RCPCH Impact Report 2022

Royal College of Paediatrics and Child

Impact Report 2022

Health

Foreword from our President

The thrilling part of creating a report like this is that I am reminded in a few minutes just how much the College has done and what it has achieved in the last year! It is so easy to lose sight of the impressive range of work we do. I am so delighted and proud to go through these pages and consider the depth and breadth of our work.

With our dual mission of supporting and standard setting for paediatricians, alongside advocating for child health globally we have set ourselves a very ambitious set of targets. However, this report reflects such a rich range of examples of the extraordinary variety of work we do across policy and advocacy, education and training, research, and our global work, and I think shows just what an impact we are making in our work with partners and funders.

The needs of children and the child health workforce are enormous and so the potential areas of work are almost endless. Crucially, this report demonstrates evidence that RCPCH is committed to its mission and to seeing long-lasting meaningful change to benefit children and young people, and the paediatric workforce that serves them. The true mark of success

of improvement work is whether it is sustained after the project is over and all the attention has moved on. The projects described in this report show how deeply embedded our improvement work is and how we commit to areas of work where we are confident we can genuinely transform and improve in a long-lasting way. I have seen this with my own eyes, both at home in the UK across a whole range of projects, but also overseas in our Global Team’s work.

I sincerely hope this inspires you as a prospective partner or funder to work with us.

With my best wishes,

Dr Camilla Kingdon

Foreword – Dr Camilla Kingdon, President p3

Letter – Jo Revill, CEO p5

RCPCH impact by number p6

Advocacy and policy p8 Health and Care Bill p10

Respiratory support helpline p12 Tackling climate change p14

Education, training and professional development p15

Paediatric training p16 Progress+ p18

RCPCH Global p19 Myanmar paediatric care programme p20 Rwanda perinatal programme p23

Quality improvement p25

Epilepsy quality improvement programme p26

Diabetes quality assurance programme p28

Our focus areas p30

Closing remarks – Paul Marchant, Director of Corporate Services p32

Children and young people p34

In this report, we are setting out some of the tangible benefits we are making to the communities we serve both within the United Kingdom and internationally. All of this work is achieved by harnessing the ideas and energy of our members who work closely with College staff to take forward the improvements that we want to see.

Coming out of the COVID-19 pandemic has created challenges for medicine, but I’m proud of how the College has not only continued to deliver its activities but taken forward so many new areas of work. I hope you’ll see that there is a varied range of collaborative projects spanning areas such as: amplifying the voice of children and young people; policy and advocacy; humanitarian support; medical research; recruitment and education; training and peer support. Our membership has grown in the past year as it has for the past four years, which enables paediatrics to speak and act with a much stronger voice, achieving more influence with decision-makers.

Letter from our CEO

Jo Revill was CEO and Company Secretary of the College from June 2018 to October 2022.

Rob Okunnu is currently RCPCH Interim CEO.

It’s a great pleasure to introduce our first full impact report showing the difference we are making to paediatrics and child health and to the care for young patients across the world.

Increasingly, our activities involve project partners and funders from different sectors, including government, non-government organisations, charities, trusts and foundations, and private sector organisations. This diversity of funding helps the College to shore up its financial sustainability but importantly, brings us into contact with others who can ensure that we build on our mission.

I hope that this report encourages you to join us to play your part in working for change and we would love to have your feedback on this.

With best wishes, Jo Revill

Advocacy and policy

“We care, we have integrity, we are trusted by the public, but most importantly we bear witness to the reality of people’s lives. We owe it to our patients to speak out.”

Cllr Dr Alex Armitage, Consultant Paediatrician, Shetland

Northern Ireland

• Developed a strong manifesto –in conjunction with members and RCPCH & Us – which was sent to successful Members of the Legislative Assembly (MLAs) following the NI Assembly elections receiving praise from members and politicians alike.

• Held positions on a Department of Health established working group, significantly influencing recommendations aimed at government to support the development of regional child death overview processes in NI from a clinical perspective.

• Seven government consultations including seachange health transformation initiatives such as the NI Future Planning Model and Urgent and Emergency Care Review Priorities.

Scotland

• Seven Scottish Government consultations including A National Care Service for Scotland.

• Three Parliamentary Committee inquiries including the Health Committee’s inquiry into Health Inequalities.

• Oral evidence from Scottish Officer to the Health Committee on the Health and Wellbeing of Children and Young People inquiry.

Photo of baby Olive born at 29 weeks 3 days taken by her father Ben Turner

Wales

• Nine policy consultations including Welsh Government consultations on tobacco control, obesity and forming a new Welsh NHS Executive.

