight for childrenâ&#x20AC;&#x2122;s welfare, to fund research and to provide better education for paediatricians in whose hands lies the health of the nationâ&#x20AC;&#x2122;s children.

A bequest to the RCPCH in your Will would help the College to continue its important work. Overleaf you will find a printed form which, duly signed and witnessed, would become a codicil to your exiting Will. It can be simply filled in, detached and sent to your solicitor. If you intend to do this, will you please note the following points: 1. Please read the document to ensure that it accords with your wishes. Any alterations must be made before you sign. 2. Then date the document where indicated. 3. Then in the presence of two witnesses sign your name at the end of the document where indicated. 4. The witnesses must sign their names and write their addresses where indicated. The witnesses are needed in England, Wales and Northern Ireland; one witness in Scotland. 5. You and the witnesses must all be present together when you sign, and the witnesses must see you sign. 6. No person taking benefit under the document or the husband or wife of any such person should be a witness, otherwise such person will not be able to take any benefit under the document. 7. All alterations should be initialled by you and the witnesses in the margin opposite the alteration. 8. On no account should anything be pinned, stapled, paper-clipped or fastened in any way whatsoever to the document. Members wishing to contribute in this way are asked to contact the fund-raising section of the College (e-mail fundraising@rcpch.ac.uk), especially if they wish any bequest to be used for a specific purpose.

Please complete this form, detach and send to your solicitor.

I (name in block capitals) of

(address)

Declare this to be a Codicil which I make this

day of

To my Will which bears the date

day of

(1) I bequeath to the ROYAL COLLEGE OF PAEDIATRICS AND CHILD HEALTH (‘The College’) or to any successor body carrying out the same or similar charitable work the sum of

amount in words

free of all taxes whether payable in the United Kingdom or in countries overseas for the general purposes of the College and I declare that the receipt of the – Honorary Treasurer for the time being of the College shall be sufficient discharge for the same. (2) In all other respects I confirm my said Will. In witness thereof I have here unto set my hand the day and year first above written. Signed by the said Testor/rix (Signature) as a Codicil to his/her last Will in our joint presence and by us in his/hers.

Witness 1 (name in block capitals)

(Signature)

of (address)

Witness 2 (name in block capitals)

(Signature)

of (address)

The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in Scotland (SC038299).

Photo credits: Front cover, p6, p7, p9, p12, p13, p14, p15, p29 ÂŠ Sutterstock.

5-11 Theobalds Road, London WC1X 8SH Tel: 020 7092 6000 Fax: 020 7092 6001 e-mail: enquiries@rcpch.ac.uk

www.rcpch.ac.uk The Royal College of Paediatrics and Child Health (RCPCH) is a registered charity in England and Wales (1057744) and in Scotland (SC038299).

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Royal College of Paediatrics and Child Health