• Met representatives of the three main opposition parties in Wales; securing regular meetings with the Welsh Government Minister with responsibility for mental health, obesity, tobacco control and neurodevelopmental services; providing Senedd Committees with written evidence on planned care and waiting lists.

England

• Three parliamentary submissions and appearances including on clearing the backlog caused by the pandemic, workforce retention, vaccinations, vulnerable children and mental health.

• Two submissions to COVID-19 public inquiry including one which helped secure a greater focus on children and young people.

England – Changing policy for the benefit of children and young people

When the Health and Care Bill was first published it was clear that it would not do enough to support local systems to improve child health outcomes. We knew we had to push for changes to the Bill to ensure the needs of children and young people were placed on a statutory footing alongside integration of health and care services.

Drawing on RCPCH policy, evidence, and research, from then onwards we focused our influencing on four key areas:

• Ensuring children and young people’s needs are represented in Integrated Care Systems (ICS)

• Supporting the child health workforce

• Addressing health inequalities

• Improving how children’s data is shared between services

Throughout the Bill’s passage in Westminster, we worked to share our policy briefings with MPs and Peers to support them as they laid amendments and challenged the UK Government. We joined in coalition with other organisations such as the National Children’s Bureau to further amplify our briefings and engage civil servants.

Impact

As a result of this joint endeavour, we were delighted that the Government amended the Bill to better reflect the needs of children and young people.

This includes:

A requirement on ICBs to nominate an executive children’s lead ensuring leadership for babies, children, and young people.

A commitment from Government to publish a report that describes their policy on information sharing including on a consistent unique identifier for children.

“I would like to thank the RCPCH &Us team for helping us as children and young people get our voices heard and giving us a chance throughout the pandemic and the years before to express our views and opinions.

– RCPCH &Us volunteer

Outcome

The requirement for each ICB to appoint a children and young people’s lead will make a real difference to child health outcomes over time. It will help ensure there is much needed local strategic leadership to advocate for high quality, safe and effective integrated services.

A single unique identifier for children will utterly transform children’s experience of care especially those who have multiple needs and regularly interact with a range of services, or for safeguarding vulnerable children when quick information sharing is vital.

Ultimately, we have seen the needs of children and young people forgotten in the past. By working in collaboration with parliamentarians and organisations focused on children and young people we now have a legislative framework that will better enable paediatricians and other professionals to support the needs of children and young people and their families.

RCPCH &Us

NACAP engagement in Asthma Audit

Training for diabetes team on engagement and voice

The RCPCH &Us network for children, young people, parents and carers and the Engagement Collaborative for Professionals actively seek and share the views of children, young people and families to influence and shape policy and practice. Over the last year, the network has taken an active role in shaping national audit programmes for asthma, epilepsy and Type 2 diabetes. As a group they have attended RCPCH and external committees, conferences and meetings to advocate on behalf of children and young people everywhere, offering peer support, reassurance and encouragement.

Health inequalities

Resources developed in partnership with paediatricians to equip health practitioners with tools to address/ reduce child health inequalities. This is a College-wide effort that challenges members and the public to take action as advocates, speak openly and compassionately about poverty in clinic and develop quality improvement methods aimed to reduce health inequalities. Actions also include signing an open letter to members of the child health workforce to set policies that provide and fair and equal access to care.

Increase in mortality rates in most deprived areas

27% of children in the UK live in poverty

Guidance used to advise on health policy in all four Nations

#ShiftTheDial on child health inequalities

Safeguarding guidance for early medical abortion

Published

on RCPCH Child Protection Portal

Commissioned by the UK Government, RCPCH published guidance for commissioners and providers of early medical abortions (EMA) for under 18s. The purpose is to ensure young people have access to EMA in a timely manner and that safeguarding needs are identified and acted upon. This ensures consistency across health organisations and more opportunities to consider the safeguarding needs of every child and young people, with support offered when appropriate.

NHSE Youth Challenge Pack

Support for children with respiratory conditions

RCPCH worked with the children’s charity Barnardo’s on a national campaign to support families from marginalized communities.

The campaign aimed to reduce winter pressures by helping families experiencing socio-economic deprivation to manage symptoms of respiratory illness in the face of an anticipated surge in rates of infection, particularly from respiratory syncytial virus (RSV) in babies and infants over the winter of 2021.

Seeking and providing external second opinions in paediatrics

A helpline and web chat service was established offering guidance to families in 13 languages, alongside provision of community-based awareness sessions delivered with existing partner organisations, and associated communications.

Impact

The programme exceeded its targets with 19% more direct contacts than the original target of 600 (actual contacts 716). Calls to the helpline were less than predicted due to lower levels of RSV in the community, but this was offset by increased activity through face-to-face awareness sessions and the level of traffic to the RSV-specific web page, totalling more than 32,000 site visits – significantly higher than the target of 10,000.

In addition, the helpline was promoted to over 300,000 followers across social media and 32 families were helped with basic needs (hand-held devices, furniture, food vouchers).

Among callers to the helpline there were 14 different ethnic backgrounds with nearly a quarter (24%) being black African. At awareness raising sessions, 37% of participants were Pakistani and 28% were from Sierra Leone, with remaining participants covering 12 different ethnicities.

Outcome

Campaign materials continued to evolve throughout the six-month project and the project expanded to include 64 focus groups encompassing members of the following communities: black British, black Caribbean, Asian British, Arab, Pakistani, Other Asian, Indian, black African, Chinese, white and white Eastern European. The focus groups raised awareness of the campaign and identified any ongoing issues or barriers to healthcare, as well as further refining project materials and use of the RSV website. Issues of cultural and ethnic concern were openly discussed, e.g. “One of the NHS videos I watched talked about turning blue, what would that look like with black skin?” which provided very helpful feedback to be addressed by the campaigns Expert Advisory Group and incorporated into guidance for call handlers and team members running awareness raising sessions.

Its purpose is to standardise practice and improve transparency, with the broader aim of reducing disagreements in healthcare. Our teams developed the external second opinion (ESO) guidance for health professionals and tailor-made information leaflets for families to access online.

This work was in response to a gap in the health system, an inconsistent and varied second opinion process and confusion among families about how to seek a second opinion.

Impact

This guidance ensures the right foundations are in place to encourage a collaborative and transparent external second opinion process. Including –listening to the views of children and their families, prioritising a child’s best interests, using the principles of ‘reasonableness’ and the power of collaboration.

It strengthens the information gathering process, including how to develop the request, when and how to involve a family advocate, and who should provide a second opinion. Furthermore, professional bodies and those responsible for setting the health agenda, will have guidance to assist them in setting national and local policy.

Outcome

There are far-reaching gains that will be made because of this guidance. More families, healthcare professionals and service planners will have access to an actionable resource to mitigate and prevent disagreements in healthcare. The ESO process will become a standard practice with improved transparency – even encouraging paediatricians to undertake work as expert witnesses where their opinions can inform the court system.

Making decisions for the care of a critically ill child is difficult for both parents and clinical teams. In partnership with other local charities, the College produced a first of its kind guidance for healthcare professionals and families of children facing significant life changing decisions.

Our work on tackling climate change

Research

We draw on the expertise of our members to produce a number of key outputs like our position statement and policy briefing shared at COP26. We were pleased to see progress on one of our recommendations for targeted investment in climate-resilient, lowcarbon and sustainable health services. We focus on sharing research to inspire action. We established a regular climate change abstract category at our annual conference, and were delighted in 2022 to receive 16 submissions of different sustainable paediatrics projects from around the UK and internationally.

Communities

Over 80 RCPCH members volunteered to be part of our Climate Change Working Group across five dedicated workstreams–Advocacy, Support for members, Research, College building and resources and International. We’ve also seen impact across our wider membership, particularly through the medium of cycling. In September, a group of London-based paediatricians cycled around five hospitals with a paediatric intensive care unit in London to raise awareness of the impact of climate change and poor air quality on child health as part of #RideforTheirLives. And a group of four-Leeds-based paediatricians completed the 100-mile Ride London Essex challenge, raising an impressive £6k to come directly back into our climate change action work.

Advocacy

We use our collective voice as paediatricians to influence national and international climate change policy. Six of our members attended World Health Organisation events at COP26 in Glasgow to share our key messages. We also focus on air pollution and its impacts on pregnancy, women and children, hosting a roundtable for MPs encouraging them to set stronger targets for air quality in England and publishing in the BMJ. Our advocacy work on climate change and child health is already showing huge impact. We are ranked #1 in an independent survey of medical royal colleges and professional bodies in relation to our climate change actions and commitments. This demonstrates the success of our working group and our recognised impact as a leader in speaking out on this topic.

Education

A key ambition for this work is to educate our members. In 2021 we hosted our first continuing professional development event with 160 delegates, and our first podcast on climate action in paediatrics has received over 1000 downloads. We have also curated and published 38 resources on our website to support our members, including a toolkit to support paediatricians with upskilling on talking to local councils about air pollution which has allowed our members to have impactful conversations locally.

Education, training and professional development

“

It is one of the joys and privileges of our profession, that we never stop learning, that our patients and their families teach us so many long lasting lessons and that we work in teams that can share the learning and support each other when those lessons are by turn painful and joyous.”

Dr Cathryn Chadwick, VP Training and Assessment, General Paediatric Consultant at Northampton General Hospital

Accessible and flexible training

The COVID-19 pandemic has changed the way education is delivered. Robust technical solutions are needed to provide online offerings that maintain the quality and community of face-to-face teaching. This was a challenge the College faced head-on in 2020 and 2021 to deliver an educational and professional development portfolio designed to support and benefit paediatricians and child health professionals.

The Education and Professional Development (EPD) team worked to move all face-to-face courses online using new technology and educational infrastructure. Hosting courses online allowed the College to widen its international reach and provide flexible learning options while adopting sensible cost-cutting measures.

Impact

Using our College Strategy 2021 – 24 as a guide, EPD provided a portfolio that not only met the immediate needs of the workforce but laid the foundation for training in the future There was also a keen understanding to make the offerings educationally robust and show positive impact on practice. In the end the offerings provided a surplus of learning in addition to our paid-for provisions.

EPD worked closely with faculty to identify changing workforce requirements for relevant and up-to-date learning. This was achieved by utilising transparent quality assurance processes to assess all aspects of our provision. Evaluation measures were put in place to record demonstrable changes in personal perceptions of confidence and competence to practice.

Outcome

We employed several novel teaching methods to promote interactivity and engagement. Funding was used to transform online creative tools to encourage online debates, problem-solving and in-depth discussions. Online quizzes

offered further improvement through comprehension of their subject. This also underscored the importance of understanding how individuals learn such as more visual offerings like infographics and mind maps.

Our attendance record for academic year 2021–22 saw an increase by nearly 100% year-on-year.

We achieved an average score of 4.5 out of 5 for satisfaction. Verbal feedback from members was equally encouraging and showed that we were on the right educational path.

“

– Member course attendee

The College has pushed even further to enhance its learning platform and launched RCPCH Learning in June to better train paediatricians and other health practitioners. In the two months since launch, we have had more than 2,000 registered users and nearly 6,000 views across the site. Sustained support and funding in this area will further develop this offering providing quality education and connecting our member community at a level not seen in our College’s history.

1.00%

Projects on the horizon

0.50%

Paediatric & Child Health Curriculum Framework (PCHCF) (Advanced Clinical Practice)

Stronger trainer engagement

0.00% Q1Q2 Q3 2016 2017 2018 2019 2020 Q4 Q1Q2 Q3 Q4 Q1Q2 Q3 Q4 Q1Q2 Q3 Q4 Q1Q2 Q3 Q4

As part of the vision of Progress+ bespoke, spontaneity and flexibility in training has been an area that has been promoted regularly. Along with long term supervision by the same educational supervisors to help with continuity for trainees, RCPCH are also working hard to ensure that key changes in training are shared with all trainees.

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As part of the work being done to promote flexibility in Paediatric training, and also to acknowledge professionals ‘doing the work’ through non doctor roles; the RCPCH has recently submitted a curriculum framework aimed at providing a structured post graduate programme that will offer a range of medical professionals, such as paediatric nurses, a Masters’ level qualification which will acknowledge and rubber stamp the work that they do as they continue to significantly support paediatricians. This project has been funded by Health Education England (HEE) and has recently been reviewed for endorsement – due to be launched in November 2022.

We have introduced a series of workshops for educational supervisors that not only prepare them for Progress+, but also seek to answer their questions, respond to their concerns and provide tips on how to make training much more innovative and meaningful.

1.50% Sagaing Magway Ayeyarwady Kayin Linear (Average) Average 0

500

Steady increase in course delegate participation

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3000 Total

Q4 Q3 Q2 Q1

Course Delegates

3000 Autumn Winter Spring Summer Total 20/2121/22 20/21 21/22

The interaction with presenters/peers and cases was exceptional.

Progress+

The move towards capability training in medical education has been the result of the pioneering work at the College – developing and implementing Progress+ back in 2018, and a significant response to the Shape of Training’s recommendations. It also encouraged the College to promote integration between paediatric and primary care and mental health training – a partnership that proved to be desperately needed.

This is not “tick-box” training. Capability training ensures that our trainees are assessed in a way that allows them to demonstrate their learning and development.

We have been strategic in planning for this next move in paediatric training through engagement with our stakeholders to ensure that they feel ready, supported and reassured by the revisions that have been made. The College’s Training & Quality department have held several virtual and face-to-face events with trainees and trainers across the four nations. These events were aimed at strengthening the messaging behind Progress+ and providing opportunities for stakeholders to share any feedback about the upcoming changes.

Impact

We tapped into our in-house brain trust. The Training & Quality department set up a transition planning group to identify, discuss and respond to issues relating to Progress+. This is a core group of College member clinicians that include our Vice President for Training & Assessment, our officers for Scotland and Wales, our Chair of the Less-ThanFull-Time trainee group, a representative from Community Child Health and our Chair of the Trainee Committee.

As part of the College’s efforts to connect with as many stakeholders as possible, we introduced a Heads of School Forum, a series of Educational Supervisor workshops and increased our College Tutor network events. We are

also launching a forum for our Training & Programme Directors to ensure that trainers are made aware of how Progress+ will impact their role as a trainer. This activity, coupled with collaborative work with our Trainee Network representatives and several updates at our Trainee Network meetings, has reaped dividends in circulating updates about Progress+ as well as responding to concerns about the revised programme’s implementation.

Outcome

Our commitment to training and supporting paediatricians has never been stronger. Through this group we have been able to develop some effective communications geared to pre-empt and reassure about issues relating to trainee recruitment, pay progression, training post planning and exposure to training, particularly for those studying on the Community Child Health and Neonates subspecialty pathway.

The COVID-19 pandemic pushed forward the inevitable change that Progress+ will bring and the foresight of College leaders made this transition possible. This can only be strengthened through continued funding and support as we prepare for launch and beyond.

“

RCPCH global humanitarian programmes “

“My hope is that every young person is asked about their mood at every hospital appointment and is given the time for themselves and their families to voice any concerns.

– RCPCH &Us volunteer

We have the opportunity to really change the conversation around [global child health]. And we should think about how we really capitalise on that moving forward in the interests of children, right across the globe, not just based in the UK.”

Dr Sue Broster, RCPCH Global Officer

Nursing staff in Sierra

Myanmar neonatal and emergency paediatric care programme

A RCPCH and UNICEF partnership

In late 2019, Myanmar Paediatric Society (MPS) and RCPCH Global started the process of merging the paediatric and neonatal streams of intervention as one integrated programme – the ‘Myanmar Neonatal & Emergency Paediatric Care Programme’ (MNEPCP). A key feature of this development was to start to draw down the proportion of programme activity involving international trainers/mentors, building instead ‘Quality Support Teams’ (QST), with international involvement but primarily recruited, populated and managed by Myanmar clinicians.

The emphasis on QSTs was to shift from external intervention to the creation of a sustainable, wholly national quality improvement faculty within Myanmar – coordinated under the national paediatric body, and able to provide direct technical training, advice and mentoring to local colleagues across the hospital network on a regular and ongoing basis. QSTs would work to a common planning and progress assessment tool combining improvement in clinical care capability within individual facilities, and progressively raising the overall standard of care across the national hospital network.

Impact

In early 2020, the onset of the COVID-19 pandemic led RCPCH Global and UNICEF to accelerate the development of MNEPCP, in particular converting training and quality improvement initiatives into virtual and online modules. Our pre-existing relationships of familiarity and trust across a large number of hospitals made it possible for the programme to pivot relatively agilely, shift the focus to pandemic management, and maintain operational relations through largely remote media. Amongst many lessons bequeathed to us by COVID, one abiding one, relevant

to countries around the world, was the enormous risk presented by longstanding, chronic weaknesses in the secondary level of local hospital care capacity. Revitalising our understanding of, and investment in this tier of care through programmes such as those described in this document is likely to be a key strategy, within and between countries, as we seek progress towards the Sustainable Development Goals (SDGs) and prepare for the next pandemic.

Outcome

In this instance, with the generous support of UNICEF and the Government of Japan, we were able to provide significant support to hospitals’ ability to provide respiratory care, as well as strengthen clean water access for infection prevention, and personal protective equipment enabling clinicians to continue to provide care with a greater degree of safety. The provision of equipment was complemented by online support reinforcing core clinical protective practices outlined in our MNEPCP programme and protocols. We were also able to use the existing network of hospitals to maintain a degree of data collection with regard to the impact of the pandemic on paediatric admissions site by site.

Overall, our access to real-time data helped us to understand hospital needs but also to help plan for recovery in the post-COVID period. Changes in mortality across the hospitals participating in the RCPCH/MPS/UNICEF programmes over the last five years have been positive. Not spectacular, but positive. We believe this gradual shift in outcomes for babies and children in Myanmar’s hospital system reflects some

progress in both supporting the clinical skills of colleagues in-country, and in addressing the underlying processes – the human, administrative and clinical interactions, the availability and appropriate use of drugs and equipment, the management of patients through the hospital journey – that together constitute health system function and care quality.

Paediatric mortality as % of admissions, Sagaing, Magway, Ayeyarwady & Kayin regions, 2016–2020

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0.00% Q1Q2 Q3 2016 2017 2018 2019 2020 Q4 Q1Q2 Q3 Q4 Q1Q2 Q3 Q4 Q1Q2 Q3 Q4 Q1Q2 Q3 Q4

Sagaing Magway Ayeyarwady Kayin Linear (Average) Average

Rwanda perinatal care programme

RCPCH Global works in partnership with sister paediatric bodies in its operational countries. In Rwanda, we have built a strong relationship with the Rwanda Paediatric Association (RPA), sharing design, development, implementation and evaluation of our core health system strengthening programmes.

Our programmes are designed to fit within and contribute to national health system development strategy, which means that we aim to collaborate as closely as possible with government counterparts and colleagues. In Rwanda, all our work is carried out consultatively under the aegis of the Ministry of Health as policy-setting institution, and the Rwanda Biomedical Center as implementing agency.

Our work focuses on strengthening core, routine care functions at secondary District Hospitals. But as our programmes have developed, we have extended our reach upwards, to support more advanced clinical skills at referral level, downwards to support in-referring primary health centres, and laterally, to work not only with doctors, but with nurses and midwives, building vital team-working practices, with biomedical engineers, data managers and administrators, all under the critical leadership of hospital Director-Generals.

Improving the quality of perinatal care is key to progress on maternal and newborn survival. ‘Quality improvement’ (QI) methodologies, however, themselves need to evolve to maximise potential for impact. Much of the original development of QI methods originates in high-income country (HIC) settings – which can be poorly adapted or unsuitable for the system conditions in resource poor regions.

Impact

RCPCH Global’s approach to QI is based on the belief that technical training –whilst vital – is not, on its own, enough

to improve child-care and health outcomes. We view training as one component of quality improvement.

As we support training to improve knowledge and skills, we also work to improve access to essential medicines and equipment, address infrastructural obstacles to efficient patient flow, and strengthen leadership in monitoring, reviewing and improving care delivery management systems. We approach care QI as a whole-of-hospital endeavour. It combines a core of clinical training and skills within a wider process of strengthening care systems (drugs, equipment, infrastructure), contextualised by strengthening hospital management and leadership in adopting a QI model.

The overarching aim of our programme work is to support sustainable improvement in the quality and outcomes of perinatal care – for mothers and newborns – across the health system in Rwanda. Over three principal programme phases, we have: (1) Built a community of professional trust and clinical support with doctors, nurses and midwives working at hospitals and health centres across the country (2) Extended our work under the aegis of the Rwanda Government through increasingly close collaboration with the Ministry of Health and the Rwanda Biomedical Center (3) Seen significant improvement in key indicators of ‘Quality of Care’ in maternal and newborn services, associated with substantial reduction in neonatal mortality.

OPD/Emergency care

Delivery rooms

Pharmacy and Supplies

Paediatric ward

Respiratory infections, diarrhoea, Pneumonia and

Maternity ward

Hospital records

Neonatal care unit

Outcome

Over this time, we have also progressively analysed and identified the key priorities for care delivery through which change and improvement are made sustainable. Through our partnership with the Rwanda Paediatric Association, MoH and RBC, we aim to continue refining the focus of our work to engage with and address these key dimensions. The priority areas are: Human Resources, Clinical Equipment and Data.

All of the work described in these three key domains will focus increasingly on RCPCH Global’s role as facilitator and technical support agency, with the bulk of programme delivery taken on by RPA management and through local clinical quality assurance teams, mentors and champions.

We view this as the necessary route to sustainable Rwandan ownership. We believe that focusing on these three core structural areas of perinatal care quality demonstrates both how we have evolved over the programme phases to date, and how, increasingly, we understand out role as contributory to sustainable foundations of national care capability rather than front-line service delivery or substitution.

Quality improvement

Hospital staff in Rwanda

It is imperative that as paediatricians, we support, participate and lead research. We owe it to our patients and families... to learn from their stories and keep searching for the answers.”

Dr Cheryl Battersby, Clinical Senior Lecturer, NIHR Clinician Scientist at Imperial College London and Honorary Consultant Neonatologist

Hospital staff in Rwanda

Epilepsy Quality Improvement programme

The RCPCH epilepsy quality improvement programme is the first of its kind. It aims to develop the workforce, throughout NHS paediatric epilepsy services in England and Wales, to be skilled, knowledgeable and empowered to make improvements where they provide care for children with epilepsy.

Participant teams are given the tools through hybrid training to successfully develop their service, so it delivers efficient person engagement and sustained improvement in clinical outcomes for children, young people and their families.

Led by an external quality improvement (QI) expert, training facilitators provide support for each of the teams in designing, implementing and monitoring their project interventions alongside monthly training and coaching sessions. Ultimately, each member of the teams feel a sense of empowerment and gain leadership skills in spreading improvement in their networks, following the programme’s completion.

Impact

On 17 June 2019 we launched the first paediatric epilepsy QI collaborative pilot in England and Wales. The RCPCH EQIP has supported paediatric epilepsy service teams to identify sustainable improvements within their services for children and young people with epilepsy.

Since the launch of the pilot in 2019, the EQIP has seen the participation of 29 NHS Hospital Trusts in England and Wales, including piloting an ICS structure of six Trusts. The programme has trained 169 NHS members of staff within paediatric epilepsy services.

Outcome

The pilot outcomes from individual team projects and shared learning, led to recommission the programme in 2021– 2022, where have successfully continued to train a further 17 paediatric epilepsy service teams including an Integrated Care System (ICS) made up of six NHS Trusts. Our programme has now been extended to run for another year from September 2022–2023.

“I learned a lot about engaging the patients/parents in the process and about better techniques to gather the info needed. I felt inspired by the co-production lecture.

– Project participant

“

The Healthcare Quality Improvement Partnership (HQIP) is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage and develop the National Clinical Audit and Patient Outcomes Programme (NCAPOP), comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies. www.hqip.org.uk/national-programmes

Team Problem Solution

Participant teams initially focused on the negative barriers they faced, in comparison to the successes they achieved as a service.

By using QI methodology, service teams gained skills in how to break down challenges and find solutions. Trusts were therefore able to achieve outcomes meeting their specific service goals. For example, the successful development of an integrated digital Epilepsy Passport–co-designed with patients and their families–shows the barriers that can be overcome when working with multi-faceted teams.

Some service teams struggled to communicate effectively; especially when working across different sites within their NHS Trust, or across multiple Trusts in ICS structures.

Many were unsure what an effective epilepsy service team looked like beyond the roles of the consultant and Epilepsy Specialist Nurse.

The ICS team have increased their outputs by working on improving effective communication methods across six sites. The group shared knowledge in developing pathways in mental health support, establishing effective transition clinics and reporting on a reduction in waiting times for first seizure referrals.

Further examples of incremental changes to services has led to the implementation of new ED patient referral processes to paediatric epilepsy clinics. These have been embedded within Trust guidelines.

Services lacked clear processes to meet national standards, measured in the Epilepsy12 audits.

Teams used the audit data to review areas for improvement and help plan their projects. Several projects focused on building new processes, for example to: ensure discussion of Sudden Unexpected Death in Epilepsy (SUDEP) risk with patients and their families, establish a new mental health care pathway, developing screening tools and methods of signposting information or services.

All teams wished to improve aspects of their culture and clinical services.

All teams experienced a transformation in terms of the skills learnt from expert trainers and each other. Teams benefited from the knowledge provided through monthly coaching and support. All teams experienced incremental changes within team interactions and improvements in how they deliver their service to children and young people.

Peer-reviewed diabetes quality assurance programme

The National Diabetes Quality Programme (NDQP) has conducted over 100 peer reviews since its inception in 2017. As part of the Quality Assurance stream of the programme, all participating Paediatric Diabetes Units receive a peer review.

A multidisciplinary team of peers speak with the service team, relevant colleagues, patients and families to determine compliance against the standards and to identify areas of good practice for sharing more widely and recommendations to improve outcomes.

The approach to peer review is developmental, encouraging teams to share their challenges so that barriers can be explored as well as highlighting achievements so that good practice can be disseminated.

Impact

The benefits of peer review are mutual, with reviewers and those being reviewed challenged and encouraged to learn from colleagues, share good practice examples and develop their own practice and team.

As part of the peer review, the service’s achievements are highlighted and recommendations for improvement are made by the peer review team. In addition, serious concerns are raised when an issue is identified that is likely to have a moderate to significant detrimental impact on the quality of care that is received by patients, and/or patient safety. Out of 108 peer reviews conducted so far, 76 had serious concerns, with some services raising multiple serious concerns. 137 serious concerns were identified in total. Serious concerns

require additional follow up by the NDQP’s Clinical Advisory Group, which meets to review the service’s progress and provide additional recommendations and support. Serious concerns have been raised most frequently in 4 areas – Transition, Psychology provision, Consultant Paediatrician provision and Dietetic provision.

Over 90% (160) of paediatric diabetes units (PDUs) in England and Wales participated voluntarily.

In a recent survey, 100% of peer reviewers said they would recommend being a peer reviewer to their colleagues.

94% either agreed or strongly agreed that they found the PR visit useful and the experience will contribute to their own practice.

Outcome

The College is in the process of evaluating results. This is the first paediatric peer review programme of this size

“[ This programme has been] very helpful to support teams and help us further highlight areas for the service that need improvement/investment from the Trust.”

– Project participant

Our focus areas

Recruitment and education

Amplifying the voices of children and young people

Quality and Improvement

Every day we promote and support excellence in child health research, advocate on public health issues, and serve as the voice for children and young people in the UK and abroad. This can be seen in our advocacy work, it can be heard on our podcasts and it can be felt in the hearts of the hundreds of volunteers who dedicate their time to improving child health–from our President to young children in primary school.

Fundraising ensures that vital programmes and projects led by the College can continue uninterrupted. Support from funders through grant awards, donations and sponsorships makes our mission to transform child health through knowledge, innovation and expertise achievable.

Training and peer support

Policy and advocacy across the United Kingdom

Humanitarian support

With your help, we can do even more.

The College already works alongside an incredibly diverse range of partners and funders to help meet its strategic goals. These include Government, charitable trusts, foundations, health bodies, charities, private sector companies as well as our links with international development bodies who have helped to fund our successful global humanitarian programmes.

We are incredibly proud of the joint impact that we’ve collectively delivered alongside others – not just in 2022 but over a sustained period of time.

Our partnerships and funders have helped us significantly enhance our core delivery – improving the delivery of essential paediatric education and training and allowing us to provide solutions in critical areas such as workforce planning, health inequalities and CYP engagement. Our external funding has not only enabled the College to develop its research and quality improvement offering work in areas such as diabetes, epilepsy and neonatal care but has also helped advance our work in new areas such as climate change and sustainability.

There is still so much more that we would like to achieve alongside others. As the health landscape continues to radically shift around us, the College is determined

Closing remarks

At RCPCH we’re incredibly proud of the difference we’ve made to paediatrics and child health, but it’s clear that we can’t achieve the type of successes outlined in this report without essential support and collaboration from others. This is where our funders and partners come in.

Partners and funders

Barnardo’s Charity bioMérieux UK Ltd

UK Department of Health and Social Care (DHSC) Dinwoodie Charitable Company

Dr Gareth Rees (Illingworth-Rees Family)

Dr Tonie Haynes

to stay on the front foot by focussing on forward looking topics such as genomics, the impact of climate change on children and young people’s health and digital technology in paediatric practice.

If we are to simultaneously address existing child health needs and take forward new innovative areas of work, we now need to attract new partners and funders to join us on the journey. This will not only widen the reach, but also the impact of our work on the ground.

In return, we will focus on driving value on every pound of funding we secure, share the success of our project work with those partners who have supported us to deliver it and work hard to establish mutually beneficial, trusting partnership relationships that are sustained into the future.

I hope this report not only highlights the breadth of achievements in 2022, but also provides you with some inspiration to get involved with RCPCH and be part of a collective effort to drive forward further improvements in child health.

We’d really love to hear from you so please do get in touch with our dedicated Grants and Partnerships team and let’s explore how we can work together in the future.

Paul Marchant Director of Corporate Services

Martyn and Amanda Hole

NHS England

Novo Nordisk

PF Charitable Trust

PTC Therapeutics

Welsh Government

Health and Wellbeing Alliance

British Society of Paediatric Gastroenterology, Hepatology and Nutrition

Healthcare Quality Improvement Partnership (HQIP)

James Percy Foundation

We invite you to take part

UNICEF

Alison Hillman Charitable Trust

National Institute of Health Research

Donations are welcomed online, through one-off donations, regular giving or by leaving us a gift in your Will. We also welcome donations from charitable trusts and foundations, companies, individuals and corporate partnerships, with those who share our aims and objectives.

Contact our team

Your partnership and funding strengthen the pillars of the College. This allows us to invest in areas like technology, member training and support or pivot our offerings based on the needs of our community. There are multiple opportunities across the College where you can make a difference in the life of a child and the career of a paediatrician.

Grants & Partnerships Team

fundraising@rcpch.ac.uk

I wanted to help other people like myself with asthma, and it’s interesting. My favourite things was creating a leaflet for different ages about what happens when they get into hospital after an asthma attack, and it’s age appropriate for different ages. Volunteering at RCPCH &Us, you really do make a big difference.”

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I would like to thank the RCPCH &Us team for helping us children and young people get our voices heard and [for] giving us a chance throughout the pandemic and the years before to express our views and opinions.”

RCPCH & Us volunteer

“

Seeing the true amount of work and opportunities within RCPCH to enable CYP voices to be heard has inspired me. Like through my own involvement with RCPCH &Us – meeting new people, involvement with COVID Book clubs and seeing the impact and reach our work can have.”

RCPCH & Us volunteer

RCPCH & Us volunteer

Royal College of Paediatrics and Child Health

Impact Report 2022

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